A brouse avec Pierre Loti

Taha Toros Arşivi, Dosya Adı: Pierre Lotiİstanbul Kalkınma Ajansı (TR10/14/YEN/0033) İstanbul Development Agency (TR10/14/YEN/0033

Towards a new theory of practice for community health psychology

The article sets out the value of theorizing collective action from a social science perspective that engages with the messy actuality of practice. It argues that community health psychology relies on an abstract version of Paulo Freire’s earlier writing, the Pedagogy of the Oppressed, which provides scholar-activists with a ‘map’ approach to collective action. The article revisits Freire’s later work, the Pedagogy of Hope, and argues for the importance of developing a ‘journey’ approach to collective action. Theories of practice are discussed for their value in theorizing such journeys, and in bringing maps (intentions) and journeys (actuality) closer together

Fractally-organized Connectionist Networks: Conjectures and Preliminary Results

A strict interpretation of connectionism mandates complex networks of simple components. The question here is, is this simplicity to be interpreted in absolute terms? I conjecture that absolute simplicity might not be an essential attribute of connectionism, and that it may be effectively exchanged with a requirement for relative simplicity, namely simplicity with respect to the current organizational level. In this paper I provide some elements to the analysis of the above question. In particular I conjecture that fractally organized connectionist networks may provide a convenient means to achive what Leibniz calls an "art of complication", namely an effective way to encapsulate complexity and practically extend the applicability of connectionism to domains such as sociotechnical system modeling and design. Preliminary evidence to my claim is brought by considering the design of the software architecture designed for the telemonitoring service of Flemish project "Little Sister".Comment: Draft of an invited paper for PEWET (1st Workshop on PErvasive WEb Technologies, trends and challenges), http://www.irpps.cnr.it/en/events/call-for-papers-pewet-pervasive-web-technologies-trends-and-challenge

Cost Effectiveness of Anticoagulation in Acute Coronary Syndromes

Background: The benefit of unfractionated heparin (UFH) added to aspirin in patients with acute coronary syndromes (ACS) was described more than 20 years ago. Ever since, a wide variety of anticoagulant drugs have become available for clinical use, including low-molecular-weight heparins (LMWH), direct thrombin inhibitors and selective factor Xa inhibitors. Objective: The aim of this study was to critically review the available evidence on the cost and incremental cost effectiveness of anticoagulants in patients with ACS. Methods: Studies were identified using specialist databases (UK NHS Economic Evaluation Database [NHS EED] and Cost-Effectiveness Analysis [CEA] Registry), PubMed and the reference lists of recovered articles. Only studies based on randomized controlled trials were considered for inclusion. Finally, 22 studies were included in the review. Results: Enoxaparin is the only LMWH that has been shown to reduce the risk of death or myocardial infarction in patients with non-ST-elevation ACS (NSTE-ACS). In economic studies based on the ESSENCE trial conducted in the late 1990s, enoxaparin was consistently associated with a lower risk of coronary events, a reduction in the number of revascularization procedures and a lower cost per patient than UFH. However, these results refer to patients managed conservatively, with little use of thienopyridines and glycoprotein IIb/IIIa inhibitors, and the results are difficult to extrapolate to moderate-to-high-risk patients managed with the present day early invasive strategy. Available studies of LMWH in ACS with persistent elevation of ST-segment (STE-ACS) are limited to patients treated with thrombolysis. In this scenario, enoxaparin was shown to be a dominant alternative compared with UFH in a study based on the ASSENT-3 study and was considered an economically attractive alternative in three studies based on the ExTRACT-TIMI 25 study. However, these results should be interpreted cautiously due to the heterogeneity of the supportive randomized trials and the possible underestimation of bleeding costs. The effectiveness and safety of bivalirudin, a direct thrombin inhibitor, were evaluated in the ACUITY study (NSTE-ACS patients managed invasively) and the HORIZONS-AMI study (STE acute myocardial infarction patients planned for primary percutaneous coronary intervention). Bivalirudin monotherapy was not inferior to heparin plus a glycoprotein IIb/IIIa inhibitor and reduced the risk of major bleeding. The economic evaluations based on these studies suggest that bivalirudin is an attractive alternative to heparin plus a glycoprotein-IIb/IIIa inhibitor. In the OASIS-5 trial, compared with enoxaparin, fondaparinux reduced the mortality in patients with NSTE-ACS, probably because of a reduced risk of bleeding. In three economic evaluations of fondaparinux versus enoxaparin based on this trial, fondaparinux was the dominant strategy in two of them, and still economically attractive in a third. Taken as a whole, the usefulness of economic studies of anticoagulants in patients with ACS is undermined by the quality of the evidence about their effectiveness and safety; the narrow spectrum of the analysed scenarios; the lack of economic evaluations based on systematic reviews; the limitations of sensitivity analyses reported by the available economic evaluations; and their substantial risk of commercial bias. Conclusions: The available studies suggest that enoxaparin is an economically attractive alternative compared with UFH in patients with NSTE-ACS treated conservatively and STE-ACS patients treated with thrombolysis. Bivalirudin in patients with ACS treated invasively is cost effective compared with heparin plus a glycoprotein IIb/IIIa inhibitor. In patients with NSTE-ACS, fondaparinux is cost effective compared with enoxaparin. The usefulness of these results for decision making in contemporary clinical practice is limited due to problems of internal and external validity

Medical innovation as a process of translation : a case from the field of telemedicine

The paper makes a case for the use of Sociology of Translation as a way of integrating the classical rational and stepwise view of innovation, showcasing its capacity to produce accounts of innovation that are process oriented, sensitive to contextual conditions, and attentive to its political, conflictual, and institutional aspects. It does so by utilising the approach to study the establishment and mainstreaming of cardiac telecare in Northern Italy. Building on the results of a three year longitudinal study, the paper describes the process through which this innovative approach carved a space within the existing texture of medical practices by enrolling in successive waves a range of allies and support. The detailed narration brings to the fore some crucial aspects of the local processes of negotiation and struggle, and, more in general, the work and effort that goes into the making of any innovation. The paper concludes that this way of studying and narrating innovation is particularly apt at bringing back time, effort, and politics into the account of the innovation process

Entanglements of creative agency and digital technology : a sociomaterial study of computer game development

Digital technology, with its distinctive characteristics that result from the fundamental process of digitalization that underpins it, is seen as fundamentally altering processes of creativity. However, we currently have limited understanding of creativity in relation to the development of digital technology. Computer game development, with its combination of esthetic, affective and cultural use features and highly sophisticated digital technologies, is a valuable setting for investigating these issues. In this paper, we explore how computer games are shaped through the interplay between the creative intentions of developers and the digital technologies involved in their production and playing. Drawing on in-depth studies conducted at three leading computer game development studios and a leading producer of the software system used in game development, this paper shows how the game developers' creative ideas for imagined novel game-playing experiences relate to a) the development of relevant digital technologies, and b) the emergence of new game development practices. The article goes on to propose a view of creativity as an on-going flow that, following an initial ‘creative impulse’, ripples through the sociomaterial entanglements of a particular setting, reconfiguring them in the process and spreading out in time and space in often unexpected ways

Constructing futures: a social constructionist perspective on foresight methodology

The aim of this paper is to demonstrate the relationship between a particular epistemological perspective and foresight methodology. We draw on a body of social theory concerned with the way that meaning is produced and assimilated by society; specifically, the social construction of knowledge, which is distinguished from its nearneighbour constructivism by its focus on inter-subjectivity. We show that social constructionism, at least in its weak form, seems to be implicit in many epistemological assumptions underlying futures studies. We identify a range of distinctive methodological features in foresight studies, such as time, descriptions of difference, participation and values, and examine these from a social constructionist perspective. It appears that social constructionism is highly resonant with the way in which knowledge of the future is produced and used. A social constructionism perspective enables a methodological reflection on how, with what legitimacy, and to what social good, knowledge is produced. Foresight that produces symbols without inter-subjective meaning neither anticipates, nor produces futures. Our conclusion is that foresight is both a social construction, and a mechanism for social construction. Methodologically, foresight projects should acknowledge the socially constructed nature of their process and outcomes as this will lead to greater rigour and legitimacy

Etiologia morbida: : as condições da vida são as condições das moléstias.

Ensinaram-lhe uma etiologia, que pouco cuidadosa das relações de causa para efeito, suspende-se nos limites da pura observação e esquiva-se assim as exigencias da ciência. Esta etiologia enuncia as diversas circustancias que tem parecido concidir com a exxploração das moléstias; ´porém incapaz de achar o laço pelo qual estas encadeiam-se naquelas, limita sua tarefa a uma simples enumeração de causas, banal, e na qual figuram, com igual titulo, o calor e o frio, o seco e o úmido

Modo de emprego da medicação isolante

Os grandes resultados que se ligam a medicação isolante e dos quais tendes recolhido numerosos exemplos em nossos diversos entretimentos clínicos, somente se obtêm, com a condição de ser o isolamento realizado de modo irreprensível. Não ficareis pois surpreendido, se nos lugares em que a disposição das partes puser obstáculo ao isolamento completo, a inflamação resistir ou não ceder senão com uma lentidão relativa