"It was hard to come to mutual understanding..." - Multidimensionality of social learning processes in natural resource use in India, Africa and Latin America

Sustainable natural resource use requires that multiple actors reassess their situation in a systemic perspective. This can be conceptualised as a social learning process between actors from rural communities and the experts from outside organisations. A specifically designed workshop oriented towards a systemic view of natural resource use and the enhancement of mutual learning between local and external actors, provided the background for evaluating the potentials and constraints of intensified social learning processes. Case studies in rural communities in India, Bolivia, Peru and Mali showed that changes in the narratives of the participants of the workshop followed a similar temporal sequence relatively independently from their specific contexts. Social learning processes were found to be more likely to be successful if they 1) opened new space for communicative action, allowing for an intersubjective re-definition of the present situation, 2) contributed to rebalance the relationships between social capital and social, emotional and cognitive competencies within and between local and external actors.

[Irritation of the iliopsoas tendon after total hip arthroplasty]

Chronic irritation of the iliopsoas tendon is a rare cause of persistent pain after total joint replacement of the hip. In the majority of cases, pain results from a mechanical conflict between the iliopsoas tendon and the anterior edge of the acetabular cup after total hip arthroplasty. Pain can be reproduced by active flexion of the hip and by active raising of the straightened leg. In addition, painful leg raising against resistance and passive hyperextension are suggestive of an irritation of the iliopsoas tendon. Symptoms evolve from a mechanical irritation of the iliopsoas tendon and an oversized or retroverted acetabular cup, screws penetrating into the inner aspect of the ilium, or from bone cement protruding beyond the anterior acetabular rim. The diagnosis may be assumed on conventional radiographs and confirmed by CT scans. Fifteen patients with psoas irritation after total hip replacement are reported on. Eleven patients were treated surgically. The acetabular cup was revised and reoriented with more anteversion in six patients, isolated screws penetrating into the tendon were cut and leveled in three patients, and prominent bone cement in conflict with the tendon was resected once. A partial release of the iliopsoas tendon only was performed in another patient. Follow-up examination (range: 11-89 months) revealed that nine patients were free of pain and two patient had mild residual complaints. Psoas irritation in combination with total hip replacement can be prevented by a correct surgical technique, especially with proper selection of the cup size and insertion of the acetabular cup avoiding a rim position exceeding the level of the anterior acetabular rim.