Injusticias epistémicas normalizadas y restricción de la agencia de las personas con discapacidad

Las injusticias epistémicas son aquellas formas de trato injusto que se relacionan con la producción, trasmisión o utilización del conocimiento por parte de los sujetos. El encuadre ético-epistémico y socio-epistémico proporcionado por estas injusticias se vincula con temas que atraviesan las principales tradiciones filosóficas como el pragmatismo, la fenomenología y la teoría crítica. Estas injusticias se interrelacionan, además, con movimientos sociales e intelectuales como el feminismo, la teoría crítica de la raza, los estudios críticos de la discapacidad y las epistemologías decolonizadoras. Sin embargo, existe un cuestionamiento a que las personas con discapacidad no han sido suficientemente abordadas. El presente artículo se posiciona en los debates actuales sobre las injusticias epistémicas y la discapacidad, y tiene como propósito aportar el concepto de "injusticias epistémicas normalizadas". Partiendo de la constatación de las formas en que se reconocen opresivamente los sujetos con discapacidad, como alejados de la "norma", establece que existen injusticias epistémicas asociadas con esta identificación. Propone que las injusticias epistémicas normalizadas ocurren en la intersección de dos ámbitos: un sistema hermenéutico capacitista y una agencia epistémica restringida en la que se producen al menos tres tipos de configuraciones: no agencia, agencias epistémicas disminuidas y agencias epistémicas en resistencia. Pensar las injusticias epistémicas considerando el peso de la "normalidad" en la constitución como sujetos de las personas con discapacidad permite reconocer una situación crítica de exclusión epistémica para algunas personas, mientras que otras resisten y luchan por ser comprendidas en los recursos hermenéuticos colectivos.

Epistemic injustices refer to those forms of unfair treatment that are related to the production, transmission, or use of knowledge by the subjects. The ethical-epistemic and socio-epistemic framework provided by these injustices is linked to themes that cross the main philosophical traditions such as pragmatism, phenomenology, and critical theory. These injustices are further intertwined with social and intellectual movements such as feminism, critical race theory, critical disability studies, and decolonizing epistemologies. However, there is a question that people with disabilities have not been sufficiently addressed. This article is positioned in the current debates on epistemic injustices and disability, and its purpose is to contribute the concept of "normalized epistemic injustices". Starting from the verification of the ways in which subjects with disabilities are oppressively recognized, as far from the "norm", it establishes that there are epistemic injustices associated with this identification. It proposes that normalized epistemic injustices occur at the intersection of two realms: a capacitist hermeneutic system and a constrained epistemic agency where at least three types of configurations are produced: non-agency; diminished epistemic agencies and epistemic agencies in resistance. Thinking about epistemic injustices considering the weight of "normality" in the constitution as subjects of people with disabilities allows us to recognize a critical situation of epistemic exclusion for some people, while others resist and fight to be understood in collective hermeneutical resources.

As injustiças epistêmicas referem-se àquelas formas de tratamento injusto que estão relacionadas à produção, transmissão ou uso do conhecimento pelos sujeitos. O enquadramento ético-epistêmico e socioepistêmico proporcionado por essas injustiças está vinculado a temas que atravessam as principais tradições filosóficas como o pragmatismo, a fenomenologia e a teoria crítica. Essas injustiças estão ainda mais entrelaçadas com movimentos sociais e intelectuais como o feminismo, a teoria crítica da raça, os estudos críticos da deficiência e as epistemologias descolonizadoras. No entanto, há uma questão de que as pessoas com deficiência não foram suficientemente abordadas. Este artigo se posiciona nos debates atuais sobre injustiças epistêmicas e deficiência, e seu objetivo é contribuir com o conceito de "injustiças epistêmicas normalizadas". A partir da verificação das formas como os sujeitos com deficiência são opressivamente reconhecidos, como distantes da "norma", constata-se que existem injustiças epistêmicas associadas a essa identificação. Propõe que injustiças epistêmicas normalizadas ocorrem na interseção de dois domínios: um sistema hermenêutico capacitista e uma agência epistêmica restrita onde pelo menos três tipos de configurações são produzidas: não-agência; agências epistêmicas diminuídas e agências epistêmicas em resistência. Pensar as injustiças epistêmicas considerando o peso da "normalidade" na constituição como sujeitos das pessoas com deficiência permite reconhecer uma situação crítica de exclusão epistêmica para algumas pessoas, enquanto outras resistem e lutam para serem compreendidas em recursos hermenêuticos coletivos.

Adolescent OCD Patient and Caregiver Perspectives on Identity, Authenticity, and Normalcy in Potential Deep Brain Stimulation Treatment.

The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients' views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and "normalcy" in the context of OCD.

Normalcy in Post-operative Period After Bilateral IJV Ligation: A Rare Case Report.

Ligation of bilateral IJV causes interruption of major part of venous drainage from Dural venous sinuses that causes complications such as gross facial edema, increased intracranial pressure, brain compression, coma and even death increasing the morbidity and mortality post-operatively. This case report illustrates a case of normalcy noted in post-operative period in a patient after ligation of bilateral IJV in left lower alveolus cancer.

Biological normalcy and body fat: Obesity prevalence, fat stigma, and allostatic load among late adolescents and young adults.

OBJECTIVES: Biological normalcy provides a framework to assess tensions between clinical definitions of "normal," statistical norms, and normative beliefs. A prevailing cultural belief is obesity directly causes poor health, but research has demonstrated consequences of fat stigma. Previous research linked fat stigma and allostatic load (AL) in adults, but this has not been demonstrated in youth, and the role of obesity prevalence is unknown. This study assesses the relationship between fat stigma and AL among youth from counties varying by obesity prevalence. MATERIALS AND METHODS: Undergraduates from 38 counties across the US state of Indiana (n = 175) were recruited. Fat stigma was measured using the brief stigmatizing situations inventory (SSI). AL was calculated using eight biomarkers representing cardiovascular, metabolic, and immune function. Poisson regression assessed relationships of interest and adjusted for potential confounding. An interaction term and stratified analyses were used to assess moderation. RESULTS: SSI was not statistically associated with obesity prevalence (RR = 0.96, p = 0.173) but did statistically significantly predict AL (RR = 1.019, p = 0.045) when adjusting for confounders. Obesity prevalence moderated the relationship between SSI and AL (RR = 0.993, p = 0.001). DISCUSSION: Results suggest that fat stigma, regardless of body fat percentage, is associated with physiologic wear and tear on the late adolescent body, and that exposure to obesity during earlier adolescence moderates this relationship. Those most at risk for high AL reported high fat stigma and lived in counties with relatively low obesity prevalence during earlier adolescence, suggesting vulnerability to fat stigma may be heightened where obesity is less common.

"The simple life experiences that every other human gets": Desire for normalcy among adolescents and young adults with advanced cancer.

BACKGROUND: Adolescents and young adults (AYAs) with advanced cancer identify normalcy as an important component of quality end-of-life care. We sought to define domains of normalcy and identify ways in which clinicians facilitate or hinder normalcy during advanced cancer care. PROCEDURE: This was a secondary analysis of a qualitative study that aimed to identify priority domains for end-of-life care. Content analysis of semi-structured interviews among AYAs aged 12-39 years with advanced cancer, caregivers, and clinicians was used to evaluate transcripts. Coded excerpts were reviewed to identify themes related to normalcy. RESULTS: Participants included 23 AYAs with advanced cancer, 28 caregivers, and 29 clinicians. Participants identified five domains of normalcy including relationships, activities, career/school, milestones, and appearance. AYAs and caregivers identified that clinicians facilitate normalcy through exploration of these domains with AYAs, allowing flexibility in care plans, identification of short-term and long-term goals across normalcy domains, and recognizing losses of normalcy that occur during cancer care. CONCLUSIONS: AYAs with cancer experience multiple threats to normalcy during advanced cancer care. Clinicians can attend to normalcy and improve AYA quality of life by acknowledging these losses through ongoing discussions on how best to support domains of normalcy and by reinforcing AYA identities beyond a cancer diagnosis.

A Spatiotemporal Solution to Control COVID-19 Transmission at the Community Scale for Returning to Normalcy: COVID-19 Symptom Onset Risk Spatiotemporal Analysis.

BACKGROUND: Following the recent COVID-19 pandemic, returning to normalcy has become the primary goal of global cities. The key for returning to normalcy is to avoid affecting social and economic activities while supporting precise epidemic control. Estimation models for the spatiotemporal spread of the epidemic at the refined scale of cities that support precise epidemic control are limited. For most of 2021, Hong Kong has remained at the top of the "global normalcy index" because of its effective responses. The urban-community-scale spatiotemporal onset risk prediction model of COVID-19 symptom has been used to assist in the precise epidemic control of Hong Kong. OBJECTIVE: Based on the spatiotemporal prediction models of COVID-19 symptom onset risk, the aim of this study was to develop a spatiotemporal solution to assist in precise prevention and control for returning to normalcy. METHODS: Over the years 2020 and 2021, a spatiotemporal solution was proposed and applied to support the epidemic control in Hong Kong. An enhanced urban-community-scale geographic model was proposed to predict the risk of COVID-19 symptom onset by quantifying the impact of the transmission of SARS-CoV-2 variants, vaccination, and the imported case risk. The generated prediction results could be then applied to establish the onset risk predictions over the following days, the identification of high-onset-risk communities, the effectiveness analysis of response measures implemented, and the effectiveness simulation of upcoming response measures. The applications could be integrated into a web-based platform to assist the antiepidemic work. RESULTS: Daily predicted onset risk in 291 tertiary planning units (TPUs) of Hong Kong from January 18, 2020, to April 22, 2021, was obtained from the enhanced prediction model. The prediction accuracy in the following 7 days was over 80%. The prediction results were used to effectively assist the epidemic control of Hong Kong in the following application examples: identified communities within high-onset-risk always only accounted for 2%-25% in multiple epidemiological scenarios; effective COVID-19 response measures, such as prohibiting public gatherings of more than 4 people were found to reduce the onset risk by 16%-46%; through the effect simulation of the new compulsory testing measure, the onset risk was found to be reduced by more than 80% in 42 (14.43%) TPUs and by more than 60% in 96 (32.99%) TPUs. CONCLUSIONS: In summary, this solution can support sustainable and targeted pandemic responses for returning to normalcy. Faced with the situation that may coexist with SARS-CoV-2, this study can not only assist global cities in responding to the future epidemics effectively but also help to restore social and economic activities and people's normal lives.

A smart school routing and scheduling problem for the new normalcy.

One of the critical actions that emerged during the onset of the New Normalcy after COVID-19 lockdowns, is the safe return to schools and workplaces. Therefore, dedicated transportation services need to adapt to meet new requirements such as arrival reliability for multiple bell times, the consequent staggering of arrivals and departures, and the decrease in bus capacity due to the physical distancing required by regulators. In this work, we address these issues plus additional labor conditions concerning drivers for a university context; with the goal of optimizing social interests such as covering demand and travel time under limited resources. We propose a bi-level approach, where firstly a bus routing generation sub-problem is solved before a bus scheduling sub-problem. This (strategic) solution is then considered as the baseline for subsequent dynamic (operational) routing. The latter is based on real-time demand provided by the students via a mobile app and considers stop-skipping to further minimize travel time. This integrated transport solution was tested in a university case, showing that with the same resources, it can meet these new requirements. In addition, numerical experimentation was also carried out with benchmark instances to identify, among available and literature-recommended solution algorithms and an effective tailored Tabu Search implementation, those that perform best for this type of problems.

A Case of Takotsubo Cardiomyopathy Diagnosed After Postponement of Surgery Due to Hypotension and Electrocardiogram Abnormality Upon Entering the Operating Room.

Takotsubo cardiomyopathy (TCM) is a rare disease that is difficult to diagnose. We experienced a case that developed just before surgery. A woman in her 80s with no complications except hypertension was scheduled for colon cancer surgery. Although she was asymptomatic, after entering the operating room, her surgery was canceled due to unexplained hypotension and ST-segment elevation on the electrocardiogram monitor. Emergency coronary angiography was performed immediately, and the presence of TCM was revealed. Her surgery was therefore performed after the improvement in her cardiac function. Once a patient is in the operating room, the normalcy bias kicks in and it becomes difficult to decide to stop the surgery. However, even at this time, it is important to stop the induction of anesthesia if there is any abnormality and to make a differential diagnosis based on the possible development of a serious disease, as seen in this case.

Everyday life in the face of conflict: Sumud as a spatial quotidian practice in Palestine.

By drawing from the engagement with the empirical case of sumud (Arabic: steadfastness) in Palestine, this article focuses on the social and political implications of everyday life in conflict settings. Proposing an alternative perspective on conflicts, this article argues that it is important also to focus on normalcy of everyday life in conflict settings and how this transforms conflict dynamics. Hence, contrary to the assumption that there is an opposition between the normalcy of everyday life and violent conflicts, this article argues that everyday life is not disrupted but that it goes on also in the face of conflicts, it only has to adapt to it. Building on Stephen Lubkemann's concept of 'culturally scripted life projects', this article will show how the attempt to pursue a regular life unfolds in an everyday setting in order to escape the predominant conflict/resistance frame. In addition to sumud as an individual practice this article highlights the broader social and political role this concept assumes in the context of Palestinian nationalism. In order to illustrate this argument, this article presents sumud as a spatial quotidian practice which is primarily aimed at realising culturally scripted life project in the face of the Israeli occupation.

The New Normalcy in Dentistry after the COVID-19 Pandemic: An Italian Cross-Sectional Survey.

BACKGROUND: After the first lockdown, Italian dentists resumed their practice while handling several challenges. Reducing contagion risk by complying with the stringent measures recommended by the Italian Ministry of Health for dental activity while also balancing patient needs was a difficult task. This work aims to understand the procedures that were adopted in the second phase of the COVID-19 pandemic (5 May-30 September 2020) and the dentists' expectations and concerns about returning to normalcy. METHODS: A national survey with 38 questions was conducted from November 2020 to January 2021 and comparisons were performed among the five main Italian geographic areas. RESULTS: Located mainly in northwest Italy, 1028 dentists were included in the survey. About 83% of the Italian dentists fully restarted their activities after the lockdown. The resumption was significantly marked in North Italy and the Center than in the South (p < 0.01). Over 80% adopted the recommended precautional guidelines, modifying them according to the specific dental treatment executed. Fifty percent of dentists were confident in returning to normalcy after the COVID-19 crisis. Many precautions adopted during the pandemic will be continued, especially in South Italy and the Islands (p < 0.01). CONCLUSIONS: Italian dentists reported excellent autonomous organizational skills and the maintaining of high-quality precautions during the reopening phase.

How Are Consensual, Non-Consensual, and Pressured Sexting Linked to Depression and Self-Harm? The Moderating Effects of Demographic Variables.

Sexting among adolescents has triggered controversial debates among scholars and the general public. However, questions regarding the associations between different types of sexting, namely consensual, non-consensual, and pressured sexting, depressive symptoms, and non-suicidal self-harm remain. In addition, little attention has been given to whether demographic variables (i.e., gender, ethnicity, disability, sexual minority) might influence these associations. To fill these gaps in the literature, the present study was conducted. Participants were 2506 adolescents (ages 13-16 years old; Mage = 15.17; SDage = 0.89) from eight high schools located in the suburbs of a large Midwestern city in the United States. Adolescents self-identified as female (50%), Caucasian (57%), approximately 15% reported that they had a disability they received school accommodation for, and 18% self-identified as a sexual minority. They completed self-report questionnaires on their sexting behaviors, depressive symptoms, and non-suicidal self-harm. Findings revealed that non-consensual and pressured sexting were positively related to depressive symptoms and non-suicidal self-harm, whereas consensual sexting was unrelated to these outcomes. Boys engaged in more non-consensual sexting compared with girls, girls were more pressured to send sexts compared with boys, and sexual minority adolescents reported greater consensual sexting compared with non-sexual minority adolescents. Moderating effects revealed that girls, non-minority adolescents, and non-sexual minority adolescents experienced greater depressive symptoms and non-suicidal self-harm when they experienced pressured sexting. These findings underscore the importance of considering various types of sexting and adolescents' demographic variables when examining the negative outcomes of sexting. Disentangling the relationships among different types of sexting, depressive symptoms, and self-harm aids in the development of evidence-based recommendations for sexting harm prevention and sexual education programs.

Two-Dimensional Aortic Size Normalcy: A Novelty Detection Approach.

Background: To develop a tool for assessing normalcy of the thoracic aorta (TA) by echocardiography, based on either a linear regression model (Z-score), or a machine learning technique, namely one-class support vector machine (OC-SVM) (Q-score). Methods: TA diameters were measured in 1112 prospectively enrolled healthy subjects, aging 5 to 89 years. Considering sex, age and body surface area we developed two calculators based on the traditional Z-score and the novel Q-score. The calculators were compared in 198 adults with TA > 40 mm, and in 466 patients affected by either Marfan syndrome or bicuspid aortic valve (BAV). Results: Q-score attained a better Area Under the Curve (0.989; 95% CI 0.984-0.993, sensitivity = 97.5%, specificity = 95.4%) than Z-score (0.955; 95% CI 0.942-0.967, sensitivity = 81.3%, specificity = 93.3%; p < 0.0001) in patients with TA > 40 mm. The prevalence of TA dilatation in Marfan and BAV patients was higher as Z-score > 2 than as Q-score < 4% (73.4% vs. 50.09%, p < 0.00001). Conclusions: Q-score is a novel tool for assessing TA normalcy based on a model requiring less assumptions about the distribution of the relevant variables. Notably, diameters do not need to depend linearly on anthropometric measurements. Additionally, Q-score can capture the joint distribution of these variables with all four diameters simultaneously, thus accounting for the overall aortic shape. This approach results in a lower rate of predicted TA abnormalcy in patients at risk of TA aneurysm. Further prognostic studies will be necessary for assessing the relative effectiveness of Q-score versus Z-score.

Full recovery of elective orthopedic surgery in the age of COVID-19: an 8-month retrospective cohort study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to dramatic disruptions to orthopedic services. The purpose of this study is to quantify the reinstatement of elective orthopedic surgeries of our institution in Shanghai, China, and share our first-hand experiences of how this region is managing the post-outbreak period. METHODS: The number of patients receiving elective orthopedic surgeries was analyzed in the timeframe of 8 months since the start of the pandemic (from January 20 to September 16) and compared with the patients receiving the same treatment during the same period in 2019. And a detailed workflow for handling patients about to receive elective surgeries in the COVID-19 post-outbreak period was described. RESULTS: The number of the selective surgeries in the first 3 months only accounted for 31.72% of the same period in 2019 (p = 0.0031), and the ratio reached 97.47% when it came to the last 5 months (p > 0.9999). The selective surgeries even surpassed the pre-epidemic level in months 7 and 8. And the difference of the surgeries was not significant in the whole eight observed months between 2019 and 2020 (p = 0.1526). No health care providers or hospitalized patients in orthopedic departments in Shanghai have been infected nosocomially. CONCLUSIONS: Elective orthopedic surgeries have been fully recovered from the COVID-19 pandemic in our institution, and the new normalcy established during the post-outbreak period helped this region co-exist with the impact of the virus well. TRIAL REGISTRATION: Retrospectively registered, registration number: ChiCTR2000039711 , date of registration: November 6, 2020.

'La Vida Normal': Young people adapting to Type 1 diabetes in Bolivia.

OBJECTIVES: To identify challenges and coping strategies of young people with Type 1 diabetes (T1D) and their families in Bolivia through qualitative analysis of interviews with beneficiaries of Centro Vivir con Diabetes (CVCD), a diabetes health center supported by the International Diabetes Federation Life for a Child (LFAC) program. METHODS: Eighteen young people aged 14-33 and at least one caregiver participated in semi-structured interviews in five cities in Bolivia from May to June 2016. Interviews were recorded, transcribed, and analyzed using inductive thematic analysis. RESULTS: Participants described needing guidance at diagnosis and facing stigma in communities. Young people expressed that life with T1D was 'la vida normal' (a normal life), although interpretations of normalcy varied. For some, 'la vida normal' meant resistance to T1D; for others it indicated acceptance. DISCUSSION: Access to interdependent spheres of support allowed young people to form a new normal around T1D. Receiving supplies through the CVCD/LFAC partnership maintained family connection to clinical care, CVCD education helped families share in T1D management, and peer support mitigated stigma for young people. Programs like CVCD that combine supply-based aid with clinical education for whole families, create effective support for young people with T1D in low- and middle-income countries.

The Perfect Postnormal Storm: COVID-19 Chronicles (2020 Edition).

This essay addresses the COVID-19 pandemic as a case study in postnormal times phenomena: a perfect postnormal storm. The essay introduces basic concepts of postnormal analysis and provides examples of the acceleration of speed, scope, scale, and simultaneity of change in a number of human and natural systems and gives examples of the accelerating complexity, chaos, and contradictions that characterize phenomenon and systems as they become more postnormal. The related concepts of the layers of ignorance and uncertainty are explored related to the movement of phenomenon toward postnormal states. The importance of the idea of manufactured normalcy fields and resistance to or accommodation of postnormal burst, such as lag and tilt, can help to better understand the postnormal landscape. For example, the pros and cons of returning to "normal" raise fundamental questions about the logic and wisdom of the dominant growth and economic paradigm.

From "business continuity" to "back to business" for orthopaedic surgeons during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges to healthcare systems worldwide. Orthopaedic departments have adopted business continuity models and guidelines for essential and non-essential surgeries to preserve hospital resources as well as protect patients and staff. These guidelines broadly encompass reduction of ambulatory care with a move towards telemedicine, redeployment of orthopaedic surgeons/residents to the frontline battle against COVID-19, continuation of education and research through web-based means, and cancellation of non-essential elective procedures. However, if containment of COVID-19 community spread is achieved, resumption of elective orthopaedic procedures and transition plans to return to normalcy must be considered for orthopaedic departments. The COVID-19 pandemic also presents a moral dilemma to the orthopaedic surgeon considering elective procedures. What is the best treatment for our patients and how does the fear of COVID-19 influence the risk-benefit discussion during a pandemic? Surgeons must deliberate the fine balance between elective surgery for a patient's wellbeing versus risks to the operating team and utilization of precious hospital resources. Attrition of healthcare workers or Orthopaedic surgeons from restarting elective procedures prematurely or in an unsafe manner may render us ill-equipped to handle the second wave of infections. This highlights the need to develop effective screening protocols or preoperative COVID-19 testing before elective procedures in high-risk, elderly individuals with comorbidities. Alternatively, high-risk individuals should be postponed until the risk of nosocomial COVID-19 infection is minimal. In addition, given the higher mortality and perioperative morbidity of patients with COVID-19 undergoing surgery, the decision to operate must be carefully deliberated. As we ramp-up elective services and get "back to business" as orthopaedic surgeons, we have to be constantly mindful to proceed in a cautious and calibrated fashion, delivering the best care, while maintaining utmost vigilance to prevent the resurgence of COVID-19 during this critical transition period. Cite this article: Bone Joint Open 2020;1-6:222-228.

Synergies between the Developmental Origins of Health and Disease framework and multiple branches of evolutionary anthropology.

The Developmental Origins of Health and Disease (DOHaD) hypothesis derives from the epidemiological and basic/mechanistic health sciences. This well-supported hypothesis holds that environment during the earliest stages of life-pre-conception, pregnancy, infancy-shapes developmental trajectories and ultimately health outcomes across the lifespan. Evolutionary anthropologists from multiple subdisciplines are embracing synergies between the DOHaD framework and developmentalist approaches from evolutionary biology. Even wider dissemination and employment of DOHaD concepts will benefit evolutionary anthropological research. Insights from experimental DOHaD work will focus anthropologists' attention on biochemical/physiological mechanisms underpinning observed links between growth/health/behavioral outcomes and environmental contexts. Furthermore, the communication tools and wide public appeal of developmentalist health scientific research may facilitate the translation/application of evolutionary anthropological findings. Evolutionary Anthropology, in turn, can increase mainstream DOHaD research's use of evolutionary theory; holistic, longitudinal, and community-based perspectives; and engagement with populations whose environmental exposures differ from those most commonly studied in the health sciences.

A Phenomenological Exploration of the Personal Implications of Female Adolescents Living With Chronic Pain.

INTRODUCTION: Chronic pain (CP) negatively impacts everyday previously taken-for-granted activities resulting in considerable psychosocial stress for the individual. Qualitative research in pediatric CP is limited despite the considerable influence CP has on the process of establishing one's personal identity during these formative years and invites the opportunity to understand how CP affects these young individuals from their perspective. The objective of the study was to inquire into the experiences of female adolescents living with CP in order to enhance our understanding of how CP affects their personal lives. METHOD: We used an interpretive phenomenological approach; two researchers interviewed eight female patients of the Montreal Children's Hospital Chronic Pain Management Clinic (aged 14-17 years) for one session each. RESULTS: Self-reported factors that improved these female adolescents' personal life included having engaging hobbies, accepting the incurability of CP, and envisioning a fulfilling future. DISCUSSION: The findings from this study suggest a need to orient CP-related services around goals and interests that female adolescents living with CP set for themselves in order to improve their perceived quality of life.

Use of the normalcy index for the assessment of abnormal gait in the anterior cruciate ligament deficiency combined with meniscus injury.

The normalcy index (NI) has been implemented by several studies as a simple index for quantitatively analyzing diffident gait abnormalities, such as children with cerebral palsy and idiopathic toe-walkers. However, whether the NI can be used in anterior cruciate ligament (ACL) deficiency with different types of meniscus injuries or not, has not been reported yet. In this study, 25 patients who combined different types of ACL and meniscus injuries were evaluated by the NI analysis. 12 healthy subjects were used to define the normal range of NI. The result showed that NI values of patients were significantly larger than the control group (P < 0.05). Meanwhile, the tendency of increasing NI values associated with increasing pathology were significant with only 5 subjects in the smallest group (Jonkheere-Terpsta test: P < 0.001). These results indicated that the NI was a concise yet effective tool to evaluate combined ACL and meniscus injury patients. Increasing severity degree of meniscus tears in ACL rupture patients is corresponded to increasing NI values. It also demonstrates that the proposed NI can be applied as a robustness factor to detect the discrepancy between healthy and patient subjects clinically, and has the potential in the quantitative evaluation of pre- or post-surgery and rehabilitation.