Während der größte Teil der Bevölkerung die kieferorthopädische Therapie, also die Veränderung der Zahn- bzw. Kieferstellung, als eine Behandlung betrachtet, die vor allem auf eine Verbesserung des Erscheinungsbildes zielt, sehen der kieferorthopädische und zahnärztliche Berufsstand sowie auch private und öffentliche Kostenträger in bestimmten Abweichungen von Zahn- oder Kieferstellungen eine Gefährdung der oralen Gesundheit und der Funktionsfähigkeit des Gebisses. Letztere Auffassung bestimmt das ärztliche Handeln in der Kieferorthopädie und begründet auch die Übernahme zumindest bestimmter Leistungen durch die gesetzlichen Krankenkassen. Anhand aktueller (...) wissenschaftlicher Erkenntnisse lassen sich jedoch in vielen Fällen keine (akuten oder potentiellen) gesundheitlichen oder essentiellen funktionellen Beeinträchtigungen und Risiken abweichender Zahnstellungen nachweisen. Ziel dieses Aufsatzes ist es, diesem Widerspruch nachzugehen. Im Folgenden werden wir aufzeigen, welche Faktoren die Anbieter kieferorthopädischer Leistungen beeinflussen, welches die entscheidenden Gründe und Grundlagen für die Behandlung sind und an welchen Kriterien sich die Leistungsübernahme durch die Krankenkassen orientiert. Dabei wird deutlich werden, dass die formalen Kriterien von Behandlung und Kostenübernahme, die tatsächliche Behandlungs- und Kostenerstattungspraxis, die Erwartungen derjenigen, die Behandlungsleistungen in Anspruch nehmen und der aktuelle Stand der Forschung zu erwartbaren Funktionsbeeinträchtigungen durch Zahnstellungsvariationen nicht zwanglos zu vereinbaren sind. Erforderlich erscheint ein interdisziplinärer normativer Diskurs über die Frage, wie die diagnostizierten Spannungen aufzulösen wären. Als Anregung für einen solchen Diskurs werden wir im Ausblick alternative Lösungsstrategien vorstellen. (shrink)

Patient-centeredness can be considered a popular, and at the same time “fuzzy”, concept. Scientists have proposed different definitions and models. The present article studies scientific publications that discuss the meaning of patient-centeredness to identify different “discourses” of patient-centeredness. Three discourses are presented; the first is labelled as “caring for patients”, the second as “empowering patients” and the third as “being responsive”. Each of these discourses has different things to say about the why of patient-centeredness; the patient’s identity; the role of (...) the healthcare professional; responsibilities for medical decision-making, and the role of health information. This article compares and contrasts the discourses in ways that allow us to see differences that matter for practitioners in healthcare. On the basis of a relational constructionist philosophy, it is argued that discursive diversity is both an inevitable and a potentially valuable aspect of conversations in healthcare. We are therefore invited to center the challenge of dealing with diversity in productive ways. This article ends with a discussion of the practical implications of the discourse analysis for projects that aim to make healthcare more patient-centered. Debates on patient-centered “Health Information Exchange” are used to explain the need for a recognition of different discourses of patient-centeredness and a reflexive stance towards them. (shrink)

In this paper we show that some standard topological constructions may be fruitfully used in the theory of closure spaces (see [5], [4]). These possibilities are exemplified by the classical theorem on the universality of the Alexandroff's cube for T 0-closure spaces. It turns out that the closure space of all filters in the lattice of all subsets forms a generalized Alexandroff's cube that is universal for T 0-closure spaces. By this theorem we obtain the following characterization of the consequence (...) operator of the classical logic: If is a countable set and C: P() P() is a closure operator on X, then C satisfies the compactness theorem iff the closure space ,C is homeomorphically embeddable in the closure space of the consequence operator of the classical logic.We also prove that for every closure space X with a countable base such that the cardinality of X is not greater than 2 there exists a subset X of irrationals and a subset X of the Cantor's set such that X is both a continuous image of X and a continuous image of X. (shrink)

Our aim in this article is to define the difficulties that clinical ethics services encounter when they are asked to demonstrate the value a clinical ethics service (CES) could and should have for an institution and those it serves. The topic emerged out of numerous related presentations at the Un- Conference hosted by the Cleveland Clinic in August 2018 that identified challenges of articulating the value of clinical ethics work for hospital administrators. After a review these talks, it was apparent (...) that the field of clinical ethics may be at a crisis of sorts due to increased pressure to provide explicit measures to healthcare institutions to concretely demonstrate that CESs make a valuable difference in healthcare delivery. In this article, we grapple with how to satisfy the need for demonstrable value in a field in which metrics alone may not capture the scope of clinical ethics practice. We suggest that capturing the value of a CES has been difficult because the benefits of ethics consultation may be overt or attributable to the CES, but are often hidden due to the systems-level and process-oriented nature of clinical ethics work. Part of the difficulty in demonstrating the value of CESs is capturing and conveying all of the ways the integration of a CES throughout an institution positively affects patients, families, visitors, healthcare professionals, administrators, and the institution itself. Our aim is to (1) elucidate the multifaceted value added by a CES, including value that tends to be hidden and (2) suggest how to demonstrate value to others in a way that is not simplistic or reductionistic. (shrink)

Clinical ethics consultants (CECs) often face some of the most difficult communication and interpersonal challenges that occur in hospitals, involving stressed stakeholders who express, with strong emotions, their preferences and concerns in situations of personal crisis and loss. In this article we will give examples of how much of the important work that ethics consultants perform in addressing clinical ethics conflicts is incompletely conceived and explained in the American Society of Bioethics and Humanities Core Competencies for Healthcare Ethics Consultation and (...) the clinical ethics literature. The work to which we refer is best conceptualized as a specialized type of interviewing, in which the emotional barriers of patients and their families or surrogates can be identified and addressed in light of relevant ethical obligations and values within the context of ethics facilitation. (shrink)

Colleges and universities exist within a political arena where external demands for accountability materialize within a market-driven environment. As a result, government agencies pressure colleges and universities to rely on assessment and transparent reporting to become more market-driven assuming that the competition within the market, led by public choice and institutional selection, will drive improvements in learning and will also self-govern the institutions. This article explores how Foucault informs our conception of neoliberal governmentality through political rationality and technologies of self-governance (...) in order to inform our understanding of accountability in higher education and to challenge institutions to develop a counter dialogue which meets institutional obligations to the public and market. (shrink)

For a complete Heyting lattice , we define a category Etale (). We show that the category Etale () is equivalent to the category of the sheaves over , Sh(), hence also with -valued sets, see [2], [1]. The category Etale() is a generalization of the category Etale (X), see [1], where X is a topological space.

Jean Paul's novel The Life of Fibel, Author of the Bienrodische Fibel places itself in a specifi c relation to literacy by identifying the alphabet and the spelling-book as a matrix of its own production. Thus, the text refers itself and its sense-effects back to the arbitrariness of its elements and their combinatorics. Moreover, at the margins of the book, it feigns to be abandoned to the contingency of its preliteral physis which is suppressed by sense, authority, authorship and control (...) of the work. (shrink)

This paper is closely related to investigations of abstract properties of basic logical notions expressible in terms of closure spaces as they were begun by A. Tarski (see [6]). We shall prove many properties of -conjunctive closure spaces (X is -conjunctive provided that for every two elements of X their conjunction in X exists). For example we prove the following theorems:1. For every closed and proper subset of an -conjunctive closure space its interior is empty (i.e. it is a boundary (...) set). 2. If X is an -conjunctive closure space which satisfies the -compactness theorem and [X] is a meet-distributive semilattice (see [3]), then the lattice of all closed subsets in X is a Heyting lattice. 3. A closure space is linear iff it is an -conjunctive and topological space. 4. Every continuous function preserves all conjunctions. (shrink)

For Lack of a Better Plan: A Framework for Ethical, Legal, and Clinical Challenges in Complex Inpatient Discharge Planning Content Type Journal Article Pages 311-326 DOI 10.1007/s10730-009-9117-6 Authors Jane Jankowski, Albany Medical Center Albany NY 12208 USA Terese Seastrum, Northeast Health 2212 Burdett Ave. Troy NY 12180 USA Robert N. Swidler, Northeast Health 2212 Burdett Ave. Troy NY 12180 USA Wayne Shelton, Alden March Bioethics Institute, Albany Medical College 47 New Scotland Avenue, MC 153 Albany NY 12208-3478 USA Journal (...) HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

This essay will discuss how the Theory of Communicative Action incorporates the systemic complexification process and the Systems and Life World duality. Part of this process will be carried out with the discussion of communicative action, as a space for dialogue between people seeking understanding. The process of new forms of understanding and construction of knowledge is possible through the integrative structure of the lifeworld, such as semantic dimension, social space, and historical time. However, there is the other side, the (...) Systems, where the manifestations of crisis and disturbances, the pathologies of society, which in cultural reproduction appear as a loss of meaning of culture, loss of legitimacy of society and in personality, there is a crisis of belonging. (shrink)

The history of Italian Jews from 1861 to 1938 is often viewed as the period in which they totally assimilated into the Italian nation. This article, however, argues that rather than their assimilation it was a period of their integration into Italian society. Various approaches to this question are presented, including a review of the literature, with a view to reconsidering the relationship between Jewish culture and Italian culture, or rather non-Jewish culture. Italian Jewish history is shown not to be (...) separated from, but to be “internal” to Italian social, cultural, and political history—part of the dynamic process of change that occurred during this period not only in Italy but throughout Europe. (shrink)

This paper discusses the ethical issues related to hemicorporectomy surgery, a radical procedure that removes the lower half of the body in order to prolong life. The literature on hemicorporectomy (HC), also called translumbar amputation, has been nearly silent on the ethical considerations relevant to this rare procedure. We explore five aspects of the complex landscape of hemicorporectomy to illustrate the broader ethical questions related to this extraordinary procedure: benefits, risks, informed consent, resource allocation and justice, and loss and the (...) lived body. (shrink)

?Starting from the literary translations and reflections on the theory of translation of Christoph Martin Wieland, this book deals with different modalities and methods of translating and transmitting? not only from language to language, but also between literary genres, epochs, knowledge formations and nations. Wieland is portrayed as an author and editor who devoted himself? with experimental openness? to a project of mediating and resolving dichotomies such as cosmopolitism and nation.".

D. Scott in his paper [5] on the mathematical models for the Church-Curry -calculus proved the following theorem.A topological space X. is an absolute extensor for the category of all topological spaces iff a contraction of X. is a topological space of Scott's open sets in a continuous lattice.

In this article I discuss the history of Italian Jews from the Emancipation to the racial laws of 1938 and their present-day attitudes to Judaism and the State of Israel. My aim is to suggest how the policy of social integration enabled Italian Jews to construct a new identity without losing their ancestral heritage. The example of Italian Jewry is relevant to understanding the growing need in today‘s European Union—now comprising 27 countries with different languages, cultures, and values—of revising the (...) concept of national identity and of exploring ways of constructing a new European identity. (shrink)

The main result of this paper is the following theorem: a closure space X has an , , Q-regular base of the power iff X is Q-embeddable in It is a generalization of the following theorems:(i) Stone representation theorem for distributive lattices ( = 0, = , Q = ), (ii) universality of the Alexandroff's cube for T 0-topological spaces ( = , = , Q = 0), (iii) universality of the closure space of filters in the lattice of all (...) subsets for , -closure spaces (Q = 0). By this theorem we obtain some characterizations of the closure space given by the consequence operator for the classical propositional calculus over a formalized language of the zero order with the set of propositional variables of the power . In particular we prove that a countable closure space X is embeddable with finite disjunctions preserved into F iff X is a consistent closure space satisfying the compactness theorem and X contains a 0, -base consisting of -prime sets. (shrink)