Training residents to become humanistic physicians capable of empathy, compassionate communication, and holistic patient care is among our most important tasks as physician educators. Narrative medicine aims to foster those highly desirable characteristics, and previous studies have shown it to be successful in fostering self-reflection, emotional processing, and preventing burnout. We aimed to evaluate pediatric residents’ perceptions of a novel narrative medicine curriculum. After the initiation of a longitudinal narrative medicine curriculum, focus groups were conducted with residents who participated (...) in at least one narrative medicine session. The curriculum was viewed positively, and residents found the sessions to be helpful in developing empathy, offering a space for reflection, and introducing new perspectives. Challenges noted were perception of relevance, timing of sessions, and interpretation by non-native English-speaking residents. With attention to linguistics and thematic undertones, narrative medicine is a feasible, replicable, and accepted teaching modality for pediatric residents to foster empathy, process emotions, and participate in self-reflection. (shrink)

As one of the main competencies, professionalism is to be taught and evaluated during the residency period. The aim of this research is to investigate the professionalism perception among medical residents of Tabriz University of Medical Sciences. This cross-sectional study was conducted in 2017 using Persian Professionalism Questionnaire American Board of Internal Medicine (American Board of Internal Medicine). Probability proportional to size sampling was used to recruit the participants (n = 250). Data analysis was done using SPSS24 through descriptive and (...) analytical statistics. The mean age of residents was 33.28 (SD = 5.56). About 46% of residents were not familiar with professionalism. Mean of perceived professionalism score by the residents was to be 6.85 (of 10) ± 1.52. Honor/Integrity dimension with a score of 7.53 ± 2.1 had the highest mean, while professional excellence with a score of 6.2 ± 1.43 had the lowest mean. No statistically significant relationship was observed between residents’ demographic characteristics and perceived professionalism. Medical residents’ professionalism perception was not at an acceptable level. It is necessary to spread the concept of professionalism in the form of formal and informal training programs to promote residents’ professional behaviors. Moreover, it was experienced that peer to peer observation could be used to assess professionalism in the working environment. (shrink)

This paper analyses the evolutionary characteristics of the interprovincial population mobility network structure in China and explores the roles of provinces from 2010 to 2015. By constructing the interprovincial population mobility network, we examine the provinces’ functions during periods of population mobility through population mobility diversity, population mobility, and population mobility intermediation. The results show that the coverage and tightness of the interprovincial population mobility network were influenced by national economic development, increasing steadily from 2010 to 2014 and then (...) suddenly falling in 2015. The regions that played essential roles in the province’s mobility diversity and intermediation showed a dispersion trend. In contrast, areas that played a vital role in the inflows or outflows were relatively concentrated and stable. Additionally, this work further explores how economic factors, e.g., GDP, residents’ consumption levels, total population, unemployment rate, and consumer price index, are used as independent variables to analyse the provinces’ roles in the interprovincial population mobility network. The analysis shows that the inflow or outflow volumes are easily affected by the five indices. These five indices are significantly related to network role indicators to different extents. (shrink)

Socialist buildings in the city of Kruja (Albania) date back after the Second World War between the years 1945-1990. These buildings were built during the time of the socialist Albanian dictatorship and the totalitarian communist regime. A questionnaire with 30 questions was conducted and 14 people were interviewed. The interviewed residents belong to a certain area of the city of Kruja. Based on the results obtained, diagrams have been conceived and mathematical regression models have been developed which will serve as (...) a base for drawing conclusions. The purpose of this study is to find a relationship that specifies the role of the inhabitants, the role of the dwellings, the physical-mechanical characteristics, and their energy efficiency, in order to improve the living conditions of the inhabitants. The independent variables interact with each other assuming positive or negative values depending on the probabilistic mathematical regression, giving different results based on the calculated data. The variables that co-exist among them are living space, quality of life, time spent at home, social interaction of residents, dwelling humidity level, dwelling orientation, satisfaction level of the inhabitants, dwelling improvements demand, and monthly electricity bills. (shrink)

Psychological dualism (or dualism herein) purports that there is a complementary, non-material/physical, mind-active component associated with a living organism. Thus mind would not simply be an expression of brain function as confidently believed by neuroscience (and science in general). As earlier work has suggested that confidence can be brushed aside by considering some accepted unusual behaviors. One simple dualism-consistent example is terminal lucidity in which people return to psychological coherence shortly before death despite having been lost to “dull, unconscious, or (...) mentally ill” conditions, in some cases for years. Arguably framing these challenges to materialism, though, is genetics’ unfolding “missing heritability” crisis in which many expected DNA origins have not been found despite extensive searches. An associated soul-consistent explanation is that instead of DNA origins these innate characteristics reflect continuity associated with the earlier lives of incarnating souls (and of course with this some other particular explanations). Herein arguments for the existence of souls are considered for the very surprising case of multiple soul residency in a single organism. Discussions on this possibility focus on the stunning experiences of some heart transplant patients, and also the very difficult condition of Multiple Personality (or Dissociative Identity) Disorder. These two phenomena pose very difficult challenges for materialism (and brain function), and on the other hand are suggestive of the influences of additional souls. Finally, some of the implications of these extraordinary possibilities are briefly considered. (shrink)

This study analyzes the influence of grandmothers’ household residency on the presence of low height-for-age and excessive fat, waist circumference, and sum of triceps and subscapular skinfolds in a sample of 247 6- to 8-year-old urban Maya children from Yucatan, Mexico. Between September 2011 and January 2014, we obtained anthropometric and body composition data from children and mothers, as well as socioeconomic characteristics of participants and households. Grandmothers’ place of residence was categorized as either in the same household (...) as their grandchildren or in separate households. Multiple logistic regression models were used to analyze the association between grandmothers’ residency and outcome variables. Models were adjusted for maternal anthropometric characteristics and the following socioeconomic variables: family size, location, maternal education, monthly family income, and household crowding. Models showed that the presence of grandmothers in their grandchildren’s households was not associated with any of the outcome variables. In contrast, larger family size, overcrowding in the household, and lower family income predicted low height-for-age in children. Larger family size decreased the risk for being overweight based on the three parameters of body composition. Overcrowding in the household increased the risk for greater skinfolds thickness, while low family income increased the risk for higher fat mass index. The residency of grandmothers in their adult daughters’ households is not significantly associated with the outcome variables in this sample of urban Maya families. Instead, maternal anthropometric characteristics and socioeconomic conditions of the family have a greater influence on the overall growth of children. (shrink)

It is well known that environmental burdens are more pronounced in socioeconomically disadvantaged communities, a phenomenon known as environmental injustice. Yet, there have been few studies that have addressed whether the degree of environmental injustice has changed over time. We analyze toxic releases in the United States over the first 26 years of the toxics release inventory and examine whether the decreases in toxic releases differ according to characteristics of the communities in which the emitters reside. We find that (...) decreases over these years are universal but far more substantial in high-income areas. Our results speak to both the nascent literature on information disclosure and that on environmental justice. (shrink)

This paper firstly extracts the humanised design elements of urban small and micro public space from the connotation of urban small and micro public space and humanised design, and applies its design elements to actual projects. The questionnaire is taken as the main source of research data in this paper, and the independent variables, dependent variables and control variables are additionally set. Combining the research data with mathematical and statistical methods, we explore the interaction relationship between the humanised design of (...) urban micro and small public spaces and the subjective well-being of residents. It is found that the regional characteristics of the humanised design elements of urban small and micro public spaces have the greatest influence on subjective well-being, with a regression coefficient of 0.418. In addition, it can be concluded that site selection, regional characteristics, scale, and visual mentality have significant correlation on life happiness, life satisfaction, and economic satisfaction, satisfying P. (shrink)

With the advent of big data, the use of network data to characterize travel has gradually become a trend. Tencent Migration big data can fully, dynamically, immediately, and visually record the trajectories of population migrations with location-based service technology. Here, the daily population flow data of 346 cities during the Spring Festival travel rush in China were combined with different travel modes to measure the spatial structure and spatial patterns of an intercity trip network of Chinese residents. These data were (...) then used for a comprehensive depiction of the complex relationships between the population flows of cities. The results showed that there were obvious differences in the characteristics of urban networks from the perspective of different modes of travel. The intercity flow of aviation trips showed a core-periphery structure with national hub cities as the core distribution. Trips by train showed a core-periphery structure with cities along the national railway artery as the core. This gradually decreased toward hinterland cities. Moreover, the intercity flow of highway trips indicated a spatial pattern of strong local aggregation that matched the population scale. (shrink)

As the development trend of the future housing field, green housing is an effective way to reduce pollution, save energy, and promote industrial upgrading. At the same time, the green house is of great significance to change the development mode of the construction industry and promote the sustainable development of the social economy. This study proposes a comprehensive research model to examine the influencing mechanism of residents’ intention to purchase green buildings. The proposed model is empirically tested using data collected (...) from 1,338 urban residents in China. Based on logit, probit, and ivprobit models, factors such as personal characteristics, housing price, and the number of real estate ownership are selected to conduct empirical analysis and mechanism analysis on willingness that affects consumers’ purchase of green houses. The results show that housing assets significantly affect the willingness of householders to pay for green houses. The more houses they own, the higher their willingness to pay for a green house will be. Similarly, if the housing prices are higher, householders are more willing to buy a green house. The amount of housing assets will affect the willingness of householders to pay for green housing through the way of individual happiness. In terms of the characteristics of the householder, if the householder is more educated, unmarried, his willingness to buy a green house will be stronger, and owning housing assets may affect the individual happiness due to the housing wealth effect brought by rising housing prices. People with more housing assets are more likely to have the happiness brought by higher wealth, which may affect the purchase intention of householders. (shrink)

Using data from the China Family Panel Studies, this paper investigates the effects of Internet use on residents’ risk attitudes. Both Generalized Ordered Logit Model and Logit model are used to identify the effects of Internet use. The results reveal an association between Internet use and increases in both subjective and objective risk preferences that remains even after we adjust for possible endogeneity. The heterogeneity analysis also reveals that these impacts are different among groups with different reasons for Internet use (...) and different personal characteristics. Our study expands the research on the effects of Internet on people’s concepts from the micro perspective and suggests that while promoting the application of information technology we should also pay attention to the individual characteristics of residents so that we can better share the “digital dividend” brought by the popularization of information technology in the whole society. (shrink)

In 1991 the United Nations General Assembly adopted the Principles for Older Persons as a framework for international policy responses to population ageing. These principles promote independence, participation, care, self-fulfilment and dignity as legitimate entitlements of all older people. Although these principles, or variations of them, are embedded in standards of best-practice in residential aged care facilities, the literature shows that in reality institutional care can deny older people opportunities to exercise some of these entitlements. More specifically, residential aged care (...) facilities can deprive older people of access and support to pursue opportunities for the full development of their potential, i.e. their entitlement to self-fulfilment. This discussion article explores the influence of institutional care on older people’s ability to exercise their entitlement to self-fulfilment. We identify the characteristics of a ‘good life’ in institutional care, according to aged care residents themselves. The Eden Alternative™ is presented as a model of aged care that aims to create the conditions for a ‘good life’ and self-fulfilment for aged care residents. (shrink)

With the further acceleration of urbanization in China, the proportions of both urban residents’ energy consumption and energy-consuming terminal electricity are showing an increasing trend at the same time. In view of the dynamic and time-varying complex system characteristics of power system, it is of great significance to study the impact mechanism of urbanization residents’ electricity consumption on the realization of demand-side management and environmental protection. Based on the one-year follow-up survey data obtained from household meter reading, this paper (...) studies the impact mechanism of urban residents’ electricity consumption in different seasons and terminals by descriptive analysis and multiple linear regression model. The results show that, on the whole, electricity is a necessity for urban households and does not change significantly with changes in income. At the turn of summer and autumn and the turn of winter and spring, high-income families tend to use higher levels of energy in pursuit of comfort, while low- and middle-income families do not have luxury consumption. In different seasons, the influence mechanism of household electricity consumption at different terminals is different. (shrink)

The study aimed to examine the influence of personal characteristics on activity preferences using decision tree analysis and examine the effects of the variables using conventional approaches. A descriptive study was conducted with 251 nursing home residents with dementia in Korea to examine the relationship between their personal characteristics and activity preferences. Decision tree analysis was used to classify participants’ activity preferences, and preference levels were examined using logistic regression analysis. Activities were classified as either physical and social (...) activities or cognitive and affective activities. This model showed an accuracy rate of 85.7% for positively predicting physical and social activity preference and 30.3% for positively predicting cognitive and affective activity preference. Gender was the strongest determinant of activity preference. The odds of preferring physical and social activities were 3.179 times higher among women, while the odds for preferring cognitive and affective activities were 0.412 times higher among men. Notably, cognitive and affective activity preference increased to 58.8% for married male participants. This study’s findings can contribute to the development of programs to decrease behavioral and psychological symptoms among older people with dementia residing in nursing homes and provide scientific evidence for integrating these activities into long-term services for this population. (shrink)

The subject of the current study is the process of implementing the social housing policy and its impact on increasing the quality of life of vulnerable people. The analysis is related to the Social Housing Program introduced by the city of Gdańsk. The study has been carried out using the case study method with the use of document analysis, analysis of existing data, and five in-depth interviews with program managers. The theoretical framework has been developed around three major explicatory perspectives: (...) multi-level governance, QOL, and social exclusion. Meeting the housing needs is one of the primary tasks of local governments. If such a policy is to be called positive, it should be combined with social policy tasks related to social inclusion, and it should be carried out through partnerships forming housing cooperation networks. A characteristic feature of the cooperation is the cross-sectoral nature of the actors. The results have revealed a significant positive relationship between the use of social housing tools and the quality of satisfying the living needs of the residents. This study contributes to the discussion by revealing the role of social work and social and professional activation in meeting housing needs. The results suggest that a combination of housing and social policy measures can help vulnerable people develop social competencies conducive to housing maintenance and increase the social cohesion of local environments. (shrink)

Different nations responded to the global spread of COVID-19 differently. How do people view the governance practices and effects of various countries? What factors affect their views? Starting from the three-dimensional model of cognitive-affective-media, this study examines how pandemic perception, the national feeling, which is the emotional preference of public for different countries, and media use affect the Chinese public views on the performance of other countries in controlling COVID-19. After performing regression analysis on the data of 619 Chinese public (...) samples collected by an online survey, it reveals the following: pandemic perception is negatively correlated with the evaluation of controlling-pandemic performance in different countries by Chinese residents, whereas national feeling is positively correlated with the evaluation of controlling-pandemic performance. The use of media has different characteristics in the evaluation of controlling-pandemic performance in different countries by Chinese residents. Television has a significant influence on the evaluation of controlling-pandemic performance in the United States, China, and Germany by Chinese residents. Collectivist cultural orientation has no significant impact on the evaluation of the anti-pandemic performance of different countries by Chinese residents, whereas virus perception only has a significant impact on the evaluation of the controlling-pandemic performance of the United States and Italy. Research has confirmed the existence of the cognitive-affective-media model in the evaluations by public on the governance of other countries, and prospects for the superimposed role of media in the cognitive-affective model. (shrink)

Background: In the Netherlands, people with severe cognitive deficits due to Korsakoff syndrome are generally admitted to a specialized nursing home. Professional caregivers experience that these residents are often not aware of their deficits, and consequently, their willingness to accept care is relatively low. However, these residents need permanent support when performing daily tasks due to severe cognitive deficits. The combination of objective care needs and low subjective responsiveness makes caring for people with Korsakoff syndrome a complex undertaking. It is (...) unknown how professional caregivers deal with this complex task and how they manage the associated ethical challenges. Objectives: The aim of this study was to explore the professional caregivers’ perspectives on good care for residents with Korsakoff syndrome. Methods: A qualitative study design was used. Data were collected via semi-structured interviews. The Framework Method was used for the thematic analyses of the interview data. Participants and research context: Five specialized nursing homes participated in this study. Twelve professional caregivers, including nurses, nursing assistants, and support workers, were selected based on the ability to provide rich information on the study topics and to capture a variety of demographic and professional characteristics. Ethical considerations: The institutional review board of the VU University Medical Center Amsterdam approved the research protocol. The study was conducted in accordance with the ethical principles for medical research involving human subjects. Findings: Three perspectives on good care emerged: (1) making daily life a joint effort, (2) being steadfast, and (3) treating with respect. Discussion and conclusion: Professional caregivers try to achieve responsiveness in people with Korsakoff syndrome in three different ways. These perspectives reflect fundamentally different views on the care relationship and the autonomy of the resident. By elucidating the three perspectives, we hope to promote the practitioners’ reflection on their own ideas about good care for people with Korsakoff syndrome. (shrink)

The studies presented here apply the concept of entitativity in order to understand how belonging to a particular geographical area – neighborhood - can determine the way others organize information and form impressions about area’s residents. In order to achieve this objective, three studies were carried out. The first study aims to verify if a neighborhood varies in terms of perceived entitativity, and identify the physical and social characteristics of the neighborhoods that are more strongly associated with the perception (...) of entitativity. The Study 2 and 3 used an experimental paradigm to explore how people’s perceptions of neighborhoods’ entitativity influenced their impressions of residents. To activate stereotypes, Study 2 used the name of real neighborhoods, and Study 3 employed only a set of pictures of unknown neighborhoods. The results show that the neighborhoods vary significantly with the regard to the perception of entitativity, and a set of physical attributes of place were strongly related with entitativity. The results showed that, independent of stimuli, the neighborhoods perceived as highly entitative, the supposed residents were subject to more extreme and quicker trait judgments, supported by greater confidence on the part of perceivers. Study 3 also reported that in highly entitative neighborhoods, the perceivers transferred more traits from the group to individual members. These results provide strong evidence that physical structure of neighborhoods imply different entitatity judgments that influences the way in which residents are perceived. (shrink)

Biologists studying short-lived organisms have become aware of the need to recognize an explicit temporal extend of a population over a considerable time. In this article we outline the concept and the realm of populations with explicit spatial and temporary boundaries. We call such populations “temporally bounded populations”. In the concept, time is of the same importance as space in terms of a dimension to which a population is restricted. Two parameters not available for populations that are only spatially defined (...) characterise temporally bounded populations: total population size, which is the total number of individuals present within the temporal borders, and total residence time, which is the sum of the residence times of all individuals. We briefly review methods to estimate these parameters. We illustrate the concept for the large blue butterfly (Maculinea nausithous) and outline insights into ecological and conservation-relevant processes that cannot be gained without the use of the concept. (shrink)

The social banking market constitutes a small but rapidly growing submarket of the global banking sector. Due to an explicit commitment to sustainability, social banking is a segment of banking services which is not exclusively focused on economic performance criteria, but pursues ecological and social goal dimensions on an equal footing. Information on the number and reachability of potential social banking customers is essential for social banks to further promote sustainable consumption in finance. In scientific research, social banking is considered (...) a relatively new field, still lacking empirical analyses regarding the market size and specific consumer behaviour. This study addresses the research gap by generating first insights into the German social banking market. Based on an online survey using an adaptive conjoint analysis, a large data set covering 3537 respondents was compiled. Sample 1 comprises 2896 respondents who are customers of three major social banks in Germany. Sample 2 covers the remaining 641 respondents who represent the German adult population and exclusively buy from conventional banks. Logistic regression modelling reveals that social banking customers differ significantly from their conventional counterparts regarding several socio-demographic, behavioural and psychographic factors. In comparison with conventional banking customers, social banking customers tend to be younger, higher educated and located in larger places of residence. Contrary to existing research on socially responsible investors, they are male to a higher proportion than female. Moreover, social banking customers demonstrate stronger sustainable buying patterns and weaker preferences for financial, but stronger preferences for social return than conventional banking customers. The results further indicate a considerable untapped growth potential for social banks by uncovering a market size ranging between 10 and 26% of the German adult population. Finally, suggestions for marketing strategies and future research are given. (shrink)

Background The purpose of this study was to examine whether extended use of a variety of screen-based devices, in addition to television, was associated with poor dietary habits and other health-related characteristics and behaviors among US adults. The recent phenomenon of binge-watching was also explored. -/- Methods A survey to assess screen time across multiple devices, dietary habits, sleep duration and quality, perceived stress, self-rated health, physical activity, and body mass index, was administered to a sample of US adults (...) using the Qualtrics platform and distributed via Amazon Mechanical Turk (MTurk). Participants were adults 18 years of age and older, English speakers, current US residents, and owners of a television and at least one other device with a screen. Three different screen time categories (heavy, moderate, and light) were created for total screen time, and separately for screen time by type of screen, based on distribution tertiles. Kruskal-Wallis tests were conducted to examine differences in dietary habits and health-related characteristics between screen time categories. -/- Results Aggregate screen time across all devices totaled 17.5 h per day for heavy users. Heavy users reported the least healthful dietary patterns and the poorest health-related characteristics – including self-rated health – compared to moderate and light users. Moreover, unique dietary habits emerged when examining dietary patterns by type of screen separately, such that heavy users of TV and smartphone displayed the least healthful dietary patterns compared to heavy users of TV-connected devices, laptop, and tablet. Binge-watching was also significantly associated with less healthy dietary patterns, including frequency of fast-food consumption as well as eating family meals in front of a television, and perceived stress. -/- Conclusions The present study found that poorer dietary choices, as well as other negative health-related impacts, occurred more often as the viewing time of a variety of different screen-based devices increased in a sample of US adults. Future research is needed to better understand what factors among different screen-based devices might affect health behaviors and in turn health-related outcomes. Research is also required to better understand how binge-watching behavior contributes impacts health-related behaviors and characteristics. (shrink)

RESUMEN. El autor describe algunos elementos distintivos del estatus y de las funciones del ciudadano en la Atenas del siglo V así como en el contexto democrático ateniense, en el que nació la figura del ciudadano. Pone de relieve el carácter excluyente y las instituciones "limitadas" que hacen de la ciudadanía un estatus exclusivo, reservado para los hombres, para los hijos de ambos padres atenienses y que de esa manera excluía a los extranjeros residentes (metecos), a los otros griegos y (...) a los bárbaros. A partir de la categoría aristotélica de "ciudadano en sentido absoluto", el autor muestra cómo incluso dentro de la comunidad de los atenienses libres, por varias razones, grupos como el de los jóvenes, de los ancianos y de las mujeres en particular, estén excluidos de la plena participación en la vida política de la ciudad, en definitiva, a las decisiones y la gestión del poder. Al mismo tiempo, la investigación muestra cómo los atenienses, a pesar de que sean una minoría de hombres libres dentro de la ciudad, durante dos siglos en forma gradual desarrollen un alto nivel de participación en la vida política de la ciudad, en el sentido de que incluso las clases menos privilegiadas pudieran ocupar cargos políticos que antes eran reservados solo para los más ricos. De este modo se aplicaría plenamente el principio democrático con el cual todo el pueblo gobierna y, al mismo tiempo, a través del primer ejército hecho enteramente de ciudadanos, defiendan sus propias decisiones. ABSTRACT. The author describes a number of distinctive traits of the status and role of citizens in the democratic Athens of the 5th-century BC and in the Athenian democratic framework which saw the establishment of the figure of the citizen. He highlights the exclusiveness of citizenship and the legal institutes that “closed” access to citizenship status. Citizenship was reserved to males born to Athenian parents, and excluded resident aliens (meteci), the other Greeks and the Barbarians. Starting with the Aristotelian category of “citizens in the absolute sense”, the author shows that even within the community of free Athenians, young people, the elderly and, above all, women, were barred from fully participating in the political life of the city for various reasons. Such categories were in all effects excluded from the decision-making process and from the management of power. At the same time the research shows how Athenian citizens, made up of free men which formed but a minority in the city population, succeeded within two centuries to fully develop a high degree of participation in the political life of the city. It was not long before members of lower-income groups started holding key positions in the city that were previously reserved to individuals belonging to the wealthier classes. It was a turnaround that reflected the full realisation of the democratic principle according to which it was the people of Athens as a whole that governed and defended the choices made with an army made up of Athenian citizens. (shrink)

In the UK, over 70% of AIDS, including new cases, is located in a few Districts in central London where the distribution of previously occurring and new cases is essentially confined to the original risk groups of homosexual/bisexual men, drug addicts of both sexes, and some of their sexual partners and consorts. But control policy is still based on the assumption that HIV has already spread from persons in these risk groups into the general population, and that it will spread (...) hereafter at an increased rate because of heterosexual transmission to cause a widespread epidemic of AIDS.The basis and implications of this policy were investigated in the South East region adjacent to London, Analysis of demographic and epidemiological data shows that, with one exception, there is very little extension of AIDS from affected Districts in London to the surrounding region or even to the suburban fringe. Where AIDS is prevalent, as in this exception, the distribution follows the same, original pattern which relates essentially to risks arising from life-styles. There is no significant association between the prevalence or spread of AIDS and conventional markers of deprivation, economic and social disadvantage.Allocations of personnel, services and expenditure, assessed from returns required under the AIDS Control Act of 1987 and official registration data, continue to follow the original policy assumptions. They are therefore unrelated to the numbers of existing and new cases, disproportionate and unrealistic. Claims that this widespread excess of effort is justified by the fact that AIDS has not spread to the general population are falsified by the continuation of cases almost exclusively in risk groups. There is nothing in the data required under the Act or in registrations in this main locus of AIDS in the UK to suggest any change in this or to justify continuation of current expenditure and redundant activities.There is no evidence in these data that ethnic variations in the resident populations of Districts are associated with variations in the prevalence of AIDS. However, the larger figures available in some of the national data do indicate a disproportionate increase in some minority ethnic groups. Further detail about risks factors in these groups are required and, meanwhile, effort and expenditure should be re-orientated toward treatment, contact tracing and other public health measures for more effective containment of the continuing spread of AIDS in all the high risk groups. (shrink)

Effects of globalization have amplified the magnitude and frequency of corporate abuses, particularly in developing economies where weak or absent rules undermine social norms and principles. Improving multinational enterprises’ (MNEs) ethical conduct is a factor of both the ability of firms to change behaviors in the direction of the moral good, and their willingness to do so. Constraints and enablers of a firm’s ability to act ethically emanate from the external environment, including the industry environment of which the firm is (...) a resident, and the host country environment in which it operates. A firm’s willingness to engage in ethical conduct is determined by the effective bundling of internal resources and the commitment of those resources to social ends. The interaction of external and internal conditions carves out categories of expected firm behaviors and suggests interventions that would push these behaviors in a more positive ethical direction. With reference to integrative social contracts theory (ISCT), these categories of firms are examined, and a conceptual model for analysis is developed to explain the drivers of corporate choices in the adoption and implementation of codes of conduct, and the relative power of relevant communities to the process. (shrink)

Despite the prevalent role of guanxi in conducting business in Chinese, it is unclear whether interpersonal guanxi fosters interfirm trust. Taking a contingency approach, this study examines how institutional (government–market relationship and Buddhism influence) and individual (relative role performance and the span of partner control) factors moderate the association between interpersonal guanxi and interfirm trust. Based on a paired survey between salespersons and sales managers and two secondary datasets, this study finds that interpersonal guanxi is positively associated with interfirm trust. (...) Moreover, this positive effect is stronger when firms operate in regions with strong government–market relationships and strong Buddhism influence. In addition, the positive relationship is weaker when guanxi resides in boundary spanners who have relatively high role performance, but becomes stronger when boundary spanners have a broad span of partner control. These findings highlight the situations in which guanxi at an interpersonal level is more or less likely to foster interfirm trust. (shrink)

The city of Kruja (Albania)contains three types of dwellings that date back to different periods of time: the historic ones, the socialist ones, the modern ones. This paper has to deal only with the historic building's typology. The questionnaire that is applied will be considered for the development of mathematical regression based on specific data for this category. Variation between the relevant variables of the questionnaire is fairly or inverse-linked with a certain percentage of influence. The aim of this study (...) is to have better insights into the important role of building occupancy, people's lifestyle, economic level, and the quality of life of the residents in the inner medieval citadel, the physics characteristics, and the energy efficiency of the historical dwellings. The variables such as the number of residents, quality of life, the surface of the dwellings, heating instruments and time spent in the dwelling, current living conditions, monthly bills, level of satisfaction, restoration, and building improvements, interact with each other with probabilities with different positive or negative percentages. (shrink)

Play resides at the heart of the Platonic dialogues, shaping their insights as well as informing their style. "The Play of the Platonic Dialogues" traces the prominent role of play, both as a general philosophical characteristic and as influencing the treatment of key issues. The nature of the forms, of the city, of virtue, of the soul and its immortality - these and others have been shaped by play. This book shows how Platonic playfulness is joined with the deepest seriousness (...) throughout the dialogues. (shrink)

Background: Centralization of IRB reviews have been increasing in the US and elsewhere, but many questions about it remain. In the US, a few centralized IRBs (CIRBs) have been established, but how they do and could operate remain unclear. Methods: I contacted 60 IRBs (every fourth one in the list of the top 240 institutions by NIH funding), and interviewed leaders from 34 (response rate = 55%) and an additional 12 members and administrators. Results: These interviewees had often interacted with (...) CIRBs, but supported local reviews, and offered advantages and disadvantages of each. Interviewees argued that local IRBs can provide "local knowledge" of subjects and PIs, and "curbside consults" with PIs, facilitating mutual trust. PIs may interact more fully and informally, and hence effectively with local IRBs. IRBs also felt additional responsibility to protect "their own" subjects. Respondents mentioned a few advantages of CIRBs (e.g., CIRBs may streamline reviews), though far more rarely and cursorily. Overall, interviewees were wary of CIRBs, which they saw as varying widely in quality, depending on who happened to be members. Both local and centralized IRBs appear to have unintended consequences. For instance, discrepancies arose between IRBs that appeared to reflect differences in institutional culture and history, and personalities of chairs and/or vocal members, more than in local community values per se, and thus do not seem to be the intent of the regulations. While some critics see CIRBs as solutions to many IRB problems, critical tradeoffs and uncertainties emerge. Conclusions: These data have critical implications for future policy and research. Debates need to evolve beyond simply a binary discussion of whether CIRBs should replace local IRBs, to examine how and to what degree different models might operate, and what the relative advantages and disadvantages of each are. While some critics see CIRBs as panaceas, certain problems appear likely to continue. Careful consideration needs to be given to whether the advantages of local IRBs outweigh the problems that result, and whether a system can be developed that provides these benefits, while avoiding the disadvantages of local IRBs. (shrink)

Residency training in the Netherlands is to be restructured over the coming years. To this end a general competence profile for medical specialists has been introduced. This profile is nearly the same as the Canadian CanMEDS 2000 model, which describes seven general areas of medical specialist competence, one of which is professionalism. In order to establish a training programme for residents and their instructors based on this competence, it is necessary to develop a vision that does justice to everyday medical (...) practice. The two most prevailing views of professionalism—as personal, or as a behavioural characteristic—fall short of this. Only when professionalism is understood as reflective professionalism does it encompass the fundamental contextuality of medical treatment. This means that the focus of training and assessment must be shifted to accountability for treatment. (shrink)

Reflecting on a three year long exploratory research of ethics committees in the Czech Republic authors discuss the current role and identity of research ethics committees. The research of Czech ethics committees focused on both self-presentation and self-understanding of ECs members, and how other stakeholders (representatives of the pharmaceutical industry) view them. The exploratory research was based on formal and informal communication with the members of the ethics committees. Members of the research team took part at six regular voluntary meetings (...) of the ethics committees' members, organised by the Forum of Czech Ethics Committees, and at three summer schools of medical ethics. There were realised twenty-five semi-structured interviews as well as six focus group sessions and a participant observation of several regular meetings of three ethics committees. On the grounds of experience from the interviews a simple questionnaire survey was realised among the members of the ethics committees. The ethics committees comprise a community of members working voluntarily, without claims to remuneration or prestige; the unifying goal is protection of subjects of research. The principal working methods are dialogue and agreement. The members of the ethics committees thus, among other things, create an informal community, which can be to a certain extent seen as a Kantian ethical community in a weak sense. The phenomenon of ethics committees can also be described by terms of an epistemic community and a community of practice. These concepts, which are borrowed from other authors and areas, are used as a way how to think of ECs role and identity a bit differently and are meant as a contribution to the current international debate on the topic. (shrink)

Those residing in the Rocky Mountains enjoy both nature and culture in ways not characteristic of many inhabited landscapes. Landscapes elsewhere in the United States and in Europe involve a nature-culture synthesis. An original nature, once encountered by settlers, has been transformed by a dominating culture, and on the resulting landscape, there is little experience of primordial nature. On Rocky Mountain landscapes, the model is an ellipse with two foci. Much of the landscape is in synthesis, but there is much (...) landscape where the principal determinant remains spontaneous nature, contrasted with the developed, rebuilt landscape in which the principal determinant is culture. Life in the Rockies permits both use and admiration of nature, with constant reminders that the human scale of values is rather tentatively localized in a more comprehensive environment. (shrink)

Should people with exceptionally profound disabilities be given an equal chance of surviving a pandemic, even when their care might require a greater use of limited medical resources? How might an ethics of care be used to shape a policy regarding these patients?

‘Researcher identity’ affects global health research in profound and complex ways. Anthropologists in particular have led the way in portraying the multiple, and sometimes tension-generating, identities that researchers ascribe to themselves, or have ascribed to them, in their places of research. However, the central importance of researcher identity in the ethical conduct of global health research has yet to be fully appreciated. The capacity of researchers to respond effectively to the ethical tensions surrounding their identities is hampered by lack of (...) conceptual clarity, as to the nature and scope of the issues involved. This paper strives to provide some clarification of these ethical tensions by considering researcher identity from the perspective of (1) Guillemin and Heggen's (2009) key distinction between procedural ethics and ethics in practice, and (2) our own distinction between perceptions of identity that are either symmetrical or asymmetrical, with the potential to shift research relationships toward greater or lesser ethical harmony. Discussion of these concepts is supported with ethnographic examples from relevant literature and from our own (United States (US) Government-funded) research in South Africa. A preliminary set of recommendations is provided in an effort to equip researchers with a greater sense of organization and control over the ethics of researcher identity. The paper concludes that the complex construction of researcher identity needs to be central among the ethical concerns of global health researchers, and that the conceptual tools discussed in the paper are a useful starting point for better organizing and acting on these ethical concerns. (shrink)

The rapid acceleration of societal change has subjected contemporary individuals to prolonged periods of diverse pressures, leading to substantial psychological strain, resulting in anxiety, depression, and compromised mental well-being. Within this context, the home has evolved into a vital refuge for modern individuals, offering both physical and psychological respite. Through experimental intervention, this study examines two distinct residential groups: those adhering to traditional housing and those residing in characteristic folk houses, specifically Gannan Hakka architecture. Analysing the psychological state of contemporary (...) individuals and integrating Gannan Hakka architectural elements into folk house design through a psychologically informed approach, this research aims to enhance residents’ aesthetic experiences and alleviate psychological distress. The study involved 120 volunteers with varying psychological stress levels, categorised into characteristic and traditional folk house groups. Psychological assessments evaluated stress, self-efficacy, and quality of life. Findings reveal significantly improved psychological well-being, self-efficacy, and quality of life among the characteristic residential group, affirming the benefits of Gannan Hakka architecture integration. This research underscores the importance of addressing modern individuals’ environmental needs and proposes the integration of Gannan Hakka cultural elements into residential design to enhance well-being. Contribution: This study demonstrates the application of Hakka culture in contemporary housing profoundly influences residents’ lives, enabling both relaxation and a deeper cultural connection. This integration facilitates a comprehensive understanding of Hakka culture, promoting its preservation. Notably recognised for hospitality and diligence, Hakka culture enhances individuals’ appreciation of tradition, fostering physical and mental rejuvenation. These findings offer valuable insights for practical theology scholars and practitioners exploring the impact of religious aspects on modern residential design from a psychological perspective. (shrink)

Those residing in the Rocky Mountains enjoy both nature and culture in ways not characteristic of many inhabited landscapes. Landscapes elsewhere in the United States and in Europe involve a nature-culture synthesis. An original nature, once encountered by settlers, has been transformed by a dominating culture, and on the resulting landscape, there is little experience of primordial nature. On Rocky Mountain landscapes, the model is an ellipse with two foci. Much of the landscape is in synthesis, but there is much (...) landscape where the principal determinant remains spontaneous nature, contrasted with the developed, rebuilt landscape in which the principal determinant is culture. Life in the Rockies permits both use and admiration of nature (fruited plains), with constant reminders (mountain majesties) that the human scale of values is rather tentatively localized in a more comprehensive environment. (shrink)

The main characteristic of the French local tax system undoubtedly resides in a convoluted structure which impedes any progress in the development of tax competition between local authorities. On the contrary, recent legislative evolutions make obvious a trend of recentralization of the French local finance system illustrated by the fact the State is presently the first tax contributor to the local authorities’ budgets. As a result, it becomes blatant that any new competence transfer to the local authorities without setting up (...) an explicit financing scheme for these transfers will put an end to the local authorities’ autonomy.L’ensemble du système fiscal local français est caractérisé par une structure complexe peu propice au développement de la concurrence fiscale entre collectivités locales. Bien au contraire, les évolutions récentes témoignent d’un phénomène de recentralisation des finances locales françaises par lequel l’Etat devient le premier contributeur à la fiscalité des collectivités locales. Au total, il semble évident que tout accroissement de transfert de compétences non accompagné d’une remise à plat du système fiscal local français ne peut conduire à terme qu’à la fin de l’autonomie des collectivités locales. (shrink)

The Yi nationality mainly resides in Yunnan province, Sichuan province and Guizhou province and has a large population. After their antecedents entered into class society, in marriage status, there formed characteristics of inner nationality marriage, outer clan marriage, inner class marriage and trans-family marriage. After the establishment of chieftain system, the level of chieftains appointed by the central kingdom is beyond all other classes and would not marry those of lower classes. They would only marry chieftain families of the (...) same classes. Therefore, their marriage covers Yunnan, Guizhou and Sichuan provinces. On another hand, since the Ming Dynasty, Yi chieftain areas had experienced dramatic social reforms, which also changed the original class system. It was then hard to maintain the originally fixed marriage relationship. They had to change their traditional marriage concepts, after which more and more inner nationality marriages and cross-class marriages occurred. Therefore, their marriage characteristics were in a contradict development of tradition and change, which exerted important and long lasting influence over the southeastern area. (shrink)

Objectives: To explore how subjects in a placebo-controlled vitamin A supplementation trial among Ghanaian women aged 15–45 years perceive the trial and whether they know that not all trial capsules are the same, and to identify factors associated with this knowledge.Methods: 60 semistructured interviews and 12 focus groups were conducted to explore subjects’ perceptions of the trial. Steps were taken to address areas of low comprehension, including retraining fieldworkers. 1971 trial subjects were randomly selected for a survey measuring their knowledge (...) that not all trial capsules are the same. The subjects’ fieldworkers were also interviewed about their characteristics and trial knowledge. Factors associated with knowledge were explored using multi-level modeling.Results: Although subjects knew they were taking part in research, most thought they were receiving an active and beneficial medication. Variables associated with knowledge were education and district of residence. Radio broadcasts benefited those with some schooling. Fieldworkers’ characteristics were not associated with subjects’ knowledge.Conclusions: Research and debate on new or improved consent procedures are urgently required, particularly for subjects with little education. (shrink)

The purpose of this article is to present a phenomenological description of how athletes in specific risk sports explore human interaction with natural elements. Skydivers play with, and surf on, the encountering air while falling towards the ground. Kayakers play on the waves and with the stoppers and currents in the rivers. Climbers are ballerinas of the vertical, using cracks and holds in the cliffs to pull upwards against gravity forces. The theoretical background for the description is found in the (...) phenomenology of Heidegger and Merleau-Ponty. The phenomenology of Husserl focused on the theoretical intentionality of the transcendental ego. With Heidegger the human being's concrete and practical interaction with the environing world moved to the foreground. Heidegger's analyses of ?equipmentality? also throw important light on equipmentality in sports and how we deal with tools and equipment in sports. However, in Heidegger's analyses the body resides in the background both as subject and object. The importance of the active body-subject is well documented in the work of Merleau-Ponty, and also Todes. The human being is a bodily ?being-in-the-world? and the body is the active medium through which the world is grasped. The body is however also situated and aligned with the fundamental dimensions of the world, with vertical gravity and with horizontal action space. In this article I show in a concrete way how in some sports we use fundamental characteristics of the environing world in a mode of playfulness. In these sports human beings play in an extreme way with fundamental elements of nature. The article thus puts phenomenology to a test. It should be able to move from general characteristics to specific features of our bodily human involvement with the environing world. (shrink)

I consider different versions of a structuralist view of mathematical objects, according to which characteristic mathematical objects have no more of a 'nature' than is given by the basic relations of a structure in which they reside. My own version of such a view is non-eliminative in the sense that it does not lead to a programme for eliminating reference to mathematical objects. I reply to criticisms of non-eliminative structuralism recently advanced by Keränen and Hellman. In replying to the former, (...) I rely on a distinction between 'basic' and 'constructed' structures. A conclusion is that ideas from the metaphysical tradition can be misleading when applied to the objects of modern mathematics. (shrink)

William James argued for a philosophy of democracy and pluralism that advocates individual and collective responsibility for our social arrangements, our morality, and our religion. In James' view, democracy resides first and foremost not in governmental institutions or in procedures such as voting, but rather in the characteristics of individuals, and in qualities of mind and conduct. It is a philosophy for social change, counselling action and hope despite the manifold challenges facing democratic politics, and these issues still resonate (...) strongly today. In this book, Stephen Bush explores how these themes connect to James' philosophy of religion, his moral thought, his epistemology, his psychology, and his metaphysics. His fresh and original study highlights the relevance of James' thought to modern debates, and will appeal to scholars and students of moral and political philosophy. (shrink)

During the pandemic lockdown period, residents had to stay at home and increased stress and other mental health problems have been associated with the lockdown period. Since most public parks were closed, community parks within gated residential areas became the most important green space in Chinese cities, and the use of such space might help to reduce the residents’ stress levels. This study aimed to investigate to what extent urban residents in China used community parks, engaged in outdoor activity during (...) the lockdown period and if the use of such spaces helped to reduce their stress levels. An online questionnaire survey was carried out from 23 March to 23 April 2020. Ordinary Least Squares regression was used to analyse the association between community park use, outdoor activity, willingness to engage in outdoor activity, and stress level. All results have been further analysed by two-sampled t-test to explore the difference between young and old age groups. We found that the overall self-reported stress level of the respondents was relatively moderate during the lockdown period. Respondents had generally reduced their use of community parks and engagement in outdoor activity. There was no significant association between stress level and the use of community parks or the engagement in outdoor activities. However, we found that older people showed much lower stress levels, used community parks more frequently, and engaged in more outdoor activities than younger adults. The findings suggest that outdoor activities and spatial characteristics in urban China differ from Western studies and advance the need to integrate the stress management role of community parks with urban green space policy to optimise the use of community parks blended in with everyday life, particularly during the lockdown period. (shrink)

“This is surely the ultimate expression of the top-down approach to consciousness, written with Sommerhoff's characteristic clarity and precision. It says far more than other books four times the size of this admirably concise volume. This book is destined to become a pillar of the subject.” —Rodney Cotterill, Technical University of Denmark The problem of consciousness has been described as a mystery about which we are still in a terrible muddle and in Understanding Consciousness: Its Function and Brain Processes, the (...) author attempts to unravel this mystery by offering a clarification of the main concepts related to consciousness, and positing a comprehensive biological explanation. Consequently, this book will be ideal for a wide-range of upper level undergraduate and postgraduate courses. The author interprets consciousness as a property that can be possessed by many creatures lacking a language faculty and comprises all of the following: awareness of the surrounding world; awareness of the self as an entity; and awareness of such things as thoughts and feelings. He argues that a biological approach can achieve both the necessary conceptual clarifications and a joint explanation of these divisions of awareness in terms of just two accurately defined concepts of 'internal representation' and two empirically supported assumptions about the functional architecture of a specific set of brain processes. Despite this striking simplicity, his model covers these divisions of awareness both as objective faculties of the brain and as subjective experience. These conclusions are applied to a broad range of fundamental questions, including the biological rationale of subjective experience and where consciousness resides in the neural networks. (shrink)

Civic agriculture is an approach to agriculture and food production that—in contrast with the industrial food system—is embedded in local environmental, social, and economic contexts. Alongside proliferation of the alternative food projects that characterize civic agriculture, growing literature critiques how their implementation runs counter to the ideal of civic agriculture. This study assesses the relevance of three such critiques to urban farming, aiming to understand how different farming models balance civic and economic exchange, prioritize food justice, and create socially inclusive (...) spaces. Using a case study approach that incorporated interviews, participant observation, and document review, I compare two urban farms in Baltimore, Maryland—a “community farm” that emphasizes community engagement, and a “commercial farm” that focuses on job creation. Findings reveal the community farm prioritizes civic participation and food access for low-income residents, and strives to create socially inclusive space. However, the farmers’ “outsider” status challenges community engagement efforts. The commercial farm focuses on financial sustainability rather than participatory processes or food equity, reflecting the use of food production as a means toward community development rather than propagation of a food citizenry. Both farms meet authentic needs that contribute to neighborhood improvement, though findings suggest a lack of interest by residents in obtaining urban farm food, raising concerns about its appeal and accessibility to diverse consumers. Though not equally participatory, equitable, or social inclusive, both farms exemplify projects physically and philosophically rooted in the local social context, necessary characteristics for promoting civic engagement with the food system. (shrink)

Profiles of art education in nineteen countries around the world by citizens or longtime residents of those countries comprise the core of this book. Guidelines for the cross-cultural study of art education are presented by the editors in a general introduction and three part introductions, and also by contributing specialists. The nineteen national profiles, with accompanying examples of children's artwork, make up the largest section of the book, Part II. The three chapters in Part I review research that has identified, (...) on one hand, certain universal characteristics of children's artwork attributable to common human stages of development, and, on the other hand, certain differing and unique cultural influences. The need for further research on this distinction is emphasized. Contributors to Part I are Elliot W. Eisner, William Ives and Howard Gardner, and Marjorie and Brent Wilson. The three chapters in Part III discuss three major problems in art education: the use of museum visits, the worldwide attempt to establish valid tests of teacher and pupil proficiency in art, and the design of sound and useful cross-cultural research. Resources for such research are described. Contributors to Part III are Robert Ott and Lois Swan Jones, William Bradley, and Frances E. Anderson. Professionals and students in art education can broaden their perspective through Art in Education, while their counterparts in child development and psychology can gain insights into the creative process. Profiles: Western Europe—England,Finland, Germany, Netherlands; Eastern Europe—Hungary, Poland, Soviet Union; Middle East and South Asia Afghanistan, Egypt, India, Israel; East Asia and the Pacific Australia, China, Japan; Africa—Ghana, Nigeria, South Africa; The Americas—Brazil, United States. (shrink)

This paper offers an introduction to the philosophy and science of embodied learning, conceived as both the stabilizing and expansionary process that sustains order and novelty within learners’ worlds enacted through observing and describing. Embodied learning acknowledges stability and change as the purposeful conjoined characteristics that sustain learners. It is, in many respects, a composite theory that represents work from various disciplines. This ‘naturalized epistemology’ conceives a world of fact inevitably imbued with the values that our own structural histories (...) guarantee us observers, whether acknowledged or not within our reflective awareness. These values, however, are not simple sets of preferences, for they are constituted in our individual learning histories that, for good or bad, influence the course of future learning. This conservational element of our condition is only half the story, however. The more radical aspect resides in the expansionary capacity of embodied observers to change, to enact worlds that are not pre‐given but, rather, brought forth by learners as observers and describers. Furthermore, embodied learning seeks a grounding for understanding in the often‐unexplored epistemological terrain between positivist absolutism or its mirrored polar opposite, postmodern nihilism. Its epistemological stance derives from its ontology, which is grounded in the profound obviousness that ‘everything said is said by someone’. (shrink)

Patterns of human kinship commonly involve preferential treatment of relatives based on lineal descent (lineages) rather than degree of genetic relatedness (kindreds), presenting a challenge for inclusive fitness theory. Here, we examine effects of lineage and kindred characteristics on reproductive success (RS) and number of grandchildren for 130 men and 124 women in a horticultural community on Dominica. Kindreds had little effect on fitness independently of lineage characteristics. Fitness increased with the number of lineal relatives residing in the (...) community but decreased beyond an apparently optimal lineage size, suggesting resource enhancement and competition among kin. Female-biased patrilineage sex ratio was positively associated with men’s fitness, while male-biased matrilineage sex ratio was positively associated with women’s fitness. Number of brothers in the community was negatively associated with men’s, but not women’s, fitness. Parents and number of sisters had no effect on either male or female reproduction; however, women with younger sisters had higher RS, suggesting benefits of kin support for childcare. In sum, imposed norms for lineage social organization may enhance lineal ancestors’ inclusive fitness at a cost to individual inclusive fitness. (shrink)

Objective Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians’ attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus. Design, Setting, Participants A survey of resident/fellow physicians and internal medicine (...) attendings at an academic medical center, May to August 2013. Measurements We used a 24-item, internet-based survey assessing physician-respondents’ demographic characteristics, knowledge, and attitudes regarding decisional authority for adult VA-ECMO. Qualitative narratives were also collected. Main Results A total of 179 physicians completed the survey (15 percent response rate); 48 percent attendings and 52 percent residents/ fellows. Only 32 percent of the respondents indicated that a surrogate’s consent should be required to discontinue VA-ECMO; 56 percent felt that physicians should have the right to discontinue VA-ECMO over a surrogate’s objection. Those who self-reported as “knowledgeable” about VA-ECMO, compared to those who did not, more frequently replied that there should not be presumed consent for VA-ECMO (47.6 percent versus 33.3 percent, p = 0.007), that physicians should have the right to discontinue VAECMO over a surrogate’s objection (76.2 percent versus 50 percent, p = 0.02) and that, given its cost, the use of VA-ECMO should be restricted (81.0 percent versus 54.4 percent, p = 0.005). Conclusions Surveyed physicians, especially those who self-reported as knowledgeable about VA-ECMO and/or were specialists in pulmonary/ critical care, favored a medical locus of decisional authority for VA-ECMO. VA-ECMO is complex, and the data may (1) reflect physicians’ hesitance to cede authority to presumably less knowledgeable patients and surrogates, (2) stem from a stewardship of resources perspective, and/or (3) point to practical efforts to avoid futility and utility disputes. Whether these results indicate a more widespread reversion to paternalism or a more circumscribed usurping of decisional authority occasioned by VA-ECMO necessitates further study. (shrink)

Although we theorize that nurses ‘make a difference’ to patient outcomes and speculate that this happens because nurses ‘care’, there is so far little evidence to support this nebulous claim. Efforts to promote care as the defining characteristic of nursing, and an ‘ethic of care’ as the ethical basis of nursing, have sparked debate within the discipline. This debate has resulted in a polarization that has effectively stalled productive discourse on the issues. Moreover, the focus on care has been at (...) the expense of understanding the true nature of the relationship between caring and the broader base of ethical knowledge that underpins nursing and that must underpin nursing if it is a viable practice profession. This paper used the framework of philosophical argument to explore the moral and ethical foundations of nursing from the perspective of personal and public morals, and responsive nurse–patient relationships as the reflection of ethical nursing knowledge. The foundation of ethical nursing knowledge is the personal moral sense that resides within the individual and that nurses hold in common with others. Personal moral knowledge is transformed into disciplinary ethical knowledge specific to nursing through disciplinary consensus. Responsive relationships are conceptualized in the nursing literature as founded on three essential elements: respect, trust, and mutuality. These three elements are grounded in ethical nursing knowledge; therefore responsive nurse–patient relationships reflect both personal moral knowledge and disciplinary ethical knowledge. By facilitating the articulation of ethical nursing knowledge in practice, responsive relationships connect theory, ethical knowledge, and clinical outcomes. (shrink)

This article gives a survey of the position of migrant workers in the Belgian labor market and social security system. Total employment of migrants has increased from 114,000 in 1954 to 224,900 in 1970.In contrast to overall employment in the Belgian economy, it went on climbing till 1978, up to a 245,900 level. Beyond this year, forecasts point at a slight decrease. Since WWII, the gravity point of the sectoral division of migrant workers has shifted from minig and industry, to (...) industry and tertiary activities. The share of industry in the employment of migrants bas remained relatively stable, in contrast to the tertiary sector, that witnessed a considerable expansion. However, the latter has not contributed substantially to the quality level of the average guest worker's job.On the whole, there is a strong correspondence between the unstable position of migrants in the labor market and their demographic characteristics on one side, their participation in the social security system on the other side. Their young family structure is reflected in a high share in family allowances and a limited appeal to pension funds. Statistical analysis at the aggregate level does not point at discriminatory practices vis-à-vis migrants and their families in social security ; but at thedisaggregate level and through the inspection of laws, regulations and international conventions, it appears that non-EEC nationals, with an unstable professional career, do not have the same rights as Belgians or EEC-citizens having a confortable position in the labor market and the social security system. In order to guarantee the rights of the farmer, the author suggests to establish a citizenship entitling to full social security rights after five years of regular residence in Belgium. (shrink)