Under pressure: The paradox of autonomy and social norms in drug education

Much contemporary youth drug education operates from the assumption that young people's decisions to use alcohol and other drugs often stem from a misunderstanding that youth consumption is so common as to constitute a 'social norm'. Known as the 'social norms' approach, the stated aim of this form of drug education is to empower young people to avoid consumption by constituting it as uncommon and, therefore, abnormal. Taking the relationship between autonomy and norms as my primary concern, I examine key assumptions of the social norms approach through an analysis of a dataset of 23 'evidence-based' drug education texts currently recommended for use in Australian secondary schools. Drawing on Rasmussen's (2011) analysis of autonomy as a 'paradox' in which young people are compelled to demonstrate their autonomy by submitting to external authority, I argue that drug education constitutes young people's (lack of) autonomy as the key cause of and solution to youth drug use through three strategies: (1) decision-making exercises that position consumption as the result of an inability to make the rational choice; (2) activities that equate drug consumption with succumbing to peer pressure and failing to demonstrate autonomy; and (3) deployment of population level data on youth drug use that constitutes it as atypical. Together these strategies suggest that while drug education often purports to empower young people to make empowered decisions, it operates as a broader social intervention that seeks to produce compliant rather than autonomous subjects.

Endovascular embolization with EVOH for the treatment of a Rasmussen aneurysm

First-line treatment of pulmonary artery aneurysms/pseudoaneurysms (PAA/PAPA) is percutaneous or endovascular embolization. The present case of a Rasmussen aneurysm, a PAPA caused by Tuberculosis (TB), was successfully treated with ethylene-vinyl alcohol (EVOH), a radiopaque liquid embolic agent with favorable characteristics. A 35-year-old man presented as a new patient with hemoptysis, and CT imaging revealed multiple cavitary lesions and a 2.1 cm aneurysm in the upper right lobe. Endovascular treatment was delivered and a complete lack of filling of the lesion was noted on post-treatment angiography. The patient's history includes risk factors and past TB infection. Despite the suspicious imaging, diagnostic tests were negative for active TB in this patient. He was then found to have MRSA bacteremia and a mediastinal lymph node positive for M. avium. The etiology of this aneurysm is suspicious for the superinfection of a chronic tuberculous cavity with M. avium, MRSA, or both.

Second surgery after vertical paramedian hemispherotomy for epilepsy recurrence

Background

Vertical Paramedian Hemispherotomy (VPH) is considered an effective surgical treatment for drug-resistant epilepsy with 80% of patients experiencing seizure freedom or worthwhile improvement. Identifying persistent connective tracts is challenging in failed VPH.

Methods

We reviewed our series of consecutive patients undergoing VPH for hemispheric drug-resistant epilepsy and included cases with recurrent epileptic seizures undergoing second surgery with at least 6 months of postoperative follow-up. The cases were extensively assessed to propose a targeted complementary resection.

Results

Two children suffering from seizure recurrence following hemispherotomy leading to second surgery were included. After complete assessment, persisting amygdala residue was suspected responsible for the epilepsy recurrence in both patients. Complementary resection of the amygdala residue led to seizure freedom for both patients (Engel IA/ILAE Class 1) without complication. Different diagnostic tools are used to assess patients after failed hemispherotomy including routine EEG, prolonged video EEG, MRI (particularly DTI sequences), SPECT or PET scans and clinical evaluation. These tools allow to rule out epileptic foci in the contralateral hemisphere and to localize a potentially persisting epileptogenic zone. Assessment of these patients should be as systematic and integrated as the initial workup. Although our two patients suffered from Rasmussen's encephalitis, seizure recurrence after VPH has been described in other pathologies.

Conclusion

Lying deep and medially in the surgical corridor of VPH, the amygdala can be incompletely resected and cause recurrent epilepsy. Complementary selective resection of the amygdala residue may safely lead to success in epilepsy control.

The bioeconomy in spain as a new economic paradigm: the role of key sectors with different approaches

The bioeconomy includes the sectors that use renewable biological resources to produce value added products, such as food, feed, energy, and bio-based products. Its importance has been demonstrated by its inclusion as a priority in specific and related policies such as the bioeconomy strategy, the Sustainable Development Goals, the European Green Deal, and the Next Generation recovery plan. Spain has not lagged behind and considers the bioeconomy as a priority in its policy strategies to achieve a more sustainable economy. Despite its importance, the analysis of the potential of the bioeconomy sectors in Spain is limited. To carry out policy-relevant impact assessment in support of bioeconomy development, specific databases describing bio-based products are required. Hence, this work based on the Bio Social Accounting Matrix (BioSAM) for Spain for the year 2010 with a high disaggregation of bio products to perform a structural analysis based on two different and complementary methods: the traditional and the Hypothetical Extraction approach. The structural analysis results reveal promising products as key wealth generators and growth promoters and allow to identify the most suitable to be stimulated with policies to promote the development of the Spanish bioeconomy. Therefore, this paper provides some proposed avenues that should be considered by policymakers.

Age-Dependent Reduction in Severity and Discrete Topographical Patterns in Rasmussen Encephalitis: A Link to Cortical Maturation?

BACKGROUND

Autopsy studies in Rasmussen encephalitis reveal areas of sparing within the affected hemisphere. Clinical progression and inflammation are milder with an older onset. We sought to demonstrate radiological corroboration for these patterns.

METHODS

In our retrospective study, 38 cases were dichotomized into severe pan-hemispheric (all lobes involved) and sub-hemispheric groups (others) to identify age demographics and other severity predictors. The extent and patterns of radiological pathology in the cortex and subcortical structures were assessed by structured visual grading. Relevant clinical data were also reported.

RESULTS

Children with pan-hemispheric involvement were younger at onset (P < 0.001) and were more likely to present with status epilepticus (odds ratio 8.5, 95% confidence interval 1.5 to 50.0, P = 0.022). A history of perinatal asphyxia/hospitalization (P < 0.001) and delayed milestones (P = 0.013) were encountered exclusively in this group, and progression to a low-amplitude record background on electroencephalography, suggesting that cortical damage was identified frequently (P = 0.038, odds ratio = 5.7, 95% confidence interval 1.3 to 25.0). Visual grading revealed significant differences among both cortical (P < 0.001) and subcortical (P < 0.001) regions. On multivariate analysis, the odds for pan-hemispheric disease decreased per year of age at onset (P = 0.022, odds ratio 0.51, 95% confidence interval 0.085 to 0.725). Epilepsy surgery (n = 14) was associated with Engel Class 1 seizure control (P < 0.001). Immunosuppressive therapy (n = 20) did not demonstrate a significant seizure remission (P = 0.157, odds ratio 0.39, 95% confidence interval 0.10 to 1.55).

CONCLUSIONS

Our case series confirms the presence of specific topographical patterns of macroscopic radiological pathology over the affected hemisphere with a marked age-associated reduction in the odds for severe pan-hemispheric disease.

Rasmussen's Epileptogenic Encephalitis in a Tropical Country

Background

Encephalitis of Rasmussen is an inflammatory hemiencephalopathy of unknown etiology. It is a cause of drug-resistant epilepsy.

Aim

To report two cases of Rasmussen's encephalitis (RE) in a low-income setting.

Clinical Observation

The cases concerned were that of an 8-year-old boy and a 4-year-old girl. The illness began with daily several seizures at the age of 28 months in the boy and 23 months for the girl. Epileptic seizures were generalized in the elder one and focal in the younger. The elder presented right hemiplegia with severe cognitive impairment. In the younger child, the expression of the language was disturbed, associated with right hemiparesis at 4/5. The electroencephalography recording showed background theta asymmetric rhythm associated with discharges of periodic lateralized epileptiform discharges (PLEDs) into the left hemisphere in the two cases. Brain imaging showed left hemisphere atrophy. The seizures had decreased in intensity after association of several anticonvulsant molecules over a period of 3-6 months. The diagnosis of RE was based on clinical, paraclinical, therapeutic, and evolution arguments.

Conclusion

There was a delay to establish the diagnosis. Further studies are needed to evaluate rehabilitation capacities in children with RE before brain maturation.

Reflecting on Jens Rasmussen's legacy (2) behind and beyond, a 'constructivist turn'

This article is the second part of a study on the legacy of Jens Rasmussen. The first article, subtitled 'A Strong Program for a Hard Problem', looks back on his 30 years of scientific contribution, from 1969 to 2000. This second article explores and investigates some of the intellectual roots which influenced his thinking, using them as a basis to understand some limits and move forward. Indeed, historically oriented studies such as this one are not only tributes to researchers, but a way to differentiate and contrast our present situation with the past in order to integrate contemporary trends, be they theoretical or empirical, or oriented towards research and new models. In the first section of this article, I offer a synthesis of the background covered in the previous article, but I use a tree here as a graphical complement. Branches of the tree show the many fruitful directions opened by Jens Rasmussen, directions which inspired many researchers. In the second part, I address what I believe to be behind this wealth of engineering legacy: cybernetics. I contend that cybernetics has had a profound influence on his thinking and provided him key principles for his inspiring and successful models. To develop the tree image, one might say that cybernetics is the trunk of the tree. Finally, in the third part, I take the opportunity to explore the relevance of extending and sensitising his program to constructivist discourses. After an introduction to this discourse, identifying four types of constructivisms (cognitive, social, epistemological and anthropological), I characterise this move as a 'constructivist turn'.

Rasmussen's legacy in the great outdoors: A new incident reporting and learning system for led outdoor activities

Jens Rasmussen's seminal risk management framework and accompanying Accimap method have become highly popular in safety science circles. Despite this, widespread adoption of the model and method in practice has not yet been achieved. This paper describes a project involving the development and implementation of an incident reporting and learning system underpinned by Rasmussen's risk management framework and Accimap method. The system was developed for the led outdoor activity sector in Australia to enable reporting and analysis of injuries and near miss incidents, with the aim of supporting the development of more effective countermeasures. An analysis of the data derived from the first 3 months use of the system by 43 organisations is presented. The outputs provide an in-depth Accimap-based analysis of all incidents reported by participating organisations over the 3 month period. In closing, the importance of developing usable domain specific tools to support translation of Ergonomics theory and methods in practice is discussed.

Rasmussen's legacy: A paradigm change in engineering for safety

This paper describes three applications of Rasmussen's idea to systems engineering practice. The first is the application of the abstraction hierarchy to engineering specifications, particularly requirements specification. The second is the use of Rasmussen's ideas in safety modeling and analysis to create a new, more powerful type of accident causation model that extends traditional models to better handle human-operated, software-intensive, sociotechnical systems. Because this new model has a formal, mathematical foundation built on systems theory (as was Rasmussen's original model), new modeling and analysis tools become possible. The third application is to engineering hazard analysis. Engineers have traditionally either omitted human from consideration in system hazard analysis or have treated them rather superficially, for example, that they behave randomly. Applying Rasmussen's model of human error to a powerful new hazard analysis technique allows human behavior to be included in engineering hazard analysis.

Rasmussen's legacy and the long arm of rational choice

Rational choice theory says that operators and others make decisions by systematically and consciously weighing all possible outcomes along all relevant criteria. This paper first traces the long historical arm of rational choice thinking in the West to Judeo-Christian thinking, Calvin and Weber. It then presents a case study that illustrates the consequences of the ethic of rational choice and individual responsibility. It subsequently examines and contextualizes Rasmussen's legacy of pushing back against the long historical arm of rational choice, showing that bad outcomes are not the result of human immoral choice, but the product of normal interactions between people and systems. If we don't understand why people did what they did, Rasmussen suggested, it is not because people behaved inexplicably, but because we took the wrong perspective.