We are never illness or disease, but, rather, always their sum in the world of day-to-day experience. Disease and illness are not closed systems, but mutually constitutive and continuously interacting worlds. In the patient’s case it is always experience as well. Pain, sickness and death help make that particular experienced identity unavoidable, and at some level ultimately inaccessible to medicine’s changing understanding of disease and tools for managing it. Health—rather than cost containment, specific conditions, or technologies—should be the central focus (...) for health care and health-care reform. A compelling reason to focus on health comes from the observation that the prevalence of disease over the .. (shrink)
It is widely believed that people can remember the age at which they first had sexual intercourse. Questions about age at onset are routinely asked in population sexual behaviour surveys and in clinical history[hyphen]taking. However, there are limited testretest correlations for recalled age at first intercourse were 0·85 for females and 0·91 for males. Consistency was slightly lower among older people and women with a history of sexual abuse. There were no significant associations between consistency of recall and measures of (...) personality, educational background or history of alcohol dependence and depression. (shrink)
The Gibbs states of binary lattice systems can be characterized by their stability with respect to certain microscopic transitions which have a simple physical interpretation. A detailed analysis is provided for the case of a one-dimensional lattice gas with nearest-neighbor interactions.
In this paper we argue that knowledge in health care is a multidimensional dynamic construct, in contrast to the prevailing idea of knowledge being an objective state. Polanyi demonstrated that knowledge is personal, that knowledge is discovered, and that knowledge has explicit and tacit dimensions. Complex adaptive systems science views knowledge simultaneously as a thing and a flow, constructed as well as in constant flux. The Cynefin framework is one model to help our understanding of knowledge as a personal construct (...) achieved through sense making. Specific knowledge aspects temporarily reside in either one of four domains – the known, knowable, complex or chaotic, but new knowledge can only be created by challenging the known by moving it in and looping it through the other domains. Medical knowledge is simultaneously explicit and implicit with certain aspects already well known and easily transferable, and others that are not yet fully known and must still be learned. At the same time certain knowledge aspects are predominantly concerned with content, whereas others deal with context. Though in clinical care we may operate predominately in one knowledge domain, we also will operate some of the time in the others. Medical knowledge is inherently uncertain, and we require a context-driven flexible approach to knowledge discovery and application, in clinical practice as well as in health service planning. (shrink)
Nobody should have a monopoly of the truth in this universe. The censorship and suppression of challenging ideas against the tide of mainstream research, the blacklisting of scientists, for instance, is neither the best way to do and filter science, nor to promote progress in the human knowledge. The removal of good and novel ideas from the scientific stage is very detrimental to the pursuit of the truth. There are instances in which a mere unqualified belief can occasionally be converted (...) into a generally accepted scientific theory through the screening action of refereed literature and meetings planned by the scientific organizing committees and through the distribution of funds controlled by "club opinions". It leads to unitary paradigms and unitary thinking not necessarily associated to the unique truth. This is the topic of this book: to critically analyze the problems of the official (and sometimes illicit) mechanisms under which current science (physics and astronomy in particular) is being administered and filtered today, along with the onerous consequences these mechanisms have on all of us. The authors, all of them professional researchers, reveal a pessimistic view of the miseries of the actual system, while a glimmer of hope remains in the "leitmotiv" claim towards the freedom in doing research and attaining an acceptable level of ethics in science. (shrink)
Jannie Pretorius and Michael Von Maltitz have identified some of the most pressing problems in South African education.1 They have argued that the education system is still suffering from the fragmented effects of apartheid and that the postapartheid government is struggling to set schools in motion to provide learners with authentic perspectives on the realities of their existence in a postapartheid South Africa. Naledi Pandor, the country's previous minister of education, painted a rather somber picture of the situation in the (...) Eastern Cape, one of South Africa's nine provinces:In a context in which there is ineffective system response on core obligations, it is very important to isolate those attributes that are .. (shrink)
Early reactions to the publication of Harold Garfinkel's Studies in Ethnomethodology, which have persisted over the passing decades, was that ethnomethodology could not address what sociology deemed to be socially significant matters such as 'power' and 'the state'. This, however, is not the case. How such matters enter into the practical everyday affairs of members is of equal interest to ethnomethodology when compared to how any matter enters into members' everyday life, and how they display that. It just does not (...) have more importance. Egon Bittner spelt this out with regard to Weber's interest in bureaucracy when he reminds sociology that when Weber talked about efficiency he was not referring to an objective standard but as something that is attuned to practical interests as they emerge in the context of everyday life. This paper examines some of the actions and interactions that were encountered in a Governmental Department in one of the European countries. It makes visible how characterisations of bureaucracy such as 'rational', and 'efficient' are achieved in the actions and interactions of Department employees, and some of the practices involved in that achievement. Garfinkel, and ethnomethodology in general, are not, in principle, to be found wanting where matters of overarching, primordial interest to sociology are concerned. (shrink)