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Epistolary novel

An epistolary novel is a novel written as a series of letters between the fictional characters of a narrative. The term is often extended to cover novels that intersperse documents of other kinds with the letters, most commonly diary entries and newspaper clippings, and sometimes considered to include novels composed of documents even if they do not include letters at all. More recently, epistolaries may include electronic documents such as recordings and radio, blog posts, and e-mails. The word epistolary is derived from Latin from the Greek word epistolē, meaning a letter. This type of fiction is also sometimes known by the German term Briefroman or more generally as epistolary fiction.

The epistolary form can be seen as adding greater realism to a story, due to the text existing diegetically within the lives of the characters. It is in particular able to demonstrate differing points of view without recourse to the device of an omniscient narrator. An important strategic device in the epistolary novel for creating the impression of authenticity of the letters is the fictional editor.

Early works

There are two theories on the genesis of the epistolary novel: The first claims that the genre is originated from novels with inserted letters, in which the portion containing the third-person narrative in between the letters was gradually reduced. The other theory claims that the epistolary novel arose from miscellanies of letters and poetry: some of the letters were tied together into a (mostly amorous) plot. There is evidence to support both claims. The first truly epistolary novel, the Spanish "Prison of Love" (Cárcel de amor) (c. 1485) by Diego de San Pedro, belongs to a tradition of novels in which a large number of inserted letters already dominated the narrative. Other well-known examples of early epistolary novels are closely related to the tradition of letter-books and miscellanies of letters. Within the successive editions of Edmé Boursault's Letters of Respect, Gratitude and Love (Lettres de respect, d'obligation et d'amour) (1669), a group of letters written to a girl named Babet were expanded and became more and more distinct from the other letters, until it formed a small epistolary novel entitled Letters to Babet (Lettres à Babet). The immensely famous Letters of a Portuguese Nun (Lettres portugaises) (1669) generally attributed to Gabriel-Joseph de La Vergne, comte de Guilleragues, though a small minority still regard Marianna Alcoforado as the author, is claimed to be intended to be part of a miscellany of Guilleragues prose and poetry. The founder of the epistolary novel in English is said by many to be James Howell (1594–1666) with "Familiar Letters" (1645–50), who writes of prison, foreign adventure, and the love of women.

Perhaps first work to fully utilize the potential of an epistolary novel was Love-Letters Between a Nobleman and His Sister. This work was published anonymously in three volumes (1684, 1685, and 1687), and has been attributed to Aphra Behn though its authorship remains disputed in the 21st century. The novel shows the genre's results of changing perspectives: individual points were presented by the individual characters, and the central voice of the author and moral evaluation disappeared (at least in the first volume; further volumes introduced a narrator). The author furthermore explored a realm of intrigue with complex scenarios such as letters that fall into the wrong hands, faked letters, or letters withheld by protagonists.

The epistolary novel as a genre became popular in the 18th century in the works of such authors as Samuel Richardson, with his immensely successful novels Pamela (1740) and Clarissa (1749). John Cleland's early erotic novel Fanny Hill (1748) is written as a series of letters from the titular character to an unnamed recipient. In France, there was Lettres persanes (1721) by Montesquieu, followed by Julie, ou la nouvelle Héloïse (1761) by Jean-Jacques Rousseau, and Choderlos de Laclos' Les Liaisons dangereuses (1782), which used the epistolary form to great dramatic effect, because the sequence of events was not always related directly or explicitly. In Germany, there was Johann Wolfgang von Goethe's The Sorrows of Young Werther (Die Leiden des jungen Werther) (1774) and Friedrich Hölderlin's Hyperion. The first Canadian novel, The History of Emily Montague (1769) by Frances Brooke, and twenty years later the first American novel, The Power of Sympathy (1789) by William Hill Brown, were both written in epistolary form.

Starting in the 18th century, the epistolary form was subject to much ridicule, resulting in a number of savage burlesques. The most notable example of these was Henry Fielding's Shamela (1741), written as a parody of Pamela. In it, the female narrator can be found wielding a pen and scribbling her diary entries under the most dramatic and unlikely of circumstances. Oliver Goldsmith used the form to satirical effect in The Citizen of the World, subtitled "Letters from a Chinese Philosopher Residing in London to his Friends in the East" (1760–61). So did the diarist Fanny Burney in a successful comic first novel, Evelina (1788).

The epistolary novel slowly became less popular after 18th century. Although Jane Austen tried the epistolary in juvenile writings and her novella Lady Susan (1794), she abandoned this structure for her later work. It is thought that her lost novel First Impressions, which was redrafted to become Pride and Prejudice, may have been epistolary: Pride and Prejudice contains an unusual number of letters quoted in full and some play a critical role in the plot.

The epistolary form nonetheless saw continued use, surviving in exceptions or in fragments in nineteenth-century novels. In Honoré de Balzac's novel Letters of Two Brides, two women who became friends during their education at a convent correspond over a 17-year period, exchanging letters describing their lives. Mary Shelley employs the epistolary form in her novel Frankenstein (1818). Shelley uses the letters as one of a variety of framing devices, as the story is presented through the letters of a sea captain and scientific explorer attempting to reach the north pole who encounters Victor Frankenstein and records the dying man's narrative and confessions. Published in 1848, Anne Brontë's novel The Tenant of Wildfell Hall is framed as a retrospective letter from one of the main heroes to his friend and brother-in-law with the diary of the eponymous tenant inside it. In the late 19th century, Bram Stoker released one of the most widely recognized and successful novels in the epistolary form to date, Dracula. Printed in 1897, the novel is compiled entirely of letters, diary entries, newspaper clippings, telegrams, doctor's notes, ship's logs, and the like.

Types
Epistolary novels can be categorized based on the number of people whose letters are included. This gives three types of epistolary novels: monophonic (giving the letters of only one character, like Letters of a Portuguese Nun and The Sorrows of Young Werther), dialogic (giving the letters of two characters, like Mme Marie Jeanne Riccoboni's Letters of Fanni Butler (1757), and polyphonic (with three or more letter-writing characters, such as in Bram Stoker's Dracula).

A crucial element in polyphonic epistolary novels like Clarissa and Dangerous Liaisons is the dramatic device of 'discrepant awareness': the simultaneous but separate correspondences of the heroines and the villains creating dramatic tension. They can also be classified according to their type and quantity of use of non-letter documents, though this has obvious correlations with the number of voices – for example, newspaper clippings are unlikely to feature heavily in a monophonic epistolary and considerably more likely in a polyphonic one.

Notable works

The epistolary novel form has continued to be used after the eighteenth century.

Eighteenth century

 * Lettres persanes, a 1721 novel by Montesquieu.
 * Pamela; or, Virtue Rewarded, by Samuel Richardson 1740, a bestselling early epistolary novel which prompted artistic interest in the epistolary form.
 * Julie; or, The New Heloise, an epistolary novel by Jean-Jacques Rousseau, published in 1761.
 * The Sorrows of Young Werther is a 1774 novel by Johann Wolfgang Goethe.
 * Les Liaisons dangereuses is a 1782 French novel by Pierre Choderlos de Laclos, about the Marquise de Merteuil and the Vicomte de Valmont, two narcissistic rivals (and ex-lovers) who use seduction as a weapon to socially control and exploit others, all the while enjoying their cruel games and boasting about their talent for manipulation (also seen as depicting the corruption and depravity of the French nobility shortly before the French Revolution). The book is composed entirely of letters written by the various characters to each other.
 * Cartas marruecas (Moroccan Letters), a 1789 novel by José Cadalso, Spanish author, poet, playwright and essayist.
 * Marquis de Sade's Aline and Valcour (1795).

Nineteenth century

 * Fyodor Dostoevsky used the epistolary format for his first novel, Poor Folk (1846), as a series of letters between two friends, struggling to cope with their impoverished circumstances and life in Imperial-era Russia.
 * The Moonstone (1868) by Wilkie Collins uses a collection of various documents to construct a detective novel in English. In the second piece, a character explains that he is writing his portion because another had observed to him that the events surrounding the disappearance of the eponymous diamond might reflect poorly on the family, if misunderstood, and therefore he was collecting the true story. This is an unusual element, as most epistolary novels present the documents without questions about how they were gathered. He also used the form previously in The Woman in White (1859).
 * Spanish foreign minister Juan Valera's Pepita Jiménez (1874) is written in three sections, the first and third being a series of letters, the middle part narrated by an unknown observer.
 * Bram Stoker's Dracula (1897) uses not only letters and diaries, but also dictation cylinders and newspaper accounts.

Twentieth century

 * Dorothy L. Sayers and Robert Eustace's The Documents in the Case (1930).
 * E.M. Delafield's Diary of a Provincial Lady (1930).
 * Kathrine Taylor's Address Unknown (1938) is an anti-Nazi novel in which the final letter is returned marked "Address Unknown", indicating the disappearance of the German character.
 * C. S. Lewis used the epistolary form for The Screwtape Letters (1942), and considered writing a companion novel from an angel's point of view – though he never did so. It is less generally realized that his Letters to Malcolm: Chiefly on Prayer (1964) is a similar exercise, exploring theological questions through correspondence addressed to a fictional recipient, "Malcolm", though this work may be considered a "novel" only loosely in that developments in Malcolm's personal life gradually come to light and impact the discussion.
 * Thornton Wilder's fifth novel Ides of March (1948) consists of letters and documents illuminating the last days of the Roman Republic.
 * Saul Bellow's novel Herzog (1964) is largely written in letter format. These are both real and imagined letters, written by the protagonist Moses Herzog to family members, friends, and celebrities.
 * Shūsaku Endō's novel Silence (1966) is an example of the epistolary form, half of which consists of letters from Rodrigues, the other half either in the third person or in letters from other persons.
 * Daniel Keyes's short story and novel Flowers for Algernon (1959, 1966) takes the form of a series of lab progress reports written by the main character as his treatment progresses, with his writing style changing correspondingly.
 * The Anderson Tapes (1969, 1970) by Lawrence Sanders is a novel primarily consisting of transcripts of tape recordings.
 * Stephen King's novel Carrie (1974) is written in an epistolary structure through newspaper clippings, magazine articles, letters, and book excerpts.
 * Margaret Atwood's The Handmaid's Tale, 1985, ends with an epilogue consisting of the minutes from the meeting of a historical society in the future discussing the text of the novel, revealed to have been recently transcribed from a series of cassette tape recordings made by the protagonist Offred.

 * Alice Walker employed the epistolary form in The Color Purple (1982). The 1985 film adaptation echoes the form by incorporating into the script some of the novel's letters, which the actors deliver as monologues.
 * John Updike's S. (1988) is an epistolary novel consisting of the heroine's letters and transcribed audio recordings.
 * Patricia Wrede and Caroline Stevermer's Sorcery and Cecelia (1988) is an epistolary fantasy novel in a Regency setting from the first-person perspectives of cousins Kate and Cecelia, who recount their adventures in magic and polite society. Unusually for modern fiction, it is written using the style of the letter game.
 * Avi's young-adult novel Nothing but the Truth (1991) uses only documents, letters, and conversation transcripts.
 * Last Words from Montmartre (1995) by Qiu Miaojin is a novel written in the form of twenty letters that can be read in any order.
 * Last Days of Summer (1998) by Steve Kluger is written in a series of letters, telegrams, therapy transcripts, newspaper clippings, and baseball box scores.
 * The Perks of Being a Wallflower (1999) was written by Stephen Chbosky in the form of letters from an anonymous character to a secret role model of sorts.
 * House of Leaves by Mark Z. Danielewski (2000) is written as a series of found footage film transcripts, essays, fictitious footnotes, and letters spread over several layers of metafiction.

Twenty-first century

 * Between Friends by Debbie Macomber (2001) tells the story of a lifelong friendship between Jillian Lawton and Lesley Adamski from the 1950s to the early 2000s, using a combination of letters (later becoming emails) and daily paraphernalia like a gas station receipt.
 * Mark Dunn's Ella Minnow Pea (2001) is a progressively lipogrammatic epistolary novel – the letters become increasingly more difficult to read as the lipogrammatic constraints are brought in, and this requires the reader to attempt to interpret what is being written.
 * La silla del águila ("The Eagle's Throne") by Carlos Fuentes (2003) is a political satire written as a series of letters between persons in high levels of the Mexican government in 2020. The epistolary format is treated by the author as a consequence of necessity: the United States impedes all telecommunications in Mexico as a retaliatory measure, leaving letters and smoke signals as the only possible methods of communication, particularly ironic given one character's observation that "Mexican politicians put nothing in writing."
 * We Need to Talk About Kevin by Lionel Shriver (2003) is a monologic epistolary novel written as a series of letters from Eva, Kevin's mother, to her husband Franklin.
 * The Sluts (2004) by Dennis Cooper is composed of online posts, reviews and email correspondence. Each contributes to a central mystery, fuelled by competing narratives about an escort.
 * The 2004 novel Cloud Atlas by David Mitchell tells a story in several time periods in a nested format, with some sections told in epistolary style, including an interview, journal entries and a series of letters.
 * March (2005), by Geraldine Brooks, is a novel depicting the events of the protagonist's experiences during the American Civil War in 1862 through letters.
 * World War Z: An Oral History of the Zombie War (2006), by Max Brooks, is a series of interviews from various survivors of a zombie apocalypse.
 * Salmon Fishing in the Yemen (2007) by Paul Torday, is a series of letters, e-mails, interview transcripts, newspaper articles and other non-narrative media.
 * The White Tiger (2008) by Aravind Adiga, winner of the 40th Man Booker Prize in 2008, is a novel in the form of letters written by an Indian villager to the Chinese Premier Wen Jiabao.
 * The Guernsey Literary and Potato Peel Pie Society (2008), by Mary Ann Shaffer and Annie Barrows, is written as a series of letters and telegraphs sent and received by the protagonist.
 * A Visit from the Goon Squad (2010) by Jennifer Egan has parts which are epistolary in nature. One chapter is written as a report of a celebrity interview, and another as a PowerPoint presentation.
 * The Sacred Diary of Adrian Plass Aged 37 $3⁄4$ is one of a series of books written by Adrian Plass, this one consisting entirely of diary entries. Another consists of transcripts of tapes, yet another consists of letters.
 * Illuminae, by Jay Kristoff and Amie Kaufmann, is told exclusively through a series of classified documents, censored emails, interviews, and others.

title: Epistolary novel


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Evidence-based medicine

Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ... [It] means integrating individual clinical expertise with the best available external clinical evidence from systematic research." The aim of EBM is to integrate the experience of the clinician, the values of the patient, and the best available scientific information to guide decision-making about clinical management. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients.

The EBM Pyramid is a tool that helps in visualizing the hierarchy of evidence in medicine, from least authoritative, like expert opinions, to most authoritative, like systematic reviews.

Background, history, and definition
Medicine has a long history of scientific inquiry about the prevention, diagnosis, and treatment of human disease. In the 11th century AD, Avicenna, a Persian physician and philosopher, developed an approach to EBM that was mostly similar to current ideas and practises.

The concept of a controlled clinical trial was first described in 1662 by Jan Baptist van Helmont in reference to the practice of bloodletting. Wrote Van Helmont: "Let us take out of the Hospitals, out of the Camps, or from elsewhere, 200, or 500 poor People, that have fevers or Pleuritis. Let us divide them in Halfes, let us cast lots, that one halfe of them may fall to my share, and the others to yours; I will cure them without blood-letting and sensible evacuation; but you do, as ye know ... we shall see how many Funerals both of us shall have..."

The first published report describing the conduct and results of a controlled clinical trial was by James Lind, a Scottish naval surgeon who conducted research on scurvy during his time aboard HMS Salisbury in the Channel Fleet, while patrolling the Bay of Biscay. Lind divided the sailors participating in his experiment into six groups, so that the effects of various treatments could be fairly compared. Lind found improvement in symptoms and signs of scurvy among the group of men treated with lemons or oranges. He published a treatise describing the results of this experiment in 1753.

An early critique of statistical methods in medicine was published in 1835, in Comtes Rendus de l’Académie des Sciences, Paris, by a man referred to as "Mr Civiale".

The term 'evidence-based medicine' was introduced in 1990 by Gordon Guyatt of McMaster University.

Clinical decision-making
Alvan Feinstein's publication of Clinical Judgment in 1967 focused attention on the role of clinical reasoning and identified biases that can affect it. In 1972, Archie Cochrane published Effectiveness and Efficiency, which described the lack of controlled trials supporting many practices that had previously been assumed to be effective. In 1973, John Wennberg began to document wide variations in how physicians practiced. Through the 1980s, David M. Eddy described errors in clinical reasoning and gaps in evidence. In the mid-1980s, Alvin Feinstein, David Sackett and others published textbooks on clinical epidemiology, which translated epidemiological methods to physician decision-making. Toward the end of the 1980s, a group at RAND showed that large proportions of procedures performed by physicians were considered inappropriate even by the standards of their own experts.

Evidence-based guidelines and policies
David M. Eddy first began to use the term 'evidence-based' in 1987 in workshops and a manual commissioned by the Council of Medical Specialty Societies to teach formal methods for designing clinical practice guidelines. The manual was eventually published by the American College of Physicians. Eddy first published the term 'evidence-based' in March 1990, in an article in the Journal of the American Medical Association (JAMA) that laid out the principles of evidence-based guidelines and population-level policies, which Eddy described as "explicitly describing the available evidence that pertains to a policy and tying the policy to evidence instead of standard-of-care practices or the beliefs of experts. The pertinent evidence must be identified, described, and analyzed. The policymakers must determine whether the policy is justified by the evidence. A rationale must be written." He discussed evidence-based policies in several other papers published in JAMA in the spring of 1990. Those papers were part of a series of 28 published in JAMA between 1990 and 1997 on formal methods for designing population-level guidelines and policies.

Medical education
The term 'evidence-based medicine' was introduced slightly later, in the context of medical education. In the autumn of 1990, Gordon Guyatt used it in an unpublished description of a program at McMaster University for prospective or new medical students. Guyatt and others first published the term two years later (1992) to describe a new approach to teaching the practice of medicine.

In 1996, David Sackett and colleagues clarified the definition of this tributary of evidence-based medicine as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ... [It] means integrating individual clinical expertise with the best available external clinical evidence from systematic research." This branch of evidence-based medicine aims to make individual decision making more structured and objective by better reflecting the evidence from research. Population-based data are applied to the care of an individual patient, while respecting the fact that practitioners have clinical expertise reflected in effective and efficient diagnosis and thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences.

Between 1993 and 2000, the Evidence-Based Medicine Working Group at McMaster University published the methods to a broad physician audience in a series of 25 "Users' Guides to the Medical Literature" in JAMA. In 1995 Rosenberg and Donald defined individual-level, evidence-based medicine as "the process of finding, appraising, and using contemporaneous research findings as the basis for medical decisions." In 2010, Greenhalgh used a definition that emphasized quantitative methods: "the use of mathematical estimates of the risk of benefit and harm, derived from high-quality research on population samples, to inform clinical decision-making in the diagnosis, investigation or management of individual patients."

The two original definitions highlight important differences in how evidence-based medicine is applied to populations versus individuals. When designing guidelines applied to large groups of people in settings with relatively little opportunity for modification by individual physicians, evidence-based policymaking emphasizes that good evidence should exist to document a test's or treatment's effectiveness. In the setting of individual decision-making, practitioners can be given greater latitude in how they interpret research and combine it with their clinical judgment. In 2005, Eddy offered an umbrella definition for the two branches of EBM: "Evidence-based medicine is a set of principles and methods intended to ensure that to the greatest extent possible, medical decisions, guidelines, and other types of policies are based on and consistent with good evidence of effectiveness and benefit."

Progress
In the area of evidence-based guidelines and policies, the explicit insistence on evidence of effectiveness was introduced by the American Cancer Society in 1980. The U.S. Preventive Services Task Force (USPSTF) began issuing guidelines for preventive interventions based on evidence-based principles in 1984. In 1985, the Blue Cross Blue Shield Association applied strict evidence-based criteria for covering new technologies. Beginning in 1987, specialty societies such as the American College of Physicians, and voluntary health organizations such as the American Heart Association, wrote many evidence-based guidelines. In 1991, Kaiser Permanente, a managed care organization in the US, began an evidence-based guidelines program. In 1991, Richard Smith wrote an editorial in the British Medical Journal and introduced the ideas of evidence-based policies in the UK. In 1993, the Cochrane Collaboration created a network of 13 countries to produce systematic reviews and guidelines. In 1997, the US Agency for Healthcare Research and Quality (AHRQ, then known as the Agency for Health Care Policy and Research, or AHCPR) established Evidence-based Practice Centers (EPCs) to produce evidence reports and technology assessments to support the development of guidelines. In the same year, a National Guideline Clearinghouse that followed the principles of evidence-based policies was created by AHRQ, the AMA, and the American Association of Health Plans (now America's Health Insurance Plans). In 1999, the National Institute for Clinical Excellence (NICE) was created in the UK.

In the area of medical education, medical schools in Canada, the US, the UK, Australia, and other countries now offer programs that teach evidence-based medicine. A 2009 study of UK programs found that more than half of UK medical schools offered some training in evidence-based medicine, although the methods and content varied considerably, and EBM teaching was restricted by lack of curriculum time, trained tutors and teaching materials. Many programs have been developed to help individual physicians gain better access to evidence. For example, UpToDate was created in the early 1990s. The Cochrane Collaboration began publishing evidence reviews in 1993. In 1995, BMJ Publishing Group launched Clinical Evidence, a 6-monthly periodical that provided brief summaries of the current state of evidence about important clinical questions for clinicians.

Current practice
By 2000, use of the term evidence-based had extended to other levels of the health care system. An example is evidence-based health services, which seek to increase the competence of health service decision makers and the practice of evidence-based medicine at the organizational or institutional level.

The multiple tributaries of evidence-based medicine share an emphasis on the importance of incorporating evidence from formal research in medical policies and decisions. However, because they differ on the extent to which they require good evidence of effectiveness before promoting a guideline or payment policy, a distinction is sometimes made between evidence-based medicine and science-based medicine, which also takes into account factors such as prior plausibility and compatibility with established science (as when medical organizations promote controversial treatments such as acupuncture). Differences also exist regarding the extent to which it is feasible to incorporate individual-level information in decisions. Thus, evidence-based guidelines and policies may not readily "hybridise" with experience-based practices orientated towards ethical clinical judgement, and can lead to contradictions, contest, and unintended crises. The most effective "knowledge leaders" (managers and clinical leaders) use a broad range of management knowledge in their decision making, rather than just formal evidence. Evidence-based guidelines may provide the basis for governmentality in health care, and consequently play a central role in the governance of contemporary health care systems.

Steps
The steps for designing explicit, evidence-based guidelines were described in the late 1980s: formulate the question (population, intervention, comparison intervention, outcomes, time horizon, setting); search the literature to identify studies that inform the question; interpret each study to determine precisely what it says about the question; if several studies address the question, synthesize their results (meta-analysis); summarize the evidence in evidence tables; compare the benefits, harms and costs in a balance sheet; draw a conclusion about the preferred practice; write the guideline; write the rationale for the guideline; have others review each of the previous steps; implement the guideline.

For the purposes of medical education and individual-level decision making, five steps of EBM in practice were described in 1992 and the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers was summarized into five steps and published in 2005. This five-step process can broadly be categorized as follows:

 * 1) Translation of uncertainty to an answerable question; includes critical questioning, study design and levels of evidence
 * 2) Systematic retrieval of the best evidence available
 * 3) Critical appraisal of evidence for internal validity that can be broken down into aspects regarding:
 * 4) * Systematic errors as a result of selection bias, information bias and confounding
 * 5) * Quantitative aspects of diagnosis and treatment
 * 6) * The effect size and aspects regarding its precision
 * 7) * Clinical importance of results
 * 8) * External validity or generalizability
 * 9) Application of results in practice
 * 10) Evaluation of performance

Evidence reviews
Systematic reviews of published research studies are a major part of the evaluation of particular treatments. The Cochrane Collaboration is one of the best-known organisations that conducts systematic reviews. Like other producers of systematic reviews, it requires authors to provide a detailed study protocol as well as a reproducible plan of their literature search and evaluations of the evidence. After the best evidence is assessed, treatment is categorized as (1) likely to be beneficial, (2) likely to be harmful, or (3) without evidence to support either benefit or harm.

A 2007 analysis of 1,016 systematic reviews from all 50 Cochrane Collaboration Review Groups found that 44% of the reviews concluded that the intervention was likely to be beneficial, 7% concluded that the intervention was likely to be harmful, and 49% concluded that evidence did not support either benefit or harm. 96% recommended further research. In 2017, a study assessed the role of systematic reviews produced by Cochrane Collaboration to inform US private payers' policymaking; it showed that although the medical policy documents of major US private payers were informed by Cochrane systematic reviews, there was still scope to encourage the further use.

Assessing the quality of evidence
Evidence-based medicine categorizes different types of clinical evidence and rates or grades them according to the strength of their freedom from the various biases that beset medical research. For example, the strongest evidence for therapeutic interventions is provided by systematic review of randomized, well-blinded, placebo-controlled trials with allocation concealment and complete follow-up involving a homogeneous patient population and medical condition. In contrast, patient testimonials, case reports, and even expert opinion have little value as proof because of the placebo effect, the biases inherent in observation and reporting of cases, and difficulties in ascertaining who is an expert (however, some critics have argued that expert opinion "does not belong in the rankings of the quality of empirical evidence because it does not represent a form of empirical evidence" and continue that "expert opinion would seem to be a separate, complex type of knowledge that would not fit into hierarchies otherwise limited to empirical evidence alone.").

Several organizations have developed grading systems for assessing the quality of evidence. For example, in 1989 the U.S. Preventive Services Task Force (USPSTF) put forth the following system:
 * Level I: Evidence obtained from at least one properly designed randomized controlled trial.
 * Level II-1: Evidence obtained from well-designed controlled trials without randomization.
 * Level II-2: Evidence obtained from well-designed cohort studies or case-control studies, preferably from more than one center or research group.
 * Level II-3: Evidence obtained from multiple time series designs with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
 * Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Another example are the Oxford CEBM Levels of Evidence published by the Centre for Evidence-Based Medicine. First released in September 2000, the Levels of Evidence provide a way to rank evidence for claims about prognosis, diagnosis, treatment benefits, treatment harms, and screening, which most grading schemes do not address. The original CEBM Levels were Evidence-Based On Call to make the process of finding evidence feasible and its results explicit. In 2011, an international team redesigned the Oxford CEBM Levels to make them more understandable and to take into account recent developments in evidence ranking schemes. The Oxford CEBM Levels of Evidence have been used by patients and clinicians, as well as by experts to develop clinical guidelines, such as recommendations for the optimal use of phototherapy and topical therapy in psoriasis and guidelines for the use of the BCLC staging system for diagnosing and monitoring hepatocellular carcinoma in Canada.

In 2000, a system was developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The GRADE system takes into account more dimensions than just the quality of medical research. It requires users who are performing an assessment of the quality of evidence, usually as part of a systematic review, to consider the impact of different factors on their confidence in the results. Authors of GRADE tables assign one of four levels to evaluate the quality of evidence, on the basis of their confidence that the observed effect (a numeric value) is close to the true effect. The confidence value is based on judgments assigned in five different domains in a structured manner. The GRADE working group defines 'quality of evidence' and 'strength of recommendations' based on the quality as two different concepts that are commonly confused with each other.

Systematic reviews may include randomized controlled trials that have low risk of bias, or observational studies that have high risk of bias. In the case of randomized controlled trials, the quality of evidence is high but can be downgraded in five different domains.
 * Risk of bias: A judgment made on the basis of the chance that bias in included studies has influenced the estimate of effect.
 * Imprecision: A judgment made on the basis of the chance that the observed estimate of effect could change completely.
 * Indirectness: A judgment made on the basis of the differences in characteristics of how the study was conducted and how the results are actually going to be applied.
 * Inconsistency: A judgment made on the basis of the variability of results across the included studies.
 * Publication bias: A judgment made on the basis of the question whether all the research evidence has been taken to account.

In the case of observational studies per GRADE, the quality of evidence starts off lower and may be upgraded in three domains in addition to being subject to downgrading.
 * Large effect: Methodologically strong studies show that the observed effect is so large that the probability of it changing completely is less likely.
 * Plausible confounding would change the effect: Despite the presence of a possible confounding factor that is expected to reduce the observed effect, the effect estimate still shows significant effect.
 * Dose response gradient: The intervention used becomes more effective with increasing dose. This suggests that a further increase will likely bring about more effect.

Meaning of the levels of quality of evidence as per GRADE:
 * High Quality Evidence: The authors are very confident that the presented estimate lies very close to the true value. In other words, the probability is very low that further research will completely change the presented conclusions.
 * Moderate Quality Evidence: The authors are confident that the presented estimate lies close to the true value, but it is also possible that it may be substantially different. In other words, further research may completely change the conclusions.
 * Low Quality Evidence: The authors are not confident in the effect estimate, and the true value may be substantially different. In other words, further research is likely to change the presented conclusions completely.
 * Very Low Quality Evidence: The authors do not have any confidence in the estimate and it is likely that the true value is substantially different from it. In other words, new research will probably change the presented conclusions completely.

Categories of recommendations
In guidelines and other publications, recommendation for a clinical service is classified by the balance of risk versus benefit and the level of evidence on which this information is based. The U.S. Preventive Services Task Force uses the following system:
 * Level A: Good scientific evidence suggests that the benefits of the clinical service substantially outweigh the potential risks. Clinicians should discuss the service with eligible patients.
 * Level B: At least fair scientific evidence suggests that the benefits of the clinical service outweighs the potential risks. Clinicians should discuss the service with eligible patients.
 * Level C: At least fair scientific evidence suggests that the clinical service provides benefits, but the balance between benefits and risks is too close for general recommendations. Clinicians need not offer it unless individual considerations apply.
 * Level D: At least fair scientific evidence suggests that the risks of the clinical service outweigh potential benefits. Clinicians should not routinely offer the service to asymptomatic patients.
 * Level I: Scientific evidence is lacking, of poor quality, or conflicting, such that the risk versus benefit balance cannot be assessed. Clinicians should help patients understand the uncertainty surrounding the clinical service.

GRADE guideline panelists may make strong or weak recommendations on the basis of further criteria. Some of the important criteria are the balance between desirable and undesirable effects (not considering cost), the quality of the evidence, values and preferences and costs (resource utilization).

Despite the differences between systems, the purposes are the same: to guide users of clinical research information on which studies are likely to be most valid. However, the individual studies still require careful critical appraisal.

Statistical measures
Evidence-based medicine attempts to express clinical benefits of tests and treatments using mathematical methods. Tools used by practitioners of evidence-based medicine include:
 * Likelihood ratio The pre-test odds of a particular diagnosis, multiplied by the likelihood ratio, determines the post-test odds. (Odds can be calculated from, and then converted to, the [more familiar] probability.) This reflects Bayes' theorem. The differences in likelihood ratio between clinical tests can be used to prioritize clinical tests according to their usefulness in a given clinical situation.
 * AUC-ROC The area under the receiver operating characteristic curve (AUC-ROC) reflects the relationship between sensitivity and specificity for a given test. High-quality tests will have an AUC-ROC approaching 1, and high-quality publications about clinical tests will provide information about the AUC-ROC. Cutoff values for positive and negative tests can influence specificity and sensitivity, but they do not affect AUC-ROC.
 * Number needed to treat (NNT)/Number needed to harm (NNH). NNT and NNH are ways of expressing the effectiveness and safety, respectively, of interventions in a way that is clinically meaningful. NNT is the number of people who need to be treated in order to achieve the desired outcome (e.g. survival from cancer) in one patient. For example, if a treatment increases the chance of survival by 5%, then 20 people need to be treated in order for 1 additional patient to survive because of the treatment. The concept can also be applied to diagnostic tests. For example, if 1,339 women age 50–59 need to be invited for breast cancer screening over a ten-year period in order to prevent one woman from dying of breast cancer, then the NNT for being invited to breast cancer screening is 1339.

Quality of clinical trials
Evidence-based medicine attempts to objectively evaluate the quality of clinical research by critically assessing techniques reported by researchers in their publications.
 * Trial design considerations: High-quality studies have clearly defined eligibility criteria and have minimal missing data.
 * Generalizability considerations: Studies may only be applicable to narrowly defined patient populations and may not be generalizable to other clinical contexts.
 * Follow-up: Sufficient time for defined outcomes to occur can influence the prospective study outcomes and the statistical power of a study to detect differences between a treatment and control arm.
 * Power: A mathematical calculation can determine whether the number of patients is sufficient to detect a difference between treatment arms. A negative study may reflect a lack of benefit, or simply a lack of sufficient quantities of patients to detect a difference.

Limitations and criticism
There are a number of limitations and criticisms of evidence-based medicine. Two widely cited categorization schemes for the various published critiques of EBM include the three-fold division of Straus and McAlister ("limitations universal to the practice of medicine, limitations unique to evidence-based medicine and misperceptions of evidence-based-medicine") and the five-point categorization of Cohen, Stavri and Hersh (EBM is a poor philosophic basis for medicine, defines evidence too narrowly, is not evidence-based, is limited in usefulness when applied to individual patients, or reduces the autonomy of the doctor/patient relationship).

In no particular order, some published objections include:
 * Research produced by EBM, such as from randomized controlled trials (RCTs), may not be relevant for all treatment situations. Research tends to focus on specific populations, but individual persons can vary substantially from population norms. Because certain population segments have been historically under-researched (due to reasons such as race, gender, age, and co-morbid diseases), evidence from RCTs may not be generalizable to those populations. Thus, EBM applies to groups of people, but this should not preclude clinicians from using their personal experience in deciding how to treat each patient. One author advises that "the knowledge gained from clinical research does not directly answer the primary clinical question of what is best for the patient at hand" and suggests that evidence-based medicine should not discount the value of clinical experience. Another author stated that "the practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."
 * Use of evidence-based guidelines often fits poorly for complex, multimorbid patients. This is because the guidelines are usually based on clinical studies focused on single diseases. In reality, the recommended treatments in such circumstances may interact unfavorably with each other and often lead to polypharmacy.
 * The theoretical ideal of EBM (that every narrow clinical question, of which hundreds of thousands can exist, would be answered by meta-analysis and systematic reviews of multiple RCTs) faces the limitation that research (especially the RCTs themselves) is expensive; thus, in reality, for the foreseeable future, the demand for EBM will always be much higher than the supply, and the best humanity can do is to triage the application of scarce resources.
 * Research can be influenced by biases such as political or belief bias, publication bias and conflict of interest in academic publishing. For example, studies with conflicts due to industry funding are more likely to favor their product.  It has been argued that contemporary evidence based medicine is an illusion, since evidence based medicine has been corrupted by corporate interests, failed regulation, and commercialisation of academia.
 * Systematic Reviews methodologies are capable of bias and abuse in respect of (i) choice of inclusion criteria (ii) choice of outcome measures, comparisons and analyses (iii) the subjectivity inevitable in Risk of Bias assessments, even when codified procedures and criteria are observed.  An example of all these problems can be seen in a Cochrane Review, as analyzed by Edmund J. Fordham, et al. in their relevant review.
 * A lag exists between when the RCT is conducted and when its results are published.
 * A lag exists between when results are published and when they are properly applied.
 * Hypocognition (the absence of a simple, consolidated mental framework into which new information can be placed) can hinder the application of EBM.
 * Values: while patient values are considered in the original definition of EBM, the importance of values is not commonly emphasized in EBM training, a potential problem under current study.

A 2018 study, "Why all randomised controlled trials produce biased results", assessed the 10 most cited RCTs and argued that trials face a wide range of biases and constraints, from trials only being able to study a small set of questions amenable to randomisation and generally only being able to assess the average treatment effect of a sample, to limitations in extrapolating results to another context, among many others outlined in the study.

Application of evidence in clinical settings
Despite the emphasis on evidence-based medicine, unsafe or ineffective medical practices continue to be applied, because of patient demand for tests or treatments, because of failure to access information about the evidence, or because of the rapid pace of change in the scientific evidence. For example, between 2003 and 2017, the evidence shifted on hundreds of medical practices, including whether hormone replacement therapy was safe, whether babies should be given certain vitamins, and whether antidepressant drugs are effective in people with Alzheimer's disease. Even when the evidence unequivocally shows that a treatment is either not safe or not effective, it may take many years for other treatments to be adopted.

There are many factors that contribute to lack of uptake or implementation of evidence-based recommendations. These include lack of awareness at the individual clinician or patient (micro) level, lack of institutional support at the organisation level (meso) level or higher at the policy (macro) level. In other cases, significant change can require a generation of physicians to retire or die and be replaced by physicians who were trained with more recent evidence.

Physicians may also reject evidence that conflicts with their anecdotal experience or because of cognitive biases – for example, a vivid memory of a rare but shocking outcome (the availability heuristic), such as a patient dying after refusing treatment. They may overtreat to "do something" or to address a patient's emotional needs. They may worry about malpractice charges based on a discrepancy between what the patient expects and what the evidence recommends. They may also overtreat or provide ineffective treatments because the treatment feels biologically plausible.

It is the responsibility of those developing clinical guidelines to include an implementation plan to facilitate uptake. The implementation process will include an implementation plan, analysis of the context, identifying barriers and facilitators and designing the strategies to address them.

Education
Training in evidence based medicine is offered across the continuum of medical education. Educational competencies have been created for the education of health care professionals.

The Berlin questionnaire and the Fresno Test are validated instruments for assessing the effectiveness of education in evidence-based medicine. These questionnaires have been used in diverse settings.

A Campbell systematic review that included 24 trials examined the effectiveness of e-learning in improving evidence-based health care knowledge and practice. It was found that e-learning, compared to no learning, improves evidence-based health care knowledge and skills but not attitudes and behaviour. No difference in outcomes is present when comparing e-learning with face-to-face learning. Combining e-learning and face-to-face learning (blended learning) has a positive impact on evidence-based knowledge, skills, attitude and behavior. As a form of e-learning, some medical school students engage in editing Wikipedia to increase their EBM skills, and some students construct EBM materials to develop their skills in communicating medical knowledge.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Evidence-based medicine


text:
End zone

The end zone is the scoring area on the field, according to gridiron-based codes of football. It is the area between the end line and goal line bounded by the sidelines. There are two end zones, each being on the opposite side of the field. It is bordered on all sides by a white line indicating its beginning and end points, with orange, square pylons placed at each of the four corners as a visual aid (however, prior to around the early 1970s, flags were used instead to denote the end zone). Canadian rule books use the terms goal area and dead line instead of end zone and end line respectively, but the latter terms are the more common in colloquial Canadian English. Unlike sports like association football and ice hockey which require the ball/puck to pass completely over the goal line to count as a score, both Canadian and American football merely need any part of the ball to break the vertical plane of the outer edge of the goal line.

A similar concept exists in both rugby football codes, where it is known as the in-goal area. The difference between rugby and gridiron-based codes is that in rugby, the ball must be touched to the ground in the in-goal area to count as a try (the rugby equivalent of a touchdown), whereas in the gridiron-based games, simply possessing the ball in or over the end zone is sufficient to count as a touchdown.

Ultimate frisbee also uses an end zone scoring area. Scores in this sport are counted when a pass is received in the end zone.

History
The end zones were invented as a result of the legalization of the forward pass in gridiron football. Prior to this, the goal line and end line were the same, and players scored a touchdown by leaving the field of play through that line. Goal posts were placed on the goal line, and any kicks that did not result in field goals but left the field through the end lines were simply recorded as touchbacks (or, in the Canadian game, singles; it was during the pre-end zone era that Hugh Gall set the record for most singles in a game, with eight).

In the earliest days of the forward pass, the pass had to be caught in-bounds and could not be thrown across the goal line (as the receiver would be out of bounds). This also made it difficult to pass the ball when very close to one's own goal line, since merely dropping back to pass or kick would result in a safety (rules of the forward pass at the time required the passer to be five yards behind the line of scrimmage, which would make throwing the forward pass when the ball was snapped from behind one's own five-yard line illegal in itself).

Thus, in 1912, the end zone was introduced in American football. In an era when professional football was still in its early years and college football dominated the game, the resulting enlargement of the field was constrained by fact that many college teams were already playing in well-developed stadiums, complete with stands and other structures at the ends of the fields, thereby making any substantial enlargement of the field unfeasible at many schools. Eventually, a compromise was reached: 12 yards of end zone were added to each end of the field, but in return, the playing field was shortened from 110 yards to 100, resulting in the physical size of the field being only slightly longer than before. Goal posts were originally kept on the goal lines, but after they began to interfere with play, they moved back to the end lines in 1927, where they have remained in college football ever since. The National Football League moved the goal posts up to the goal line again in 1933, then back again to the end line in 1974.

As with many other aspects of gridiron football, Canadian football adopted the forward pass and end zones much later than American football. The forward pass and end zones were adopted in 1929. In Canada, college football has never reached a level of prominence comparable to U.S. college football, and professional football was still in its infancy in the 1920s. As a result, Canadian football was still being played in rudimentary facilities in the late 1920s. A further consideration was that the Canadian Rugby Union (the governing body of Canadian football at the time, now known as Football Canada) wanted to reduce the prominence of single points (then called rouges) in the game. Therefore, the CRU simply appended 25-yard end zones to the ends of the existing 110-yard field, creating a much larger field of play. Since moving the goal posts back 25 yards would have made the scoring of field goals excessively difficult, and since the CRU did not want to reduce the prominence of field goals, the goal posts were left on the goal line where they remain today. However, the rules governing the scoring of singles were changed: teams were required to either kick the ball out of bounds through the end zone or force the opposition to down a kicked ball in their own end zone in order to be awarded a point. By 1986, at which point CFL stadiums were becoming bigger and comparable in development to their American counterparts in an effort to stay financially competitive, the CFL reduced the depth of the end zone to 20 yards.

Scoring
A team scores a touchdown by entering its opponent's end zone while carrying the ball or catching the ball while being within the end zone. If the ball is carried by a player, it is considered a score when any part of the ball is directly above or beyond any part of the goal line between the pylons. In addition, a two-point conversion may be scored after a touchdown by the same means.

In Ultimate Frisbee, a goal is scored by completing a pass into the end zone.

Size
The end zone in American football is 10 yards long by $53 1/3$ yards (160 feet) wide. A full-sized end zone in Canadian football is 20 yards long by 65 yards wide. Prior to the 1980s, the Canadian end zone was 25 yards long. The first stadium to use the 20-yard-long end zone was B.C. Place in Vancouver, which was completed in 1983. The floor of B.C. Place was (and is) too short to accommodate a field 160 yards in length. The shorter end zone proved popular enough that the CFL adopted it league-wide in 1986. At BMO Field, home to the Toronto Argonauts, the end zones are only 18 yards. Like their American counterparts, Canadian endzones are marked with four pylons.

In Canadian football stadiums that also feature a running track, it is usually necessary to truncate the back corners of the end zones, since a rectangular field 150 yards long and 65 yards wide will not fit completely inside an oval-shaped running track. Such truncations are marked as straight diagonal lines, resulting in an end zone with six corners and six pylons. As of 2019, Montreal's Percival Molson Stadium is the only CFL stadium that has the rounded-off end zones.

During the CFL's failed American expansion in the mid-1990s, several stadiums, by necessity, used 15-yard end zones (some had end zones that were even shorter than 15 yards); only Baltimore and San Antonio had the endzones at the standard 20 yards.

Ultimate Frisbee uses an end zone 40 yards wide and 20 yards deep (37 m × 18 m).

The goal post
The location and dimensions of a goal post differ from league to league, but it is usually within the boundaries of the end zone. In earlier football games (both professional and collegiate), the goal post began at the goal line, and was usually an H-shaped bar. Nowadays, for player safety reasons, almost all goal posts in the professional and collegiate levels of American football are T-shaped (resembling a slingshot), and reside just outside the rear of both end zones; these goalposts were first seen in 1966 and were invented by Jim Trimble and Joel Rottman in Montreal, Quebec, Canada.

The goal posts in Canadian football still reside on the goal line instead of the back of the end zones, partly because the number of field goal attempts would dramatically decrease if the posts were moved 20 yards back in that sport, and also because the larger end zone and wider field makes the resulting interference in play by the goal post a less serious problem.

At the high school level, it is not uncommon to see multi-purpose goal posts that include football goal posts at the top and a soccer net at the bottom; these are usually seen at smaller schools and in multi-purpose stadiums where facilities are used for multiple sports. When these or H-shaped goal posts are used in football, the lower portions of the posts are covered with several inches of heavy foam padding to protect the safety of the players.

Decoration
Most professional and collegiate teams have their logo, team name, or both painted on the surface of the end zone, with team colors filling the background. Many championship and bowl games at college and professional level are commemorated by the names of the opposing teams each being painted in one of the opposite end zones. In some leagues, along with bowl games, local, national, or bowl game sponsors may also have their logos placed in the end zone. In the CFL, fully painted end zones are nonexistent, though some feature club logos or sponsors. Additionally, the Canadian end zone, being a live-ball part of the field, often features yardage dashes (usually marked every five yards), not unlike the field of play itself.

In many places, particularly in smaller high schools and colleges, end zones are undecorated, or have plain white diagonal stripes spaced several yards apart, in lieu of colors and decorations. One notable use of this design in major college football is the Notre Dame Fighting Irish, who have both end zones at Notre Dame Stadium painted with diagonal white lines. In professional football, since 2004, the Pittsburgh Steelers of the NFL have the south end zone at Acrisure Stadium (formerly Heinz Field) painted with diagonal-lines during most of the regular season, with the north end zone featuring only the city name of Pittsburgh in yellow. This is done because Acrisure Stadium, which has a natural grass playing surface, is also home to the Pittsburgh Panthers of college football and the markings simplify field conversion between the two teams' respective field markings and logos, with both teams sharing a secondary yellow color, but each having different primary colors. After the Panthers' season is over, the Steelers logo is painted in the south end zone.

Likewise, some end zones are painted in tribute to a recently deceased team figure or fan, as is done with the Steelers' AFC North rival Baltimore Ravens at M&T Bank Stadium, where the city name is painted as usual in the end zone, except for the "MO" portion, which is painted in gold or white in tribute to the late Mo Gaba, a young fan of both the Ravens and Orioles.

One of the major quirks of the American Football League was its use of unusual patterns such as argyle in its end zones, a tradition revived in 2009 by the Denver Broncos to celebrate the team's 50th anniversary, Denver itself a former AFL team. The original XFL standardized its playing fields so that all eight of its teams had uniform fields with the XFL logo in each end zone and no team identification.

title: End zone


text:
Ettore Ximenes

Ettore Ximenes (11 April 1855 – 20 December 1926) was an Italian sculptor.

Biography
Ettore Ximenes was born 11 April 1855 in Palermo, Italy. Son of Antonio Ximenes and Giulia Tolentino, a Sicilian noble woman, Ettore Ximenes initially embarked on literary studies but then took up sculpture and attended the courses at the Palermo Academy of Fine Arts. After 1872, he continued training at the Naples Academy under Domenico Morelli and Stanislao Lista. He also established a close relationship with Vincenzo Gemito. He returned to Palermo in 1874 and won a competition for a four-year grant, which enabled him to study and open a studio for sculpture in Florence. In 1873 at Vienna, he exhibited Work without Genius. In 1877 at Naples, he exhibited a life-size statue titled The Equilibrium about a gymnast walking on a sphere. He would make copies of this work in small marble and bronze statuettes.

He exhibited a stucco Christ and the Adultress and Il cuore del re (Heart of the King), the latter depicting an oft-repeated story of King Vittorio Emanuele during one of his frequent hunts, encountering and offering charity to a peasant child. At the 1878 Paris World Exposition he displayed: The Brawl and il Marmiton. In Paris, he met with Auguste Rodin and Jean-Baptiste Carpeaux.

In 1878, he also completed a life-size stucco of il Ciceruacchio, a statue of the Italian patriot Angelo Brunetti and his thirteen-year-old son, depicting them at the moment of their execution in 1849 by Austrian troops. The Cicervacchio statue, with its tinge of revolutionary zeal, did not find commissions for completing the work in marble. He then completed a nude statue of Nanà based on the novel by Émile Zola; the statue was exhibited at the 1879 Salon di Paris. The next year at the Paris Salon, he displayed La Pesca meravigliosa, where a fisherman rescues a bathing maiden. Returning to Italy, he displayed the bust del minister Giuseppe Zanardelli. At the Mostra of Rome, he displayed The assassination of Julius Caesar; and at the Exposition of Venice, Ragazzi messi in fila. Ximenes' realism gave way to Symbolist and Neo-Renaissance elements. In addition to sculpture, he also produced illustrations for the works of Edmondo De Amicis published by the Treves publishing house.

Ximenes was involved in many of the major official monumental projects in Italy from the 1880s on and devoted his energies as from 1911 primarily to commissions for important public works in São Paulo, Kyiv, New York and Buenos Aires.

In Italy

 * Bronze quadriga on Palace of Justice, Rome

In Ukraine

 * Monument to Emperor Alexander II of Russia in Kyiv (1911)
 * Monument to Pyotr Stolypin in Kyiv (1913)

In the United States

 * Giovanni da Verrazzano in the Battery, Manhattan, New York, 1909
 * Dante Alighieri in Dante Park at Lincoln Center, New York City and in Meridian Hill Park, Washington D.C. - castings of the same work, 1921

title: Ettore Ximenes


text:
Edsger W. Dijkstra

Edsger Wybe Dijkstra (11 May 1930 – 6 August 2002) was a Dutch computer scientist, programmer, software engineer, mathematician, and science essayist.

Born in Rotterdam, the Netherlands, Dijkstra studied mathematics and physics and then theoretical physics at the University of Leiden. Adriaan van Wijngaarden offered him a job as the first computer programmer in the Netherlands at the Mathematical Centre in Amsterdam, where he worked from 1952 until 1962. He formulated and solved the shortest path problem in 1956, and in 1960 developed the first compiler for the programming language ALGOL 60 in conjunction with colleague Jaap A. Zonneveld. In 1962 he moved to Eindhoven, and later to Nuenen, where he became a professor in the Mathematics Department at the Technische Hogeschool Eindhoven. In the late 1960s he built the THE multiprogramming system, which influenced the designs of subsequent systems through its use of software-based paged virtual memory. Dijkstra joined Burroughs Corporation as its sole research fellow in August 1973. The Burroughs years saw him at his most prolific in output of research articles. He wrote nearly 500 documents in the "EWD" series, most of them technical reports, for private circulation within a select group.

Dijkstra accepted the Schlumberger Centennial Chair in the Computer Science Department at the University of Texas at Austin in 1984, working in Austin, Texas, until his retirement in November 1999. He and his wife returned from Austin to his original house in Nuenen, where he died on 6 August 2002 after a long struggle with cancer.

He received the 1972 Turing Award for fundamental contributions to developing structured programming languages. Shortly before his death, he received the ACM PODC Influential Paper Award in distributed computing for his work on self-stabilization of program computation. This annual award was renamed the Dijkstra Prize the following year, in his honor.

Early years
Edsger W. Dijkstra was born in Rotterdam. His father was a chemist who was president of the Dutch Chemical Society; he taught chemistry at a secondary school and was later its superintendent. His mother was a mathematician, but never had a formal job.

Dijkstra had considered a career in law and had hoped to represent the Netherlands in the United Nations. However, after graduating from school in 1948, at his parents' suggestion he studied mathematics and physics and then theoretical physics at the University of Leiden.

In the early 1950s, electronic computers were a novelty. Dijkstra stumbled on his career by accident, and through his supervisor, Professor, he met Adriaan van Wijngaarden, the director of the Computation Department at the Mathematical Centre in Amsterdam, who offered Dijkstra a job; he officially became the Netherlands' first "programmer" in March 1952.

Dijkstra remained committed to physics for some time, working on it in Leiden three days out of each week. With increasing exposure to computing, however, his focus began to shift. As he recalled:

"After having programmed for some three years, I had a discussion with A. van Wijngaarden, who was then my boss at the Mathematical Center in Amsterdam, a discussion for which I shall remain grateful to him as long as I live. The point was that I was supposed to study theoretical physics at the University of Leiden simultaneously, and as I found the two activities harder and harder to combine, I had to make up my mind, either to stop programming and become a real, respectable theoretical physicist, or to carry my study of physics to a formal completion only, with a minimum of effort, and to become....., yes what? A programmer? But was that a respectable profession? For after all, what was programming? Where was the sound body of knowledge that could support it as an intellectually respectable discipline? I remember quite vividly how I envied my hardware colleagues, who, when asked about their professional competence, could at least point out that they knew everything about vacuum tubes, amplifiers and the rest, whereas I felt that, when faced with that question, I would stand empty-handed. Full of misgivings I knocked on Van Wijngaarden's office door, asking him whether I could 'speak to him for a moment'; when I left his office a number of hours later, I was another person. For after having listened to my problems patiently, he agreed that up till that moment there was not much of a programming discipline, but then he went on to explain quietly that automatic computers were here to stay, that we were just at the beginning and could not I be one of the persons called to make programming a respectable discipline in the years to come? This was a turning point in my life and I completed my study of physics formally as quickly as I could."

When Dijkstra married Maria "Ria" C. Debets in 1957, he was required as a part of the marriage rites to state his profession. He stated that he was a programmer, which was unacceptable to the authorities, there being no such profession then in The Netherlands. In 1959, he received his PhD from the University of Amsterdam for a thesis entitled 'Communication with an Automatic Computer', devoted to a description of the assembly language designed for the first commercial computer developed in the Netherlands, the Electrologica X1. His thesis supervisor was Van Wijngaarden.

Mathematisch Centrum, Amsterdam
From 1952 until 1962, Dijkstra worked at the Mathematisch Centrum in Amsterdam, where he worked closely with Bram Jan Loopstra and Carel S. Scholten, who had been hired to build a computer. Their mode of interaction was disciplined: They would first decide upon the interface between the hardware and the software, by writing a programming manual. Then the hardware designers would have to be faithful to their part of the contract, while Dijkstra, the programmer, would write software for the nonexistent machine. Two of the lessons he learned from this experience were the importance of clear documentation, and that program debugging can be largely avoided through careful design. Dijkstra formulated and solved the shortest path problem for a demonstration at the official inauguration of the ARMAC computer in 1956. Because of the absence of journals dedicated to automatic computing, he did not publish the result until 1959.

At the Mathematical Centre, Dijkstra and his colleague developed the first compiler for the programming language ALGOL 60 by August 1960, more than a year before a compiler was produced by another group. ALGOL 60 is known as a key advance in the rise of structured programming.

Eindhoven University of Technology
In 1962, Dijkstra moved to Eindhoven, and later to Nuenen, in the south of the Netherlands, where he became a professor in the Mathematics Department at the Eindhoven University of Technology. The university did not have a separate computer science department and the culture of the mathematics department did not particularly suit him. Dijkstra tried to build a group of computer scientists who could collaborate on solving problems. This was an unusual model of research for the Mathematics Department. In the late 1960s, he built the THE operating system (named for the university, then known as Technische Hogeschool Eindhoven), which has influenced the designs of subsequent operating systems through its use of software-based paged virtual memory.

Burroughs Corporation
Dijkstra joined the Burroughs Corporation—a company known then for producing computers based on an innovative hardware architecture—as its research fellow in August 1973. His duties consisted of visiting some of the firm's research centers a few times a year and carrying on his own research, which he did in the smallest Burroughs research facility, namely, his study on the second floor of his house in Nuenen. In fact, Dijkstra was the only research fellow of Burroughs and worked for it from home, occasionally travelling to its branches in the United States. As a result, he reduced his appointment at the university to one day a week. That day, Tuesday, soon became known as the day of the famous 'Tuesday Afternoon Club', a seminar during which he discussed with his colleagues scientific articles, looking at all aspects: notation, organisation, presentation, language, content, etc. Shortly after he moved in 1984 to the University of Texas at Austin (USA), a new 'branch' of the Tuesday Afternoon Club emerged in Austin, Texas.

The Burroughs years saw him at his most prolific in output of research articles. He wrote nearly 500 documents in the EWD series (described below), most of them technical reports, for private circulation within a select group.

The University of Texas at Austin
Dijkstra accepted the Schlumberger Centennial Chair in the Computer Science Department at the University of Texas at Austin in 1984.

Last years
Dijkstra worked in Austin until his retirement in November 1999. To mark the occasion and to celebrate his forty-plus years of seminal contributions to computing science, the Department of Computer Sciences organized a symposium, which took place on his 70th birthday in May 2000.

Dijkstra and his wife returned from Austin to his original house in Nuenen, Netherlands, where he found that he had only months to live. He said that he wanted to retire in Austin, Texas, but to die in the Netherlands. Dijkstra died on 6 August 2002 after a long struggle with cancer. He and his wife were survived by their three children: Marcus, Femke, and the computer scientist Rutger M. Dijkstra.

Character
"You can hardly blame M.I.T. for not taking notice of an obscure computer scientist in a small town in the Netherlands."

In the world of computing science, Dijkstra is well known as a "character". In the preface of his book A Discipline of Programming (1976) he stated the following: "For the absence of a bibliography I offer neither explanation nor apology." In fact, most of his articles and books have no references at all. Dijkstra chose this way of working to preserve his self-reliance.

As a university professor for much of his life, Dijkstra saw teaching not just as a required activity but as a serious research endeavour. His approach to teaching was unconventional. His lecturing style has been described as idiosyncratic. When lecturing, the long pauses between sentences have often been attributed to the fact that English is not Dijkstra's first language. However the pauses also served as a way for him to think on his feet and he was regarded as a quick and deep thinker while engaged in the act of lecturing. His courses for students in Austin had little to do with computer science but they dealt with the presentation of mathematical proofs. At the beginning of each semester, he would take a photo of each of his students in order to memorize their names. He never followed a textbook, with the possible exception of his own while it was under preparation. When lecturing, he would write proofs in chalk on a blackboard rather than using overhead foils. He invited the students to suggest ideas, which he then explored, or refused to explore because they violated some of his tenets. He assigned challenging homework problems, and would study his students' solutions thoroughly. He conducted his final examinations orally, over a whole week. Each student was examined in Dijkstra's office or home, and an exam lasted several hours.

Dijkstra was also highly original in his way of assessing people's capacity for a job. When Vladimir Lifschitz came to Austin in 1990 for a job interview, Dijkstra gave him a puzzle. Lifschitz solved it and has been working in Austin since then.

Use of technology
He eschewed the use of computers in his own work for many decades. Even after he succumbed to his UT colleagues' encouragement and acquired a Macintosh computer, he used it only for e-mail and for browsing the World Wide Web. Dijkstra never wrote his articles using a computer. He preferred to rely on his typewriter and later on his Montblanc pen. Dijkstra's favorite writing instrument was the Montblanc Meisterstück fountain pen.

He had no use for word processors, believing that one should be able to write a letter or article without rough drafts, rewriting, or any significant editing. He would work it all out in his head before putting pen to paper, and once mentioned that when he was a physics student he would solve his homework problems in his head while walking the streets of Leiden. Most of Dijkstra's publications were written by him alone. He never had a secretary and took care of all his correspondence alone. When colleagues prepared a Festschrift for his sixtieth birthday, published by Springer-Verlag, he took the trouble to thank each of the 61 contributors separately, in a hand-written letter.

In The Humble Programmer (1972), Dijkstra wrote: "We must not forget that it is not our [computing scientists'] business to make programs, it is our business to design classes of computations that will display a desired behaviour."

Dijkstra also opposed the inclusion of software engineering under the umbrella of academic computer science. He wrote that, "As economics is known as "The Miserable Science", software engineering should be known as "The Doomed Discipline", doomed because it cannot even approach its goal since its goal is self-contradictory." And "software engineering has accepted as its charter 'How to program if you cannot.'"

Personal life
Dijkstra led a modest lifestyle, to the point of being spartan. His and his wife's house in Nuenen was simple, small and unassuming. He did not own a television, a video player, or a mobile telephone, and did not go to the movies. He played the piano, and, while in Austin, liked to go to concerts. An enthusiastic listener of classical music, Dijkstra's favorite composer was Mozart.

Essays and other writing
Throughout Dijkstra's career, his work was characterized by elegance and economy. A prolific writer (especially as an essayist), Dijkstra authored more than 1,300 papers, many written by hand in his precise script. They were essays and parables; fairy tales and warnings; comprehensive explanation and pedagogical pretext. Most were about mathematics and computer science; others were trip reports that are more revealing about their author than about the people and places visited. It was his habit to copy each paper and circulate it to a small group of colleagues who would copy and forward the papers to another limited group of scientists.

EWDs
Dijkstra was well known for his habit of carefully composing manuscripts with his fountain pen. The manuscripts are called EWDs, since Dijkstra numbered them with EWD, his initials, as a prefix. According to Dijkstra himself, the EWDs started when he moved from the Mathematical Centre in Amsterdam to the Eindhoven University of Technology (then Technische Hogeschool Eindhoven). After going to Eindhoven, Dijkstra experienced a writer's block for more than a year. He distributed photocopies of a new EWD among his colleagues. Many recipients photocopied and forwarded their copies, so the EWDs spread throughout the international computer science community. The topics were computer science and mathematics, and included trip reports, letters, and speeches. These short articles span a period of 40 years. Almost all EWDs appearing after 1972 were hand-written. They are rarely longer than 15 pages and are consecutively numbered. The last one, No. 1318, is from 14 April 2002. Within computer science they are known as the EWD reports, or, simply the EWDs. More than 1300 EWDs have been scanned, with a growing number transcribed to facilitate search, and are available online at the Dijkstra archive of the University of Texas.

Writing style
His interest with simplicity came at an early age and under his mother's guidance. He once said he had asked his mother whether trigonometry was a difficult topic. She replied that he must learn all the formulas and that further, if he required more than five lines to prove something, he was on the wrong track.

Dijkstra was famous for his wit, eloquence, rudeness, abruptness and often cruelty to fellow professionals, and way with words, such as in his remark, "The question of whether Machines Can Think (…) is about as relevant as the question of whether Submarines Can Swim." His advice to a promising researcher, who asked how to select a topic for research, was the phrase: "Do only what only you can do". Dijkstra was also known for his vocal criticism and absence of social skills when interacting with colleagues. As an outspoken and critical visionary, he strongly opposed the teaching of BASIC.

Recurring themes
In many of his more witty essays, Dijkstra described a fictional company of which he served as chairman. The company was called Mathematics, Inc., a company that he imagined having commercialized the production of mathematical theorems in the same way that software companies had commercialized the production of computer programs. He invented a number of activities and challenges of Mathematics Inc. and documented them in several papers in the EWD series. The imaginary company had produced a proof of the Riemann Hypothesis but then had great difficulties collecting royalties from mathematicians who had proved results assuming the Riemann Hypothesis. The proof itself was a trade secret. Many of the company's proofs were rushed out the door and then much of the company's effort had to be spent on maintenance. A more successful effort was the Standard Proof for Pythagoras' Theorem, that replaced the more than 100 incompatible existing proofs. Dijkstra described Mathematics Inc. as "the most exciting and most miserable business ever conceived". EWD 443 (1974) describes his fictional company as having over 75% of the world's market share.

Legacy
Dijkstra won the Turing award in 1972 for his advocacy of structured programming, a programming paradigm that makes use of structured control flow as opposed to unstructured jumps to different sections in a program using Goto statements. His 1968 letter to the editor of Communications of ACM, "Go To statement considered harmful", caused a major debate. Modern programmers generally adhere to the paradigm of structured programming.

Among his most famous contributions to computer science is shortest path algorithm, known as Dijkstra's algorithm, widely taught in modern computer science undergraduate courses. His other contributions included the Shunting yard algorithm; the THE multiprogramming system, an important early example of structuring a system as a set of layers; the Banker's algorithm; and the semaphore construct for coordinating multiple processors and programs. Another concept formulated by Dijkstra in the field of distributed computing is that of self-stabilization – an alternative way to ensure the reliability of the system. Dijkstra's algorithm is used in SPF, Shortest Path First, which is used in the routing protocols OSPF and IS-IS.

Awards and honors
Among Dijkstra's awards and honors are:
 * Member of the Royal Netherlands Academy of Arts and Sciences (1971)
 * Distinguished Fellow of the British Computer Society (1971)
 * The Association for Computing Machinery's A.M. Turing Award (1972)
 * Harry H. Goode Memorial Award from the IEEE Computer Society (1974).
 * Foreign Honorary Member of the American Academy of Arts and Sciences (1975)
 * Doctor of Science Honoris Causa from the Queen's University Belfast (1976)
 * Computer Pioneer Charter Recipient from the IEEE Computer Society (1982)
 * ACM/SIGCSE Award for Outstanding Contributions to Computer Science Education (1989)
 * Fellow of the Association for Computing Machinery (1994)
 * Honorary doctorate from the Athens University of Economics & Business, Greece (2001).

In 1969, the British Computer Society (BCS) received approval for an award and fellowship, Distinguished Fellow of the British Computer Society (DFBCS), to be awarded under bylaw 7 of their royal charter. In 1971, the first election was made, to Dijkstra.

In 1990, on occasion of Dijkstra's 60th birthday, the Department of Computer Science (UTCS) at the University of Texas at Austin organized a two-day seminar in his honor. Speakers came from all over the United States and Europe, and a group of computer scientists contributed research articles which were edited into a book.

In 2002, the C&C Foundation of Japan recognized Dijkstra "for his pioneering contributions to the establishment of the scientific basis for computer software through creative research in basic software theory, algorithm theory, structured programming, and semaphores." Dijkstra was alive to receive notice of the award, but it was accepted by his family in an award ceremony after his death.

Shortly before his death in 2002, Dijkstra received the ACM PODC Influential-Paper Award in distributed computing for his work on self-stabilization of program computation. This annual award was renamed the Dijkstra Prize (Edsger W. Dijkstra Prize in Distributed Computing) the following year, in his honor.

The Dijkstra Award for Outstanding Academic Achievement in Computer Science (Loyola University Chicago, Department of Computer Science) is named for Edsger W. Dijkstra. Beginning in 2005, this award recognizes the top academic performance by a graduating computer science major. Selection is based on GPA in all major courses and election by department faculty.

The Department of Computer Science (UTCS) at the University of Texas at Austin hosted the inaugural Edsger W. Dijkstra Memorial Lecture on 12 October 2010. Tony Hoare, Emeritus Professor at Oxford and Principal Researcher at Microsoft Research, was the speaker for the event. This lecture series was made possible by a generous grant from Schlumberger to honor the memory of Dijkstra.

Selected articles

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title: Edsger W. Dijkstra


text:
Talk:Evoluon

Recent uses
I've heard this museum is not open to the public anymore. Does anyone know for sure?
 * Yes, it is no longer open to the public. Philips is using it for conferences and such, but no longer as a public museum. Herman

title: Talk:Evoluon


text:
Educational perennialism

Educational perennialism is a normative educational philosophy. Perennialists believe that the priority of education should be to teach principles that have persisted for centuries, not facts. Since people are human, one should teach first about humans, rather than machines or techniques, and about liberal, rather than vocational, topics.

Perennialism appears similar to essentialism but focuses first on personal development, while essentialism focuses first on essential skills. Essentialist curricula tend to be more vocational and fact-based, and far less liberal and principle-based. Both philosophies are typically considered to be teacher-centered, as opposed to student-centered philosophies of education such as progressivism. Teachers associated with perennialism are authors of the Western masterpieces and are open to student criticism through the associated Socratic method.

Secular perennialism
The word "perennial" in secular perennialism suggests something that lasts an indefinite amount of time, recurs again and again, or is self-renewing. Robert Hutchins and Mortimer Adler promoted a universal curriculum based upon the common and essential nature of all human beings and encompassing humanist and scientific traditions. Hutchins and Adler implemented these ideas with great success at the University of Chicago, where they still strongly influence the Undergraduate Common Core. Other notable figures in the movement include Stringfellow Barr and Scott Buchanan (who together initiated the Great Books program at St. John's College in Annapolis, Maryland), Mark Van Doren, Alexander Meiklejohn, and Sir Richard Livingstone, an English classicist with an American following. Inspired by Adler's lectures, Sister Miriam Joseph wrote a textbook on the scholastic trivium and taught it as the Freshman seminar at Saint Mary's College.

Secular perennialists espouse the idea that education should focus on the historical development of a continually advancing common orienting base of human knowledge and art, the timeless value of classic thought on central human issues by landmark thinkers, and revolutionary ideas critical to historical paradigm shifts or changes in world view. A program of studies which is highly general, nonspecialized, and nonvocational is advocated. They firmly believe that exposure of all people to the development of thought by those most responsible for the evolution of the occidental oriented tradition is integral to the survival of the freedoms, human rights, and responsibilities inherent to a true democracy.

Adler states: ... our political democracy depends upon the reconstitution of our schools. Our schools are not turning out young people prepared for the high office and the duties of citizenship in a democratic republic. Our political institutions cannot thrive, they may not even survive, if we do not produce a greater number of thinking citizens, from whom some statesmen of the type we had in the 18th century might eventually emerge. We are, indeed, a nation at risk, and nothing but radical reform of our schools can save us from impending disaster... Whatever the price... the price we will pay for not doing it will be much greater.

Hutchins writes in the same vein: The business of saying ... that people are not capable of achieving a good education is too strongly reminiscent of the opposition of every extension of democracy. This opposition has always rested on the allegation that the people were incapable of exercising the power they demanded. Always the historic statement has been verified: you cannot expect the slave to show the virtues of the free man unless you first set him free. When the slave has been set free, he has, in the passage of time, become indistinguishable from those who have always been free ... There appears to be an innate human tendency to underestimate the capacity of those who do not belong to "our" group. Those who do not share our background cannot have our ability. Foreigners, people who are in a different economic status, and the young seem invariably to be regarded as intellectually backward ...

As with the essentialists, perennialists are educationally conservative in the requirement of a curriculum focused upon fundamental subject areas, but they stress that the overall aim should be exposure to history's finest thinkers as models for discovery. The student should be taught such basic subjects as English, languages, history, mathematics, natural science, philosophy, and fine arts. Adler states: "The three R's, which always signified the formal disciplines, are the essence of liberal or general education."

Secular perennialists agree with progressivists that memorization of vast amounts of factual information and a focus on second-hand information in textbooks and lectures does not develop rational thought. They advocate learning through the development of meaningful conceptual thinking and judgement by means of a directed reading list of the profound, aesthetic, and meaningful great books of the Western canon. These books, secular perennialists argue, are written by the world's finest thinkers, and cumulatively comprise the "Great Conversation" of humanity with regard to the central human questions. Their basic argument for the use of original works (abridged translations being acceptable as well) is that these are the products of "genius". Hutchins remarks:

"Great books are great teachers; they are showing us every day what ordinary people are capable of. These books come out of ignorant, inquiring humanity. They are usually the first announcements for success in learning. Most of them were written for, and addressed to, ordinary people."

The Great Conversation is not static but, along with the set of related great books, changes as the representative thought of man changes or progresses. In this way, it seeks to represent an evolution of thought not based upon the latest cultural fads. Hutchins clarifies this:

In the course of history... new books have been written that have won their place in the list. Books once thought entitled to belong to it have been superseded; and this process of change will continue as long as men can think and write. It is the task of every generation to reassess the tradition in which it lives, to discard what it cannot use, and to bring into context with the distant and intermediate past the most recent contributions to the Great Conversation. ...the West needs to recapture and reemphasize and bring to bear upon its present problems the wisdom that lies in the works of its greatest thinkers and in the name of love

Perennialism was proposed in response to what many considered a failing educational system. Again Hutchins writes:

The products of American high schools are illiterate; and a degree from a famous college or university is no guarantee that the graduate is in any better case. One of the most remarkable features of American society is that the difference between the "uneducated" and the "educated" is so slight.

In this regard John Dewey and Hutchins were in agreement. Hutchins's book The Higher Learning in America deplored the "plight of higher learning" that had turned away from cultivation of the intellect and toward anti-intellectual practicality due, in part, to a lust for money. In a highly negative review of the book, Dewey wrote a series of articles in The Social Frontier which began by applauding Hutchins' attack on "the aimlessness of our present educational scheme.

Perennialists believe in reading being supplemented by mutual investigations involving both teacher and student and minimally-directed discussions through the Socratic method in order to develop a historically oriented understanding of concepts. They argue that accurate, independent reasoning distinguishes the developed or educated mind and stress the development of this faculty. A skilled teacher keeps discussions on topic, corrects errors in reasoning, and accurately formulates problems within the scope of texts being studied but lets the class reach their own conclusions.

Perennialists argue that many of the historical debates and the development of ideas presented by the great books are relevant to any society at any time, making them suitable for instructional use regardless of their age. They acknowledge disagreement between various great books but believe that the student must learn to recognize these disagreements, think about them, and reach a reasoned, defensible conclusion. This is a major goal of the Socratic discussions.

Religious perennialism
Perennialism was originally religious in nature, developed first by Thomas Aquinas in the thirteenth century in his work  (On the Teacher).

In the nineteenth century, John Henry Newman presented a defense of religious perennialism in The Idea of a University. Discourse 5 of that work, "Knowledge Its Own End", is a recent statement of a Christian educational perennialism.

There are several epistemological options, which affect the pedagogical options. The possibilities may be surveyed by considering four extreme positions - idealistic rationalism, idealistic fideism, realistic rationalism and realistic fideism.

Teaching pupils to think critically and rationally are the main objectives of perennialist educators. A perennialist classroom seeks to be a highly structured and disciplined setting that fosters in pupils a never-ending search for the truth.

Colleges exemplifying this philosophy

 * Reed College in Portland, Oregon is a well-known secular liberal arts college which requires a year-long humanities course covering ancient Greek and Roman literature, history, art, religion, and philosophy. Students may pursue an optional extension to this core curriculum in later years.
 * St. John's College (Annapolis/Santa Fe) in Annapolis, Maryland and Santa Fe, New Mexico is a secular liberal arts college with an undergraduate program described as "an all-required course of study based on the great books of the Western tradition".
 * The Core Curriculum of Columbia College of Columbia University, is another well-known example of educational perennialism.
 * The University of Chicago's Common Core, established by Mortimer Adler and Robert Maynard Hutchins is another well-known example of educational perennialism. Similar to Columbia College of Columbia University, it is an uncommon example of an educational perennialistic college within a large research institution.
 * Integral Program at Saint Mary's College of California in is a Great Books major at the Lasallian Catholic liberal arts college in Moraga, California. The program was designed with the assistance of faculty from St. John's College, U.S.
 * Thomas Aquinas College in Santa Paula, California is a Catholic Christian college with a Great Books curriculum. The college was founded by a group of graduates and professors of the Integral Program at Saint Mary's College of California, who were discouraged by the liberalism that became common place among the faculty and administration on Saint Mary's campus shortly after Vatican II.
 * Gutenberg College in Eugene, Oregon provides "a broad-based liberal arts education in a Protestant Christian environment", with a "great books" curriculum emphasizing "the development of basic learning skills (reading, writing, mathematics, and critical thinking) and the application of these skills to profound writings of the past".
 * Shimer College in Chicago grants a Bachelor of Arts to students who complete a program composed of humanities, social sciences, natural sciences, integrative studies and a capstone senior thesis.
 * The Torrey Honors Institute at Biola University is a Christian Great Books program.
 * George Wythe University in Cedar City, Utah, is an unaccredited liberal arts school.
 * Thomas More College in Merrimack, New Hampshire is a Catholic College with an integrated Liberal Arts curriculum . The program includes poetry and folk, art and wood guild. The College also offers a Rome Semester, when students have the chance to study Ancient and Medieval Art & Architecture.
 * The Great Books Program at Benedictine College is an example of perennialism, teaching ancient, medieval, renaissance, and modern works from the Western cannon with an emphasis on Catholicism.

title: Educational perennialism