The authors deploy an epistemic framework to represent culture and model the acquisition of cultural behavior. Yet, the framing inherits familiar problems with explaining the acquisition of norms. Such problems are conspicuous with regard to human societies where norms are ubiquitous. This creates a new difficulty for the authors in explaining change to mutually exclusive organizational structures of human life.Urban sub-Saharan Africa is in a nutrition transition shifting towards consumption of energy dense nutrient poor diets and decreasing physical activity. Determinants of nutrition transition in sub-Saharan Africa are presently not well understood. The objective of this review was to synthesize available data on determinants of dietary and physical activity behaviours among women of reproductive age in urban sub-Saharan Africa according to the socio-ecological framework. We searched MEDLINE, EMBASE, Scopus, Web of Science and bibliographies of included articles for qualitative, observational and randomized controlled studies published in English from January 2000 to September 2018. Studies conducted within general population of women aged 18 to 49 years were included. Searches were according to a predefined protocol published on PROSPERO (ID=CRD42018108532). Two reviewers independently screened identified studies. From a total of 9853 unique references, 23 studies were retained, and were mainly from South and West Africa. No rigorous designed quantitative study was identified. Hence, data synthesis was narrative. Notable determinants of dietary behaviour included; convenience, finances, social network, food skills and knowledge gaps, food deserts and culture. Cultural beliefs include strong relationship between high social status and weight gain, energy dense confectionary, salt or fat rich foods. Physical activity is influenced by fast-changing transport environment and cultural beliefs which instigate unfavourable gender stereo types. Selleck Isuzinaxib Studies with rigorous qualitative and quantitative designs are required to validate and develop the proposed frameworks further especially within East Africa. Nevertheless, available insights suggest a need for comprehensive skill-based interventions focusing on socio-cultural misconceptions and financial limitations.In this paper we consider the order of emergence of comprehension of wh-questions and polar-questions. We argue that considerations of complexity and input favour the earlier emergence of polar questions; on the other hand, if one assumes that question understanding emerges as a consequence of interactive learning this favours (certain) wh-questions, as well as a small subclass of polar questions. We offer corpus evidence from the Providence corpus that (a certain class of) wh-questions are in fact understood earlier than the polar-questions. We test this observation using elicitation studies on German and Chinese speaking children. Our results confirm the finding from the corpus study and are in line with an interactive learning perspective for the emergence of understanding of questions.Objective The disease burden of surgical site infection (SSI) following total knee (TKA) replacement is considerable and is expected to grow with increased demand for the procedure. Diagnosing and treating SSI utilizes both inpatient and outpatient services, and the timing of diagnosis can affect health service requirements. The purpose of this study was to estimate the health system costs of infection and to compare them across time-to-diagnosis categories. Methods Administrative data from 2005-2016 were used to identify cases diagnosed with SSI up to 1 year following primary TKA. Uninfected controls were selected matched on age, sex and comorbidities. Costs and utilization were measured over the 2-year period following surgery using hospital and out-of-hospital data. Costs and utilization were compared for those diagnosed within 30, 90, 180, and 365 days. A subsample of cases and controls without comorbidities were also compared. Results We identified 238 SSI cases over the study period. On average, SSI cases cost 8 times more than noninfected controls over the 2-year follow-up period (CaD$41,938 [US$29,965] vs CaD$5,158 [US$3,685]) for a net difference of CaD$36,780 (US$26,279). The case-to-control ratio for costs was lowest for those diagnosed within 30 days compared to those diagnosed later. When only patients without comorbidities were included, costs were >7 times higher. Conclusion Our results suggest that considerable costs result from SSI following TKA and that those costs vary depending on the time of diagnosis. A 2-year follow-up period provided a more complete estimate of cost and utilization.Parent report data on 82 preschool children with complex neurodevelopmental disabilities including Down syndrome, dyspraxia, autism, and global developmental delay suggests communicative language use must reach a threshold level before vocabulary size becomes the best predictor of word combining. Using the Language Use Inventory and the MacArthur-Bates CDI (with sign vocabulary option), statistical modelling using regression trees and random forests suggests that, despite high linear correlations between variables, (1) pragmatic ability, particularly children’s emerging ability to talk about things, themselves and others is a significantly better predictor of the earliest word combining than vocabulary size; and (2) vocabulary size becomes a better predictor of later word combining, once this pragmatic base has been established.Objective Hand hygiene adherence has been associated with reductions in nosocomial infection. We assessed the effect of improvements in electronically measured hand hygiene adherence on the incidence of hospital-acquired infections. Methods This quasi-experimental study was conducted in a 555-bed urban safety-net level I trauma center. The preintervention period was January 2015 through June 2016. Baseline electronic hand hygiene data collection took place from April through June 2016. The intervention period was July 2016 through December 2017. An electronic hand hygiene system was installed in 4 locations in our hospital. Performance improvement strategies were implemented that included education, troubleshooting, data dissemination, and feedback. Adherence rates were tracked over time. Rates of hospital-acquired infections were evaluated in the intervention units and in control units selected for comparison. The intervention period was subdivided into the initial and subsequent 9-month periods and were compared to the baseline period.