Academic literature on the topic 'Still-life in literature'

"The Still Life" explores debates over single manhood in the culture of the nineteenth-century United States. Until recently, the "bachelor" was less an identifiable social type than a battleground for discourses of privacy and intimacy, sympathy and sentiment, and labor and leisure. Representations of the bachelor tended to excite readers' concerns about the relationships among emotion, public behavior, and intellectual prowess. Concentrating on constructions of the bachelor within specific discursive arenas, this dissertation examines "bachelorhood" as a way culture organized a wide range of ideologies and experiences. Though the bachelor's particular significance faded in the twentieth century, a conceptual roadblock dramatized by the figure remains: the notion that an emotionally rewarding family life and the production of works of public significance are fundamentally at odds.;The Introduction traces the evolution of the notion of "bachelor" from European religious, martial, and academic origins to its United States version. Distinguishing "bachelorhood" from "single manhood," it sets the terms of inquiry within the theoretical context of cultural studies of masculinity.;The first chapter explores an apparent paradox: while much American writing of the early nineteenth century declared the single male a dangerous figure, Washington Irving's use of the bachelor as narrator evoked a quite different response. as a sentimental male narrator, Irving's bachelor participated in the construction of sympathy (crucial to post-Revolution politics) by observing the family and re-uniting alienated members of the body politic.;Chapter Two moves this discussion into the writings of Nathaniel Hawthorne and Herman Melville. Hawthorne's The Blithedale Romance and Melville's Pierre suggest a very different relationship between manhood and the domestic than Irving's model, one that criticized domesticity. Subverting the language of domestic spheres, these stories suggest that intimacy and privacy could be at odds.;The final chapter argues that we see competitive individual masculinity as a complex product of a shared domestic life. It focuses on fin-de-siecle still life paintings by William Harnett and John Peto that depicted men's paraphernalia. These paintings and the contemporary popular literature of masculine domesticity suggest that the new urban bachelor culture was a companionate one, forged in shared living spaces.

<p>In my dissertation I propose that the detailed representation of food and eating in seventeenth-century Spanish art and literature has a double purpose: to reaffirm a state of well-being in Spain, and to show a critical position, because artistic creations emphasize those subjects who, because of social status or cultural background, do not share such benefits. This double purpose explains why literature and painting stress the distance between foodstuffs and consumers, turning food into a commodity that cannot be consumed directly, but through its representation and value. Cervantes's writing is invoked because, especially in Don Quixote, readers can see how the protagonist rejects food for the sake of achieving higher chivalric values, while his companion, Sancho Panza, faces the opposite problem: having food at hand and not being able to enjoy it, especially when he achieves his dream of ruling an island. The principle is similar in genre painting: food is consumed out of the picture in still lifes, or out of the hands of the represented characters in kitchen scenes, for they are depicted cooking for others. Because of the distance between product and consumer, foodstuffs indicate how precedence and authority are established and reproduced in society. In artistic representations, these apparently unchangeable principles are mimicked by the lower classes and used to establish parallel systems of authority such as the guild of thieves who are presented around a table in a scene of Cervantes's exemplary novel "Rinconete and Cortadillo." Another problem to which the representation of foodstuffs responds is the inclusion of New Christians from different origins. In a counterpoint with the scenes in which precedence is discussed, and frequently through similar aesthetic structures, Cervantes and his contemporaries create scenes where the Christian principle of sharing food and drinking wine together is the model of inclusion that dissolves distinctions between Old and New Christians. I argue that this alternative project of community can be related to the expulsion of the Moriscos from Spain, decreed in 1609, because this event made many subjects interrogate themselves about their own status and inclusion. An artistic model of response to these interrogations about belonging is the figure of the roadside meal, which appears as the main motif of a meal shared by Sancho and a self-proclaimed Christian Morisco in the second part of Don Quixote, and reappears in a painting by Diego de Velázquez, which presents in the foreground a dark-skinned servant working in a kitchen, and in the background another roadside meal: the Supper at Emmaus. Both in literature and painting the way of preparing meals, eating and drinking creates ties, establishes a different principle of belonging, and promotes unity. In this alternative model characters are recognized as subjects of the kingdom as long as they eat and drink the way Christians do. Even though this model still leads to a single Christian kingdom, paintings and writings suggest a different form of cohesion, in which subjects are considered equal and recognize each other because of their participation.</p><br>Dissertation

AbstractThis essay explores the therapeutic possibilities opened up by literature for breathless patients today. Focusing on King Lear, it considers Shakespeare’s suggestion that we do not breathe as isolated agents but are instead ‘breathed’ by those who know and observe us. Breath emerges as fundamental to early modern personhood. Many breathless patients today still experience the inseparability of breath and aliveness, and breathlessness becomes ‘a way of life’ as they adapt their sense of what is possible in order to accommodate their condition. This life belongs not only to sufferers, however, but also to those who care for them. Considering recent clinical research on vicarious dyspnoea alongside King Lear reveals the existential and therapeutic potential of breath’s intimate, under-recognised relationality.

AbstractEconomic approaches and socio-cultural integration are still the most prominent frameworks applied to explain return migration and permanent settlement. In contrast to the bulk of literature focusing on established migrations from poorer to richer regions, the contribution analyses the permanence of emigration from economically highly developed countries. Based on a life-course approach, it highlights the interrelations between life-course domains shaping the intentions of German emigrants to settle permanently abroad, planning to return, and those who are still undecided. The analyses are based on the German Emigration and Remigration Panel Study (GERPS) surveying recently emigrated German citizens. The results show that almost half of those emigrants intend to return home after living for only a few years abroad, whereas every fifth reports permanent settlement intentions in the destination country. Multinomial logistic regressions demonstrate that the status within individual domains of the life course–particularly economic status, family arrangement, as well as existing social interactions–together with previous migration experiences shape the intended length of the current migration project.

AbstractSelf-esteem, a person’s overall evaluation that she is valued and accepted vs. devalued and rejected by others, is crucial for people quality of life. As such, self-esteem has been central in the social-psychological literature since the late eighteenth century. However, its relevance is coupled with lack of agreement on how self-esteem is best conceived and assessed. Here we review definitions and measures of self-esteem in relation to quality of life in order (a) to understand how self-esteem has been defined, operationalized and assessed, and (b) to clarify which facets of self-esteem have been overlooked and need further study. Although we found multiple definitions of self-esteem, which led to a series of measures ranging from single item to multi-dimensional measures of state, trait and contingent self-esteem, the motivational component of self-esteem and its in-context behavioral correlates have yet to be operationalized. What follows, is that whether people think, feel, or behave in particular ways is caused by, concomitant with, or causes self-esteem, is still not understood. Because self-esteem is an emotionally laden system monitoring one’s relational value to others, we suggest that future research could use new technology-based research methods and eventually grasp real-time self-report and behavioral assessment of self-esteem. This appears a promising approach to overcome the limitations of self-esteem’s current theorizations and operationalizations. Thus, a new line of research considering the momentary experience of self-esteem, its behavioral components and its social context, could potentially unveil novel processes and mechanisms linking self-esteem and quality of life that have yet to be discovered and understood.

AbstractDouble ureteral stents are amongst the commonest procedures performed in urology. However, there are complications such as infection, and encrustation associated with its use, together with uncomfortable lower urinary tract symptoms (LUTS). The latter are known as stent related symptoms (SRS) and are commonly reported in the scientific literature. SRS mentioned in literature are urgency, frequency, dysuria, haematuria, pain in the suprapubic and flank region. These can result in decreased sexual activity, reduced work performance, as well as decreased quality of life (QoL) in more than two-third of the patients. Drugs still hold the key in reducing the morbidity related to the ureteral stents.In terms of monotherapy, Alpha blockers as well as Antimuscarinics are effective in reducing SRS. Role of Mirabegron in the field is currently gaining importance. However, combination therapy reaches better outcomes than monotherapy alone while in cases with sexual dysfunction along with stent related symptoms, PDE5-I are better than other options. The role of complementary therapy for SRS with natural remedies is promising but needs to be assessed further. More randomized studies and laboratory trials are necessary to analyse possible alternative treatments for SRS that can heavily affects patients’ quality of life.

AbstractUrban Metabolism (UM) is a scientific phenomenon that comprises individual processes taking place in all cities at different spatial and temporal scales and that is based on the principle of conserving mass and energy. Analysing the metabolism of a city allows one to evaluate the impacts of urban functioning, taking into account the flows of energy, water, nutrients and waste and the materials in general that circulate within a city, and contributing to a multidimensional assessment of sustainability. Many authors have explored the phenomenon of UM and experimented with indices and evaluation methods, but there is still no consensus on the best assessment methods to use.The present paper presents an overview of UM assessment methods, particularly Life Cycle Assessment (LCA) and its possible uses for supporting territorial regeneration. A literature analysis is conducted of the evolution of this method in relation to scales that are different from the single product scale. LCA aims to assess the environmental impacts of the life cycles of single industrial products and services, but over the years it has gained increased attention in the urban planning field. Life cycle, in general, refers to all the phases that characterise the life of elements, comprising not only a single product, but extending this concept also to the wider territorial system. The concept of the life cycle of territorial systems is related to the evolution of the territory as a heritage and as a system of environmental, social and economic resources and services, whose transformation is linked to the different forms of governance. The territorial life cycle is formed by interconnected phases, referred to as the sub-systems of the resources and performance of a territory, that follow a predefined plan scenario. Consequently, the life cycle concept can be compared to that of change and it is closely linked to the analogy of ecosystems and the urban environment, which views the city as an entity in constant transformation.In the last few years, there has been an increase in activity in the LCA application field, with the introduction of scale variations and of the distinction between applications at the level of the single product and applications at the meso and macro levels. In other words, this approach is evolving and applications and hypotheses involving scales different from the micro scale are becoming popular.In this regard, extending the LCA tool to a meso perspective on a municipal scale or an individual urban district scale could prove to be a valid tool for assessing the sustainability of a territory with regard to the metabolic flows and the evolution of its life cycle.

AbstractThis chapter focuses on aged and highly aged patients who have long and rather comprehensive contacts with healthcare institutions of long-term care, either in residential aged care or in community-dwelling. Therefore, it is well accepted in the literature that a salutogenic orientation and health promotion measures could contribute to the quality of life, well-being, and health of this group. Furthermore, a good sense of coherence (SOC) can be considered as a positive resource for coping with the physical, mental, and social challenges and transitions related to aging.But the state of descriptive research on salutogenesis focusing not only on residents but also somewhat less so on community dwellers is still scarce and has mostly been conducted in few countries. Concerning intervention research only very few studies have specifically applied salutogenic principles to promote positive health among older people.In light of this scarce research situation, the authors make recommendations for further research in this relevant and growing area of health care.

AbstractEnvironmental microplastic particles (MPs) represent a potential threat to many aquatic animals, and experimental exposure studies, when done well, offer a quantitative approach to assess this stress systematically and reliably. While the scientific literature on MP studies in aquatic environments is rapidly growing, there is still much to learn, and this chapter presents a brief overview of some of the successful methods and pitfalls in experimental MP exposure studies. A short overview of some experimental design types and recommendations are also presented. A proper experimental exposure study will yield useful information on MP-organism impacts and must include the following: a comprehensive MP characterization (e.g., density, buoyancy, type, nature, size, shape, concentration, color, degree of weathering/biofilm formation, an assessment of co-contaminant/surfactant toxicity and behavior, an understanding exposure modes, dose and duration, and the type and life stage of the target species). Finally, more conventional experimental considerations, such as time, costs, and access to clean water, specialized instrumentation, and use of appropriate controls, replicate, and robust statistical analyses are also vital. This short review is intended as a necessary first step towards standardization of experimental MP exposure protocols so one can more reliably assess the transport and fate of MP in the aquatic environment as well as their potential impacts on aquatic organisms.

AbstractDebugging is one of the most expensive and challenging phases in the software development life-cycle. One important cost factor in the debugging process is the time required to analyze failures and find underlying faults. Two types of techniques that can help developers to reduce this analysis time are Failure Clustering and Automated Fault Localization. Although there is a plethora of these techniques in the literature, there are still some gaps that prevent their operationalization in real-world contexts. Besides, the abundance of these techniques confuses the developers in selecting a suitable method for their specific domain. In order to help developers in reducing analysis time, we propose methodologies and techniques that can be used standalone or in a form of a tool-chain. Utilizing this tool-chain, developers (1) know which data they need for further analysis, (2) are able to group failures based on their root causes, and (3) are able to find more information about the root causes of each failing group. Our tool-chain was initially developed based on state-of-the-art failure diagnosis techniques. We implemented and evaluated existing techniques. We built on and improved them where the results were promising and proposed new solutions where needed. The overarching goal of this study has been the applicability of techniques in practice.

Childhood depression is a very prevalent mental health condition in today's society. Its debate began to become relevant in the 1960s and, although there is no doubt about its existence, the subject is still little discussed. This paper aims to demonstrate the relevance of the subject due to its high prevalence and underdiagnosis. A literature review on Childhood Depression in Brazil was carried out based on research in Pubmed, Scielo, and Google Scholar databases, between 1989 and 2020, in Portuguese and English, using the descriptors: “child depression”, “symptoms of depression” and “treatment of childhood depression” combined. Textbooks, data from Ministério da saúde, the World Health Organization (WHO), and key articles selected from citations in other articles were used to compose the paper. From the data analysis, twenty-two titles that are directly related to the current work were selected. In Brazil, girls and children between thirteen and fourteen years old are the most affected by the disease. The DSM does not differentiate it from adult depression, despite the atypical manifestations of its symptoms in children. Families still have great difficulty on identifying this disorder the biggest obstacle is understanding and accepting that behavioral changes can be part of a depressive condition. Normalizing the discussion of the topic is important so that there is more information about the disease and, consequently, more knowledge is disseminated both to the medical community and the families of affected children. This way, it will be possible to prevent its appearance and, when present, facilitate its detection, improving life quality of those involved and avoiding negative outcomes such as child suicide.

The current stage of development of the world economy emphasizes knowledge, in the sense of the use of modern technologies and artificial intelligence, which should support sustainable development and increase the quality of life on earth. However, both the local and the global economy “suffer” as a result of the fact that financial interests from the micro to the macro level still prevail, and in this context a number of problems, such as pollution, individual health, lack of energy and other resources, wars etc., are still a harsh reality which, unfortunately, we still have to face today, and all this can only lead to the violation of fundamental human rights and, ultimately, to the degradation of life on Earth. The aim of this article is to capture the main negative aspects of the current stage of socio-economic development, both locally and internationally, generated by the ongoing struggle for supremacy. The research method is non-participatory observation. The source of information is literature, databases provided by national and international organizations and media resources. The results of the research are intended to be a warning signal and a mobilizing force for all national and, above all, international competent bodies, but also for the entire population in general, from all categories of specialists to the last citizen of this globe, with the aim of preventing or even eliminating the problems of the current stage of development, before it is too late.

Abstract According to the World Health Organization and the International Society for Prosthetics and Orthotics, between 0.5 to 0.8 percent of the global population has suffered limb amputations. In the last years, Colombia, Angola, Afghanistan, and Chechenia are the countries that have held the first places with the highest amount of landmine victims. In Colombia, this weapon has left more than 10.000 affected people, many of which have suffered traumatic lower limb amputation To recover some of the lost function, amputees are generally prescribed with a prosthesis. However, the adaptation of the user with this element depends on the comfort felt when using it and consequently, on the fit between the socket and the residual limb. The fit between these two elements is highly influenced by the relative motion between them (i.e. displacement, slip). Both excess of displacement or complete absence, have several negative consequences for the amputee. Thus, measuring displacement could be an important indicator of the quality of the socket and the suspension system, and could provide critical information to improve surgical interventions, the prescription of prosthetic elements and the design and development of new prosthetic components. Several authors have investigated this topic; however, the studies have been mostly conducted on transtibial amputees. Therefore, this review aims to summarize the gathered information about the displacement between the socket and residual limb in transfemoral amputees. A computer-aided systematic literature search was performed by two independent reviewers using three databases. The selected papers were evaluated with regards to: sample characteristics, displacement measurement instrument, measured activity, displacement axis, surfaces in contact, type of socket and type of suspension system used. Most of the studies were performed on less than five individuals with mature residual limbs and trauma caused amputation. The most common aspects of displacement were: imaging techniques (measurement instrument), gait (measured activity), vertical direction (displacement axis), bone/socket (surfaces in contact), quadrilateral (type of socket) and suction-based (suspension system). The optimal range of motion is still unknown for transfemoral amputees. A marker-based optical tracking system is promising for research purposes, while electronic sensors would be optimal for clinical use. Volume change may be an indirect and, more straightforward option to measure displacement. Further research is needed to determine the effect of using a modified socket, to find a way to measure relative motion inside the socket using marker-based optical tracking systems and to define the influence of subject-specific characteristics in the amount of displacement. A better understanding of what happens inside the socket helps to optimize prosthetic designs and to improve the amputee’s quality of life.

&lt;p&gt;The maturity of Digital Twin (DT) models has evolved in the aerospace and manufacturing industries; however, the construction industry still lags behind. DT technology can be applied to achieve smart management through the entire life cycle of structures. Particularly for bridge structures, which play an essential role in any transportation system and can have high maintenance demands throughout their long life spans. In this study, a literature review on DTs was performed, from the origins of the concept until current best practice focused on bridges. Especially concerning structural analysis and facility management, few studies that employ DT for bridges were encountered. The main challenges identified are related to treatment of the large amount of data involved in the process, mostly gathered from different platforms. Finally, a framework for smart facility management of bridges using DTs was proposed to tackle potential solutions.&lt;/p&gt;

&lt;p&gt;The maturity of Digital Twin (DT) models has evolved in the aerospace and manufacturing industries; however, the construction industry still lags behind. DT technology can be applied to achieve smart management through the entire life cycle of structures. Particularly for bridge structures, which play an essential role in any transportation system and can have high maintenance demands throughout their long life spans. In this study, a literature review on DTs was performed, from the origins of the concept until current best practice focused on bridges. Especially concerning structural analysis and facility management, few studies that employ DT for bridges were encountered. The main challenges identified are related to treatment of the large amount of data involved in the process, mostly gathered from different platforms. Finally, a framework for smart facility management of bridges using DTs was proposed to tackle potential solutions.&lt;/p&gt;

With the growth of the family, in which both parents are working or single parents, and on the other hand the growing demands of work organizations, the extension of working hours and the requirement to be constantly on call, the harmonization of work and family life is becoming increasingly difficult. Work-family balance is important for both the individual and the work organization, as it affects job satisfaction, engagement, productivity and also less employee turnover. Work-family balance is influenced by many factors, one of the most important is gender. Although men also face difficulties in work-family balance, research shows that women are still the ones with more work-family conflicts, as they take more care of children and household chores. The contribution based on previous literature and previous research presents the situation in the field of work-life balance in Slovenia from the gender point of view of. The results of a survey conducted among 343 employees in Slovenian companies were also presented, as well as possible improvements proposed at the level of both organizations and the state.

This paper establishes a structural model of the turbine disk of a certain aero-engine subjected to loads due to centrifugal force and duration at elevated temperature, and calculates the plastic and creep deformation with finite element (FE) analysis software. During creep analysis, the Norton constitutive equation was taken into account. After the temperature field distribution of the turbine disk had been obtained, structural static analysis results showed that the maximum equivalent stress and strain appeared at the area near to the disk center, which was taken as the critical point. The Manson-Coffin formula was used to predict low cycle fatigue (LCF) life based on the calculations derived from cyclic plastic-creep analysis, and creep life was obtained by applying the Larson-Miller equation. Lognormal distributions of LCF life and creep life were used as pointed out in the literature, which mainly considered the uncertainties in material parameters. Taking the lives and loads as random variables including LCF life, creep life, fatigue load and hold time, a probabilistic analysis on the turbine disk was performed under LCF-Creep, in which a failure function was proposed based on linear cumulative damage rule (LCDR). The probabilistic method of response surface (RS) was applied to fit the regression model of the LCF-Creep life with a quadratic approximation function including cross-terms. The Monte Carlo Simulation sampling technique was employed to carry out probabilistic analysis on the turbine disk life, resulting in the conclusion that the life of turbine disk under LCF-Creep follows a lognormal distribution. Furthermore, the effect of different random variables on the disk life was investigated through sensitivity analysis in order to increase the component’s life and improve its reliability. However, studies on the distributions of loads and damage theory of the component under LCF-Creep still need to be discussed in future study.

Abstract Students’ level of positive learning-centered affective states, like engagement or flow state, has been proved to be strongly related to dropouts’ prevention, higher learning rate, and better student performance in their courses. Measuring users’ engagement state in a more effective and user-independent way may help create a better design of interactive applications and develop intelligent, more sophisticated, and adaptative study environments. The engagement reviews found in the literature go through psychological definitions but do not go deeper into the physiological and behavioral indicators of the state. This review aims to analyze the current state of the art on engagement detection, to identify which are some of the most relevant physiological and behavioral indicators for engagement in students for its prediction during presential or online courses. A computer-aided systematic literature search was performed following the PRISMA methodology. A total of 24 articles were selected after removing duplicates and applying the selection criteria. These studies were analyzed to extract data relative to the physiological behavioral indicators, the classifier used, its’ accuracy, and the number of participants. Indicators, such as leaning forward or backward and parasympathetic activation (such as HR, HRV, and GSR) have proven to be strongly related to students’ engagement states. The multimodal channel systems have been proven to have better performance, but the question of the best channel combination is still on the table. Different classification methods (SVM, RF, NB) have achieved high accuracy performance in experimental setups, but there are still challenges for real-life setups detection systems.

At the time of unprecedented development of digital technologies, business owners across various industries need to stay up-to-date in terms of using cutting-edge technologies such as Industry 4.0 to ensure competitive performance. There are still many areas where their positive implications of digital technologies have not been applied. For example, the end-of-life (EoL) waste from the automotive, aerospace, and wind energy industries is still accumulating in landfills. At present, an increasing number of vehicles, airplanes, and wind turbine blades are made of Carbon Fiber Reinforced Polymer Composites (CFRPs) leading to an urgent demand for implementing sustainable waste disposal strategies. Thus, recycling CFRPs is a key research area that provides a potential for improvement, particularly, in terms of digitalization. This study addresses the issues prevalent in this sphere and proposes Industry 4.0 related technologies to be integrated into the CFRP recycling supply chain stages, including waste collection, dismantling, transportation, recycling, and re-manufacturing. For this purpose, key technologies were selected from the literature review, smart recycling trends were defined and relevant analysis was carried out to map technologies onto the CFRP recycling supply chain.

Materials creep resistance is usually determined under uniaxial constant load condition while the state of stress in real components is multiaxial in general. How to correlate multiaxial creep behavior to uniaxial creep data is still an open issue. Most of the theories available in the literature are phenomenological in nature and limited to few classes of metals and stress triaxiality ranges. From the computational point of view, stress field relaxation depends on the creep model formulation. Therefore, it is necessary to use a refined creep model capable to reproduce the effective state of stress in the material. In the present work, a mechanism based creep model proposed by Bonora and Esposito [1] was used to predict creep life of P91 high chromium steel under multiaxial state of stress. This creep model is capable to reproduce all creep stages and was validated for different classes of metals and alloys. The performance of different reference stress definitions (i.e. the principal facet stress, skeletal stress and a new formulation) was investigated. Results were compared with available creep life data obtained on round notched samples at different temperatures.

Review question / Objective: As a common type of clinical dementia, the prevalence rate of vascular dementia(VaD) increased rapidly in recent years, damaging both patients’ health and social-economic prospect. There is currently no effective treatment for VaD, though western medicines can slightly improve patients' cognitive function, but not brought a significant improvement in daily life ability. Chinese herbal medicine(CHM) has been widely employed to treat dementia for more than 2000 years in China. Despite the proliferation of relevant literature, there is still a lack of evidence to prove the effectiveness and safety of such therapy. Therefore, this systematic review and meta-analysis protocol is aimed to assess the efficacy and safety of CHM forVaD. Information sources: 6 English databases (PubMed, Web of Science, Embase, Springer, CENTRAL and WHO International Clinical Trials Registry Platform) and 4 Chinese databases (Wan fang Database, Chinese Scientific Journals Database, China National Knowledge Infrastructure Database and Chinese Biomedical Literature Database).

Education systems globally are implementing competency-based education (CBE) reforms. Vietnam's leaders have also adopted CBE in a comprehensive reform of its education since the early 2010s. Although the global idea of CBE has been widely adopted and recontextualized in various educational contexts, implementing the reform at the local level (e.g., teachers in schools) is never a linear and simple process. Given the complicated sensemaking process of competency and competency teaching, this study explores how Vietnamese teachers made sense of key competencies and adapted their teaching to competency development. Informed by a sociocultural approach and the sensemaking perspective, this study draws from a dataset of 91 secondary teachers collected over three years (2017-2019), with a particular focus on longitudinal analysis of eight teachers. The findings shed light on teachers’ ambivalence as they made sense of the target competencies and aligned their practices with the new CBE reform. Based on their prior experiences and worldviews, teachers made sense of competencies as learning foundational knowledge and skills, in addition to developing good attitude, character, and morality. Over the years, they placed a stronger emphasis on the competencies’ process-orientation, integration, and real-life application toward whole-child development. Despite teacher sensemaking and changing practices, the performativity culture for high learning outcomes still prevailed, making teaching competencies for life a challenging task. Contributing to the CBE literature and practice, this study illustrates the long and complicated process through which teachers recontextualize the CBE pedagogy. It also suggests how teacher practices can be better supported to transition to the new CBE curriculum.

Measuring 21st century skills is one of the most important tasks of education and training systems. Measurement is what allows program managers to evaluate the effectiveness of a particular education program, diagnose the needs of individual students, or assess their development over time. Still, countries in Latin America and the Caribbean and around the world face challenges in this area. Using data from interviews, case studies, and an in-depth literature review, this policy brief evaluates the advantages and disadvantages of different types of assessment tools for measuring 21st century skills, discusses challenges of applying them in less-developed countries, and offers recommendations for stakeholders seeking to measure 21st century skills among children and youth, by utilizing existing instruments or adapting and testing them in local contexts.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.