912 resultados para Medical education--Pennsylvania--History--19th century
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This study concerns the representation of space in Caribbean literature, both francophone and Anglophone and, in particular, but not only, in the martinican literature, in the works of the authors born in the island. The analysis focus on the second half of the last century, a period in which the martinican production of novels and romances increased considerably, and where the representation and the rule of space had a relevant place. So, the thesis explores the literary modalities of this representation. The work is constituted of 5 chapters and the critical and methodological approaches are both of an analytical and comparative type. The first chapter “The caribbean space: geography, history and society” presents the geographic context, through an analysis of the historical and political major events occurred in the Caribbean archipelago, in particular of the French Antilles, from the first colonization until the départementalisation. The first paragraph “The colonized space: historical-political excursus” the explores the history of the European colonization that marked forever the theatre of the relationship between Europe, Africa and the New World. This social situation take a long and complex process of “Re-appropriation and renegotiation of the space”, (second paragraph) always the space of the Other, that interest both the Antillean society and the writers’ universe. So, a series of questions take place in the third paragraph “Landscape and identity”: what is the function of space in the process of identity construction? What are the literary forms and representations of space in the Caribbean context? Could the writing be a tool of cultural identity definition, both individual and collective? The second chapter “The literary representation of the Antillean space” is a methodological analysis of the notions of literary space and descriptive gender. The first paragraph “The literary space of and in the novel” is an excursus of the theory of such critics like Blanchot, Bachelard, Genette and Greimas, and in particular the recent innovation of the 20th century; the second one “Space of the Antilles, space of the writing” is an attempt to apply this theory to the Antillean literary space. Finally the last paragraph “Signs on the page: the symbolic places of the antillean novel landscape” presents an inventory of the most recurrent antillean places (mornes, ravines, traces, cachots, En-ville,…), symbols of the history and the past, described in literary works, but according to new modalities of representation. The third chapter, the core of the thesis, “Re-drawing the map of the French Antilles” focused the study of space representation on francophone literature, in particular on a selected works of four martinican writers, like Roland Brival, Édouard Glissant, Patrick Chamoiseau and Raphaël Confiant. Through this section, a spatial evolution comes out step by step, from the first to the second paragraph, whose titles are linked together “The novel space evolution: from the forest of the morne… to the jungle of the ville”. The virgin and uncontaminated space of the Antilles, prior to the colonisation, where the Indios lived in harmony with the nature, find a representation in both works of Brival (Le sang du roucou, Le dernier des Aloukous) and of Glissant (Le Quatrième siècle, Ormerod). The arrival of the European colonizer brings a violent and sudden metamorphosis of the originary space and landscape, together with the traditions and culture of the Caraïbes population. These radical changes are visible in the works of Chamoiseau (Chronique des sept misères, Texaco, L’esclave vieil homme et le molosse, Livret des villes du deuxième monde, Un dimanche au cachot) and Confiant (Le Nègre et l’Amiral, Eau de Café, Ravines du devant-jour, Nègre marron) that explore the urban space of the creole En-ville. The fourth chapter represents the “2nd step: the Anglophone novel space” in the exploration of literary representation of space, through an analytical study of the works of three Anglophone writers, the 19th century Lafcadio Hearn (A Midsummer Trip To the West Indies, Two Years in the French West Indies, Youma) and the contemporary authors Derek Walcott (Omeros, Map of the New World, What the Twilight says) and Edward Kamau Brathwaite (The Arrivants: A New World Trilogy). The Anglophone voice of the Caribbean archipelago brings a very interesting contribution to the critical idea of a spatial evolution in the literary representation of space, started with francophone production: “The spatial evolution goes on: from the Martiniques Sketches of Hearn… to the modern bards of Caribbean archipelago” is the new linked title of the two paragraphs. The fifth chapter “Extended look, space shared: the Caribbean archipelago” is a comparative analysis of the results achieved in the prior sections, through a dialogue between all the texts in the first paragraph “Francophone and Anglophone representation of space compared: differences and analogies”. The last paragraph instead is an attempt of re-negotiate the conventional notions of space and place, from a geographical and physical meaning, to the new concept of “commonplace”, not synonym of prejudice, but “common place” of sharing and dialogue. The question sets in the last paragraph “The “commonplaces” of the physical and mental map of the Caribbean archipelago: toward a non-place?” contains the critical idea of the entire thesis.
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Diese Arbeit ist der Versuch einer Bestandsaufnahme der Diskussion um die Rolle des Fachs Eth¬nologie in den allgemeinbildenden Schulen. Eine solche Übersicht zu den im deutschsprachigen Raum veröffentlichten Beiträgen lag bis dahin noch nicht vor. Sie reicht zurück bis zum Ende des 19. Jahrhunderts. Im vorliegenden Papier wurden die grundlegenden Argumentationen dargelegt, mit denen Fachvertreter und -vertreterinnen ein völkerkundliches/ethnologisches Engagement in den Schulen, in Schulbüchern und bei der Lehrerausbildung forderten. Mit einem historisch vertieften Vergleich dieser Argumentationen wurde angestrebt, Kontinuitäten und Brüche in der Diskussion darzustellen. Diese Perspektive ermöglichte zum einen die Darstel¬lung von älteren und kaum mehr rezipierten Beiträgen in einem größeren Rahmen, zum anderen jedoch auch eine Kritik der vorliegenden, oft nur vordergründig verschiedenen Ansätze. Im Schlusskapitel stellte der Autor essentialistische/relativistische und universalistische Ansätze gegenüber und formulierte darauf basierend Ausgangspunkte eines weiteren schulischen Engagements im Rahmen einer vergleichenden Sozialwissenschaft Ethnologie. Im Anhang der Arbeit befindet sich eine chronologische Biblioghraphie all jener Beiträge, die Ethnologen und Ethnologinnen zur Integration ihres Fachs in die Schulen verfassten.
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La tesi di Dottorato, saldamente ancorata alle Medical Humanities, si è concentrata sul modo in cui la storia della letteratura italiana si intreccia con le altre discipline, per arrivare a configurare quell’ampio panorama di storia delle idee che aiuta a valutare l’evoluzione stessa delle credenze e dei pensieri dell’uomo nel corso del tempo. Essa ha contribuito a portare alla luce l’apporto dato dalla Società Medica Chirurgica di Bologna in Epoca Pontificia alla circolarità del pensiero medico, ricordando con forza che le varie correnti storico-mediche non sono appunto il semplice susseguirsi di teorie più o meno esatte. La tesi rende pienamente visibili non solo la struttura e le dinamiche della comunicazione scientifica, ma documenta attraverso la letteratura (anche quella scientifica) la presenza della medicina e delle sue pratiche all’interno della società, soffermandosi sui meccanismi, sui percorsi che legano i fenomeni tra loro; viene declinato anche il complesso e travagliato processo teso a ridefinire la figura del medico durante l’epoca del dominio pontificio nel suo declino, circondata da diffidenze e ostilità. Il fulcro della tesi è dato dalla dimostrazione inconfutabile che esiste ancora un ruolo per la cultura umanistica nella formazione del medico.
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Background In the 19th century, eminent French sociologist Emile Durkheim found suicide rates to be higher in the Protestant compared with the Catholic cantons of Switzerland. We examined religious affiliation and suicide in modern Switzerland, where assisted suicide is legal. Methods The 2000 census records of 1 722 456 (46.0%) Catholics, 1 565 452 (41.8%) Protestants and 454 397 (12.2%) individuals with no affiliation were linked to mortality records up to December 2005. The association between religious affiliation and suicide, with the Protestant faith serving as the reference category, was examined in Cox regression models. Hazard ratios (HRs) with 95% confidence intervals (CIs) were adjusted for age, marital status, education, type of household, language and degree of urbanization. Results Suicide rates per 100 000 inhabitants were 19.7 in Catholics (1664 suicides), 28.5 in Protestants (2158 suicides) and 39.0 in those with no affiliation (882 suicides). Associations with religion were modified by age and gender (P < 0.0001). Compared with Protestant men aged 35–64 years, HRs (95% CI) for all suicides were 0.80 (0.73–0.88) in Catholic men and 1.09 (0.98–1.22) in men with no affiliation; and 0.60 (0.53–0.67) and 1.96 (1.69–2.27), respectively, in men aged 65–94 years. Corresponding HRs in women aged 35–64 years were 0.90 (0.80–1.03) and 1.46 (1.25–1.72); and 0.67 (0.59–0.77) and 2.63 (2.22–3.12) in women aged 65–94 years. The association was strongest for suicides by poisoning in the 65–94-year-old age group, the majority of which was assisted: HRs were 0.45 (0.35–0.59) for Catholic men and 3.01 (2.37–3.82) for men with no affiliation; 0.44 (0.36–0.55) for Catholic women and 3.14 (2.51–3.94) for women with no affiliation. Conclusions In Switzerland, the protective effect of a religious affiliation appears to be stronger in Catholics than in Protestants, stronger in older than in younger people, stronger in women than in men, and particularly strong for assisted suicides.
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Background and Objectives: Work-related stress and burnout among physicians are of increasing relevance. The aim of this study was to investigate work-related behavior and experience patterns and predictors of mental health of physicians working in medical practice in Germany. Methods: We surveyed a stratified, random sample of 900 physicians from different specialties. The questionnaire included the standardized instruments Work-related Behavior and Experience Pattern (AVEM) and the Short Form-12 Health Survey (SF-12). Results: Only one third of physicians reported high or very high general satisfaction with their job, but 64% would choose to study medicine again. Only 18% of physicians presented a healthy behavior and experience pattern. Almost 40% presented a pattern of reduced motivation to work, 21% were at risk of overexertion, and 22% at risk for burnout. Willingness to study medicine again, fulfilled job expectations, professional years, marital status, and behavior patterns were significant predictors of mental health and accounted for 35.6% of the variance in mental health scores. Job-related perceptions also had a significant effect on burnout. Conclusions: The strong influence of work-related perceptions suggests a need for realistic expectation management in medical education, as well as support in stress management and coping strategies during medical training.
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Background Many medical exams use 5 options for multiple choice questions (MCQs), although the literature suggests that 3 options are optimal. Previous studies on this topic have often been based on non-medical examinations, so we sought to analyse rarely selected, 'non-functional' distractors (NF-D) in high stakes medical examinations, and their detection by item authors as well as psychometric changes resulting from a reduction in the number of options. Methods Based on Swiss Federal MCQ examinations from 2005-2007, the frequency of NF-D (selected by <1% or <5% of the candidates) was calculated. Distractors that were chosen the least or second least were identified and candidates who chose them were allocated to the remaining options using two extreme assumptions about their hypothetical behaviour: In case rarely selected distractors were eliminated, candidates could randomly choose another option - or purposively choose the correct answer, from which they had originally been distracted. In a second step, 37 experts were asked to mark the least plausible options. The consequences of a reduction from 4 to 3 or 2 distractors - based on item statistics or on the experts' ratings - with respect to difficulty, discrimination and reliability were modelled. Results About 70% of the 5-option-items had at least 1 NF-D selected by <1% of the candidates (97% for NF-Ds selected by <5%). Only a reduction to 2 distractors and assuming that candidates would switch to the correct answer in the absence of a 'non-functional' distractor led to relevant differences in reliability and difficulty (and to a lesser degree discrimination). The experts' ratings resulted in slightly greater changes compared to the statistical approach. Conclusions Based on item statistics and/or an expert panel's recommendation, the choice of a varying number of 3-4 (or partly 2) plausible distractors could be performed without marked deteriorations in psychometric characteristics.
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Clothes offer us a commentary on the individual who wears them, and one of those comments deals with gender. Clothing is fundamental to gender, turning male and female bodies into men and women. In the nineteenth century the preoccupation with appear- ances was greater than in previous periods thanks to changes in the social system and a reformulation of gender roles, as well as the popularity of physiognomic theory. Given this increased sensitivity to the gaze, it is curious that men would uniformly adopt the black suit as their garment of choice. This revolution in male fashion was born from contradic- tory motives. On the one hand, the man in black attempted to avoid the gaze so as not to be anyone’s object of desire. An exception to this rule was the elegante, for whom fashion was a way of life. The elegante became a frequent target of the satirical press, which ques- tioned his masculinity. On the other hand, the black suit came simbolize the power of the ascendant middle class because it recalled Spain’s most important monarchs, such as Carlos V and Felipe II. The black suit thus became a polysemic signifier, and the man who wore it attempted, impossibly, to be both the subject and object of the gaze.
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Reform is a word that, one might easily say, characterizes more than any other the history and development of Buddhism. Yet, it must also be said that reform movements in East Asian Buddhism have often taken on another goal—harmony or unification; that is, a desire not only to reconstruct a more worthy form of Buddhism, but to simultaneously bring together all existing forms under a single banner, in theory if not in practice. This paper explores some of the tensions between the desire for reform and the quest for harmony in modern Japanese Buddhism thought, by comparing two developments: the late 19th century movement towards ‘New Buddhism’ (shin Bukkyō) as exemplified by Murakami Senshō 村上専精 (1851–1929), and the late 20th century movement known as ‘Critical Buddhism’ (hihan Bukkyō), as found in the works of Matsumoto Shirō 松本史朗 and Hakamaya Noriaki 袴谷憲昭. In all that has been written about Critical Buddhism, in both Japanese and English, very little attention has been paid to the place of the movement within the larger traditions of Japanese Buddhist reform. Here I reconsider Critical Buddhism in relation to the concerns of the previous, much larger trends towards Buddhist reform that emerged almost exactly 100 years previous—the so-called shin Bukkyō or New Buddhism of the late-Meiji era. Shin Bukkyō is a catch-all term that includes the various writings and activities of Inoue Enryō, Shaku Sōen, and Kiyozawa Manshi, as well as the so-called Daijō-hibussetsuron, a broad term used (often critically) to describe Buddhist writers who suggested that Mahāyāna Buddhism is not, in fact, the Buddhism taught by the ‘historical’ Buddha Śākyamuni. Of these, I will make a few general remarks about Daijō-hibusseturon, before turning attention more specifically to the work of Murakami Senshō, in order to flesh out some of the similarities and differences between his attempt to construct a ‘unified Buddhism’ and the work of his late-20th century avatars, the Critical Buddhists. Though a number of their aims and ideas overlap, I argue that there remain fundamental differences with respect to the ultimate purposes of Buddhist reform. This issue hinges on the implications of key terms such as ‘unity’ and ‘harmony’ as well as the way doctrinal history is categorized and understood, but it also relates to issues of ideology and the use and abuse of Buddhist doctrines in 20th-century politics.
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Extension of 3-D atmospheric data products back into the past is desirable for a wide range of applications. Historical upper-air data are important in this endeavour, particularly in the maritime regions of the tropics and the southern hemisphere, where observations are extremely sparse. Here we present newly digitized and re-evaluated early ship-based upper-air data from two cruises: (1) kite and registering balloon profiles from onboard the ship SMS Planet on a cruise from Europe around South Africa and across the Indian Ocean to the western Pacific in 1906/1907, and (2) ship-based radiosonde data from onboard the MS Schwabenland on a cruise from Europe across the Atlantic to Antarctica and back in 1938/1939. We describe the data and provide estimations of the errors. We compare the data with a recent reanalysis (the Twentieth Century Reanalysis Project, 20CR, Compo et al., 2011) that provides global 3-D data back to the 19th century based on an assimilation of surface pressure data only (plus monthly mean sea-surface temperatures). In cruise (1), the agreement is generally good, but large temperature differences appear during a period with a strong inversion. In cruise (2), after a subset of the data are corrected, close agreement between observations and 20CR is found for geopotential height (GPH) and temperature notwithstanding a likely cold bias of 20CR at the tropopause level. Results are considerably worse for relative humidity, which was reportedly inaccurately measured. Note that comparing 20CR, which has limited skill in the tropical regions, with measurements from ships in remote regions made under sometimes difficult conditions can be considered a worst case assessment. In view of that fact, the anomaly correlations for temperature of 0.3–0.6 in the lower troposphere in cruise (1) and of 0.5–0.7 for tropospheric temperature and GPH in cruise (2) are considered as promising results. Moreover, they are consistent with the error estimations. The results suggest room for further improvement of data products in remote regions.
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Theoretical studies of the problems of the securities markets in the Russian Federation incline to one or other of the two traditional approaches. The first consists of comparing the definition of "valuable paper" set forth in the current legislation of the Russian Federation, with the theoretical model of "Wertpapiere" elaborated by German scholars more than 90 years ago. The problem with this approach is, in Mr. Pentsov's opinion, that any new features of the definition of "security" that do not coincide with the theoretical model of "Wertpapiere" (such as valuable papers existing in non-material, electronic form) are claimed to be incorrect and removed from the current legislation of the Russian Federation. The second approach works on the basis of the differentiation between the Common Law concept of "security" and the Civil Law concept of "valuable paper". Mr. Pentsov's research, presented in an article written in English, uses both methodological tools and involves, firstly, a historical study of the origin and development of certain legal phenomena (securities) as they evolved in different countries, and secondly, a comparative, synchronic study of equivalent legal phenomena as they exist in different countries today. Employing the first method, Mr. Pentsov divided the historical development of the conception of "valuable paper" in Russia into five major stages. He found that, despite the existence of a relatively wide circulation of valuable papers, especially in the second half of the 19th century, Russian legislation before 1917 (the first stage) did not have a unified definition of valuable paper. The term was used, in both theoretical studies and legislation, but it covered a broad range of financial instruments such as stocks, bonds, government bonds, promissory notes, bills of exchange, etc. During the second stage, also, the legislation of the USSR did not have a unified definition of "valuable paper". After the end of the "new economic policy" (1922 - 1930) the stock exchanges and the securities markets in the USSR, with a very few exceptions, were abolished. And thus during the third stage (up to 1985), the use of valuable papers in practice was reduced to foreign economic relations (bills of exchange, stocks in enterprises outside the USSR) and to state bonds. Not surprisingly, there was still no unified definition of "valuable paper". After the beginning of Gorbachev's perestroika, a securities market began to re-appear in the USSR. However, the successful development of securities markets in the USSR was retarded by the absence of an appropriate regulatory framework. The first effort to improve the situation was the adoption of the Regulations on Valuable Papers, approved by resolution No. 590 of the Council of Ministers of the USSR, dated June 19, 1990. Section 1 of the Regulation contained the first statutory definition of "valuable paper" in the history of Russia. At the very beginning of the period of transition to a market economy, a number of acts contained different definitions of "valuable paper". This diversity clearly undermined the stability of the Russian securities market and did not achieve the goal of protecting the investor. The lack of unified criteria for the consideration of such non-standard financial instruments as "valuable papers" significantly contributed to the appearance of numerous fraudulent "pyramid" schemes that were outside of the regulatory scheme of Russia legislation. The situation was substantially improved by the adoption of the new Civil Code of the Russian Federation. According to Section 1 of Article 142 of the Civil Code, a valuable paper is a document that confirms, in compliance with an established form and mandatory requisites, certain material rights whose realisation or transfer are possible only in the process of its presentation. Finally, the recent Federal law No. 39 - FZ "On the Valuable Papers Market", dated April 22 1996, has also introduced the term "emission valuable papers". According to Article 2 of this Law, an "emission valuable paper" is any valuable paper, including non-documentary, that simultaneously has the following features: it fixes the composition of material and non-material rights that are subject to confirmation, cession and unconditional realisation in compliance with the form and procedure established by this federal law; it is placed by issues; and it has equal amount and time of realisation of rights within the same issue regardless of when the valuable paper was purchased. Thus the introduction of the conception of "emission valuable paper" became the starting point in the Russian federation's legislation for the differentiation between the legal regimes of "commercial papers" and "investment papers" similar to the Common Law approach. Moving now to the synchronic, comparative method of research, Mr. Pentsov notes that there are currently three major conceptions of "security" and, correspondingly, three approaches to its legal definition: the Common Law concept, the continental law concept, and the concept employed by Japanese Law. Mr. Pentsov proceeds to analyse the differences and similarities of all three, concluding that though the concept of "security" in the Common Law system substantially differs from that of "valuable paper" in the Continental Law system, nevertheless the two concepts are developing in similar directions. He predicts that in the foreseeable future the existing differences between these two concepts will become less and less significant. On the basis of his research, Mr. Pentsov arrived at the conclusion that the concept of "security" (and its equivalents) is not a static one. On the contrary, it is in the process of permanent evolution that reflects the introduction of new financial instruments onto the capital markets. He believes that the scope of the statutory definition of "security" plays an extremely important role in the protection of investors. While passing the Securities Act of 1933, the United States Congress determined that the best way to achieve the goal of protecting investors was to define the term "security" in sufficiently broad and general terms so as to include within the definition the many types of instruments that in the commercial world fall within the ordinary concept of "security' and to cover the countless and various devices used by those who seek to use the money of others on the promise of profits. On the other hand, the very limited scope of the current definition of "emission valuable paper" in the Federal Law of the Russian Federation entitled "On the Valuable Papers Market" does not allow the anti-fraud provisions of this law to be implemented in an efficient way. Consequently, there is no basis for the protection of investors. Mr. Pentsov proposes amendments which he believes would enable the Russian markets to become more efficient and attractive for both foreign and domestic investors.
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The St. Petersburg Paradox was first presented by Nicholas Bernoulli in 1713. It is related to a gambling game whose mathematical expected payoff is infinite, but no reasonable person would pay more than $25 to play it. In the history, a number of ideas in different areas have been developed to solve this paradox, and this report will mainly focus on mathematical perspective of this paradox. Different ideas and papers will be reviewed, including both classical ones of 18th and 19th century and some latest developments. Each model will be evaluated by simulation using Mathematica.
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Background: Medical students do not accurately self-assess their competence. However, little is known about the awareness of change of competence over time. The aim of this study was to evaluate if students are aware of their progress. Summary of work: Twenty-two fourth year medical students had self- and expert-assessments of their clinical skills in musculoskeletal medicine in an OSCE like station (4 point Likert scale) at the beginning (t0) and end (t1) of their eight weeks clerkship in internal medicine. Thirteen students were assigned to the intervention of a 6x1 hour practical examination course; nine took part in the regular clinical clerkship activities only and served as controls. Summary of results/Conclusions: The intervention students significantly improved their skills (from 2.78 ± 0.36 to 3.30 ± 0.36, p<0.05) in contrast to the control students (from 3.11 ± 0.58 to 2.83 ± 0.49, n.s.). At t0, 19 students, at t1 21 out of 22 students underestimated their competence. Correlations between the change of self- and expert-assessment were r=0.43, p<0.05 (all), r=0.47, n.s. (control) and r=-0.12, n.s. (intervention), respectively. Take-home message: Medical students improving their clinical skills by an interactive course in addition to their regular clerkship activities are not aware of their progress
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High-resolution and highly precise age models for recent lake sediments (last 100–150 years) are essential for quantitative paleoclimate research. These are particularly important for sedimentological and geochemical proxies, where transfer functions cannot be established and calibration must be based upon the relation of sedimentary records to instrumental data. High-precision dating for the calibration period is most critical as it determines directly the quality of the calibration statistics. Here, as an example, we compare radionuclide age models obtained on two high-elevation glacial lakes in the Central Chilean Andes (Laguna Negra: 33°38′S/70°08′W, 2,680 m a.s.l. and Laguna El Ocho: 34°02′S/70°19′W, 3,250 m a.s.l.). We show the different numerical models that produce accurate age-depth chronologies based on 210Pb profiles, and we explain how to obtain reduced age-error bars at the bottom part of the profiles, i.e., typically around the end of the 19th century. In order to constrain the age models, we propose a method with five steps: (i) sampling at irregularly-spaced intervals for 226Ra, 210Pb and 137Cs depending on the stratigraphy and microfacies, (ii) a systematic comparison of numerical models for the calculation of 210Pb-based age models: constant flux constant sedimentation (CFCS), constant initial concentration (CIC), constant rate of supply (CRS) and sediment isotope tomography (SIT), (iii) numerical constraining of the CRS and SIT models with the 137Cs chronomarker of AD 1964 and, (iv) step-wise cross-validation with independent diagnostic environmental stratigraphic markers of known age (e.g., volcanic ash layer, historical flood and earthquakes). In both examples, we also use airborne pollutants such as spheroidal carbonaceous particles (reflecting the history of fossil fuel emissions), excess atmospheric Cu deposition (reflecting the production history of a large local Cu mine), and turbidites related to historical earthquakes. Our results show that the SIT model constrained with the 137Cs AD 1964 peak performs best over the entire chronological profile (last 100–150 years) and yields the smallest standard deviations for the sediment ages. Such precision is critical for the calibration statistics, and ultimately, for the quality of the quantitative paleoclimate reconstruction. The systematic comparison of CRS and SIT models also helps to validate the robustness of the chronologies in different sections of the profile. Although surprisingly poorly known and under-explored in paleolimnological research, the SIT model has a great potential in paleoclimatological reconstructions based on lake sediments