can be adapted and adopted by developing countries. IFC sees this as being an area where we may be able to benchmark and promote positive change. ● The force of global trade initiatives also influences animal welfare.

The composition of nitrogen-doped hydrogenated amorphous carbon films grown in a magnetically confined rf plasma-enhanced chemical vapour deposition system has been determined by X-ray photoelectron spectroscopy and compared with that determined using a combination of elastic recoil detection analysis, Rutherford back-scattering and nuclear reaction analysis. The importance of nitrogen doping or 'incorporation' in hydrogenated amorphous carbon films is discussed in relation to the significant variation in the sp 2 -to-sp 3 ratio that takes place. At 7 at.% N in the (...) a-C : H matrix, a critical change in the microstructure is observed, which governs the resulting mechanical, optical and electronic properties. Finally, the correlation between the sp 2 and sp 3 fractions determined by a non-destructive method of obtaining the bond fractions and by electron-energy-loss spectroscopy is discussed, with a view to evaluating accurately the sp 2 fraction in a-C : H : N films. (shrink)

Making research data readily accessible during a public health emergency can have profound effects on our response capabilities. The moral milieu of this data sharing has not yet been adequately explored. This article explores the foundation and nature of a duty, if any, that researchers have to share data, specifically in the context of public health emergencies. There are three notable reasons that stand in opposition to a duty to share one’s data, relating to: (i) data property and ownership, (ii) (...) just distribution of benefits and burdens and (iii) the contemporary ethos of science. We argue each reason can be successfully met with corresponding rationale in favour of data sharing. Further support for data sharing has been echoed in policies of health agencies, funding bodies and academic institutions; in documents on the ethical conduct of biomedical research; and in discussions on the nature of public health. From this, we ascertain that sharing data is the morally sound default position. This article then highlights the key roles reciprocity and solidarity play in supporting the practice of data sharing. We conclude with recommendations to regard public health research data as a common-pool resource in order to build a framework for stable data sharing management. (shrink)

It is shown that the Riemannian curvature of the 3-dimensional hypersurfaces in space-time, described by the Wilson loop integral, can be represented by a quaternion quantum operator induced by the SU(2) gauge potential, thus providing a justification for quaternion quantum gravity at the Tev energy scale.

Internal auditing has been adding value in organisations across all sectors for many years. This paper is based on research by the authors into this value in the UK, widened to include the contribution by internal auditing's professional development worldwide. This development is based mainly on international internal auditing standards, now receiving recognition by governments, regulators, external auditors and other authorities across the world. Not least by the worldwide requirements of the US Sarbanes-Oxley Act of 2003, and board responsibility for (...) the effectiveness of internal control. The paper discusses how the assurance, compliance and consultant roles of internal auditing are being recognised today at board level in many organisations as valuable contributors to good governance practices. (shrink)

Although consumers increasingly claim to demand ethical products and state that they are willing to reward firms that are ethical, studies have highlighted that there is a significant gap between consumers’ explicit attitudes toward ethical products and their actual purchase behavior. This has major implications for firm policies revolving around business ethics. This research contributes to the understanding of the attitude–behavior gap in ethical consumption that literature has identified but not explored much. We utilize the model of dual attitudes as (...) a basis for the arguments presented in the paper and test them. We suggest that the gap in ethical consumerism exists because individuals have implicit as well as explicit attitudes, which are impacted differentially by stimuli and elicit dissimilar behavioral responses and thus have different implications for business ethics policies. Two longitudinal studies are conducted to better understand the impact of an individual’s dual attitudes on preferences and choice. Our findings support the presence of dual attitudes in consumers. Explicit attitudes are found to be easily influenced by the nature of the stimuli. On the other hand, implicit attitudes are relatively unaffected by the nature of the stimuli present and remain relatively constant. Based on the findings, implicit attitudes guide behavior and determine an individual’s preferences. Even though explicit attitudes react to the stimuli presented, our findings suggest they have no impact on the choice of consumers. These findings improve the understanding of ethical consumption, provide a reason as to why the attitude–behavior gap exists, provide a foundation for future researchers and help firms better understand the impact of perceived business on creating a behavioral shift in ethical consumption. (shrink)

Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)

parte i: modernidade, subjetividade, Hegel e o Western Resumo: Trata-se de apresentar aspectos da teoria de Josef Früchtl sobre a subjetividade moderna, com base em uma associação do “Eu” filosófico e a figura do herói encontrada em alguns gêneros cinematográficos. Neste artigo, o foco será a relação entre a filosofia de Hegel e o gênero do Western, além da introdução aos princípios gerais sobre o fenômeno da modernidade e seus três estratos: o clássico, o agonal e o híbrido.

Powers and Faden argue that social justice ‘is concerned with securing and maintaining the social conditions necessary for a sufficient level of well-being in all of its essential dimensions for everyone’ (2006: 50). Moreover, social justice is concerned with the ‘achievement of well-being, not the freedom or capability to achieve well-being’ (p. 40). Although Powers and Faden note that an agent alone cannot achieve well-being without the necessary social conditions of life (e.g. equal civil liberties and basic material resources, such (...) as food and shelter), it seems that achievement requires that an agent actually pursue the six dimensions of well-being. In this article, I question the extent to which an individual has an obligation to achieve well-being, even if he or she would choose to do otherwise. For example, can an agent choose to forgo being healthy even if all the social conditions are met in her life, thereby choosing to not achieve well-being? It remains unclear how the dimension of self-determination coheres with the remaining five dimensions of well-being and the extent of society’s obligations toward an individual’s achievement of well-being, even in those instances when society’s actions may go against an individual’s right to self-determination. (shrink)

Systems thinking has emerged as a means of conceptualizing and addressing complex public health problems, thereby challenging more commonplace understanding of problems and corresponding solutions as straightforward explanations of cause and effect. Systems thinking tries to address the complexity of problems through qualitative and quantitative modeling based on a variety of systems theories, each with their own assumptions and, more importantly, implicit and unexamined values. To date, however, there has been little engagement between systems scientists and those working in bioethics (...) and public health ethics. The goal of this paper is to begin to consider what it might mean to combine systems thinking with public health ethics to solve public health challenges. We argue that there is a role for ethics in systems thinking in public health as a means of elucidating implicit assumptions and facilitating ethics debate and dialogue with key stakeholders. (shrink)

Indoor smoking bans in public places is usually held as a simple and straightforward example of the application of the harm principle in public health. However, implementing indoor smoking bans in mental health centres is difficult because of the potential neurological and social benefits of smoking for persons with schizophrenia, as suggested by some empirical studies. In this article, the ethical challenges related to smoking bans in mental health centres as justified by the harm principle are explored. Particular attention is (...) given to the case of R v. Nottinghamshire Healthcare NHS Trust . The article concludes by arguing that the possible benefits of smoking for persons with schizophrenia creates a rightful interest that cannot be ignored even if one applies the harm principle to protect others from the negative effects of second-hand smoke. Applying the harm principle in the case of smoking bans in mental health centres requires protecting the interest of persons with schizophrenia to smoke via the value of reciprocity. (shrink)

O presente trabalho pretende investigar as veredas da estética da crueldade construídas no romance Venenos de Deus, remédios do Diabo, de Mia Couto, a partir da hibridização, desterriorização e dos percursos das identidades diaspóricas criadas e fragmentadas nos discursos existentes na Vila Cacimba, cenário que documenta a história de Bartolomeu Sozinho, sua esposa Dona Munda, o médico Sidónio Rosa e a mulher que este ama e busca reencontrar em Vila Cacimba, Deolinda. Nesse cenário é que os textos acerca da língua (...) enquanto colonização, da suposta epidemia enquanto multietnicidade, da diáspora, das miscigenações vistas com muita resistência, e certas inversões de significados tidos como maniqueísmos e tabus, como sugere o próprio título Venenos de Deus, remédios do Diabo, desvelam estéticas da crueldade nos cruzamentos de fronteiras e nas fronteiras que se cruzam em discursos identitários. (shrink)

This article looks into the way in which public-service as well as commercial TV stations in the Netherlands assume their social responsibility towards a pluralist society. After all, television channels are expected to be ‘mirrors of society’; the key question is then how successful their programs are in conveying a well-balanced representation of all groups in society. By means of a quantitative analysis, the Diversity Monitor charts the presentation of different groups, with a particular focus on gender, age, and ethnicity. (...) Apart from diversity, and as a subcomponent of the Quality Card, the Monitor also reviews innovation as an indicator of program quality. The results reveal a wide diversity of TV programs in the Netherlands, but diversity as such is no guarantee of a balanced presentation of society at large. Due to selection mechanisms on the side of the broadcaster and the public, what the viewer eventually gets is at the most a mirror of his or her own group. (shrink)

Previous research has found that news coverage on immigration is often biased in negative ways and that it inspires the formation of negative attitudes towards immigrants. However, academic research about this link between news consumption and attitudes towards immigrants among adolescents remains limited. The current study aims to test this association from a media-exposure and intergroup-contact perspective using survey data from 875 adolescents in Flanders, Belgium. The findings show that only television news consumption, thus no other types of news consumption, (...) was associated with adolescents’ attitudes towards immigrants. Intergroup contact within the friend group, outside the school context, was linked to more positive attitudes. This study nuances earlier findings that news consumption predicts attitudes towards immigrants. Implications for future research are discussed. (shrink)

O presente artigo consiste no registro de memórias de um diretor e de uma diretora que atuaram em escolas públicas de M inas Gerais, e na análise de suas narrativas. O objetivo foi captar suas representações sobre as práticas administrativas e pedagógicas rememoradas dos anos de exercício profissional. Com a metodologia da história oral, nossa investigação buscou construir uma interpretação a respeito de atitudes, posturas e práticas enraizadas nos rituais da escola contemporânea. Pudemos observar que no período estudado havia uma (...) política extremamente centralizada, cujas diretrizes eram difundidas pelos órgãos centrais da administração burocrática. O trabalho de gestão das unidades escolares era pautado, principalmente, pelo controle do cumprimento das normas estabelecidas pela política pública de educação. (shrink)

There is an increasing recognition internationally of the critical impact of communication within healthcare. The link between ineffective communication, patient dissatisfaction and critical incidents is well established. Family Planning New South Wales has sought to address patient-centred care and communication in its policy platform. This article reports on research conducted within FPNSW, which analysed the discourse features that constituted effective doctor–patient1 communication in sexual and reproductive health consultations. The principal aim of the research was to understand how effectively messages were (...) conveyed and received and to what degree patients were active participants in their own sexual healthcare. Analysed consultations were characterised by extremely high levels of communicative competence on the part of the doctors who integrated medical expertise with the development of interpersonal relationships with patients, thus positioning patients as active contributors to the consultations and to decisions about their ongoing treatment. The detailed linguistic analysis identified characteristic features of patient-centred communication that are essential to patient-centred care. These interactions demonstrate that communicating care is just as important as delivering care and involves a drawing together of the medical and the interpersonal in consultations. The article details strategies for interweaving medical knowledge and establishing rapport that can inform practitioner communication practices across different healthcare contexts. (shrink)

Este texto vai explanar as diversas contribuições que as obras cinematográficas podem propiciar para a educação, ferramenta essa que pode ser uma grande aliada dos docentes em sala de aula, visto que os filmes chamam a atenção dos aprendentes, diante da transtextualidade e uso de recursos estéticos que dialogam com outras expressões artísticas, além das refrações histórico-sociais possíveis. Nessa perspectiva, compartilhamos algumas experiências didáticas oriundas do projeto “Cine-CAVN: Recepção crítica da indústria cultural na formação da leitura, da escrita e no (...) letramento midiático”, realizado na UFPB / Campus III. Tal demanda institucional surge da necessidade formativa do sujeito crítico e atuante, utilizando como mediação o cinema, arte integrante da cultura da mídia, que auxilia os participantes na produção de textos, visto que a escrita ainda é um grande desafio para a maioria dos discentes. O objetivo das ações é analisar as obras fílmicas e potencializar nos participantes um olhar problematizador, por meio de textos escritos e/ou audiovisuais, trazendo como impacto social um cidadão emancipado (FREIRE, 1986). Assim como o mundo está em constante transformação, a escola também deve se adequar a algumas necessidades dos alunos, e trazer para a sala de aula ferramentas tecnológicas do seu cotidiano, propiciando, desta forma, novos olhares para os temas sensíveis e componentes curriculares (ocultos ou não), de forma a estimular a(s) habilidades(s) crítica(s) dos aprendentes. (shrink)

BackgroundTraumatic brachial plexus injury (TBPI) causes a sensorimotor deficit in upper limb (UL) movements.ObjectiveOur aim was to investigate the arm–forearm coordination of both the injured and uninjured UL of TBPI subjects.MethodsTBPI participants (n = 13) and controls (n = 10) matched in age, gender, and anthropometric characteristics were recruited. Kinematics from the shoulder, elbow, wrist, and index finger markers were collected, while upstanding participants transported a cup to their mouth and returned the UL to a starting position. The UL coordination (...) was measured through the relative phase (RP) between arm and forearm phase angles and analyzed as a function of the hand kinematics.ResultsFor all participants, the hand transport had a shorter time to peak velocity (p < 0.01) compared to the return. Also, for the control and the uninjured TBPI UL, the RP showed a coordination pattern that favored forearm movements in the peak velocity of the transport phase (p < 0.001). TBPI participants' injured UL showed a longer movement duration in comparison to controls (p < 0.05), but no differences in peak velocity, time to peak velocity, and trajectory length, indicating preserved hand kinematics. The RP of the injured UL revealed altered coordination in favor of arm movements compared to controls and the uninjured UL (p < 0.001). Finally, TBPI participants' uninjured UL showed altered control of arm and forearm phase angles during the deceleration of hand movements compared to controls (p < 0.05).ConclusionThese results suggest that UL coordination is reorganized after a TBPI so as to preserve hand kinematics. (shrink)

The child was 2 years, 8 months old and weighed 25 pounds, one-fifth the weight of her mother, for whom she was to be the bone marrow donor. The mother had suffered a relapse of acute myelogenous leukemia; her physicians recommended a bone marrow transplant. The child was the closest human leukocyte antigen match and thus the best donor candidate for her mother's transplant.

IntroductionSymptoms of schizophrenia are closely related to aberrant language comprehension and production. Macroscopic brain changes seen in some patients with schizophrenia are suspected to relate to impaired language production, but this is yet to be reliably characterized. Since heterogeneity in language dysfunctions, as well as brain structure, is suspected in schizophrenia, we aimed to first seek patient subgroups with different neurobiological signatures and then quantify linguistic indices that capture the symptoms of “negative formal thought disorder”.MethodsAtlas-based cortical thickness values of 66 (...) patients with first-episode psychosis and 36 healthy controls were analyzed with hierarchical clustering algorithms to produce neuroanatomical subtypes. We then examined the generated subtypes and investigated the quantitative differences in MRS-based glutamate levels [in the dorsal anterior cingulate cortex ] as well as in three aspects of language production features: fluency, syntactic complexity, and lexical cohesion.ResultsTwo neuroanatomical subtypes among patients were observed, one with near-normal cortical thickness patterns while the other with widespread cortical thinning. Compared to the subgroup of patients with relatively normal cortical thickness patterns, the subgroup with widespread cortical thinning was older, with higher glutamate concentration in dACC and produced speech with reduced mean length of T-units and lower repeats of content words, despite being equally fluent.ConclusionWe characterized a patient subgroup with thinner cortex in first-episode psychosis. This subgroup, identifiable through macroscopic changes, is also distinguishable in terms of neurochemistry and language behavior. This study supports the hypothesis that glutamate-mediated cortical thinning may contribute to a phenotype that is detectable using the tools of computational linguistics in schizophrenia. (shrink)

O presente trabalho tem como objetivo refletir sobre a educação escolar no sistema prisional contemporâneo. Destacando os marcos legais e documentos oficiais que expressam e orientam o direito à educação nestes espaços não formais. Pensar a educação neste contexto é destacar a importância da educação para o processo transformador do ser humano, ou seja, a educação tem a função de promover a reintegração social do sujeito em situação de privação de liberdade. Para o desenvolvimento deste trabalho temos como abordagem qualitativa, (...) com o suporte das pesquisas bibliográfica e documental. Portanto, promover a acessibilidade da pessoa privada de liberdade, é promover não só a reintegração social via a educação, como promover o exercício da cidadania independente do fato julgado. Nestes termos, a educação escolar no sistema prisional tem sido um desafio para a reintegração social da pessoa privada de liberdade na contemporaneidade. (shrink)

In this article, we examine how the U.N. Convention on the Rights of the Child can be useful in pediatric bioethics. Adopted in 1989, the CRC reflects norms that have been deliberated upon for a long period of time and endorsed by most nations. The United States is now the only country that has not ratified the CRC.1 International human rights law shares many key moral concepts with clinical pediatric bioethics, and the CRC provides a considered language common to many (...) jurisdictions that can assist bioethicists in their daily practice and help health-care organizations in their policy development and international interactions. There may, however, be practical challenges with using the CRC in the practice of.. (shrink)

A elaboração deste artigo conjunto tem por base a continuidade de um plano editorial do Grupo Kinosophia junto a Revista Inquietude, articulada a um conjunto de aulas do Prof. Früchtl, ministradas em agosto de 2011 na Faculdade de Filosofia da UFG. Sua teoria sobre filosofia do cinema contribuiu para a formação do Grupo de Estudos Kinosophia, ao promover a discussão de suas ideias no exercício de tradução de suas aulas e textos, bem como da revisão da filmografia por ele indicada. (...) Os artigos são, portanto, resultados desta experiência contada em três etapas: 1. Modernidade, subjetividade, Hegel e o Western; 2. O romantismo, o agonístico e o filme de gângster; 3. O hibridismo, Nietzsche e a ficção científica. (shrink)

Chronic migraine is a difficult disease to diagnose, and its pathophysiology remains undefined. Its symptoms affect the quality of life and daily living tasks of the affected person, leading to momentary disability. This is a pilot, randomized, controlled, double-blind clinical trial study with female patients between 18 and 65 years old with chronic migraine. The patients underwent twelve mindfulness sessions paired with anodal transcranial direct-current stimulation over the left dorsolateral prefrontal cortex, with current intensity of 2 mA applied for 20 (...) min, three times a week for 4 weeks. In addition, 20 min of mindfulness home practices were performed by guided meditation audio files. A total of 30 participants were evaluated after the treatment, and these were subdivided into two groups—active tDCS and sham tDCS, both set to mindfulness practice. The FFMQ-BR, MIDAS, and HIT-6 questionnaires were used to evaluate the outcomes. After the treatment, the active mindfulness and tDCS group showed better results in all outcomes. The sham group also showed improvements, but with smaller effect sizes compared to the active group. The only significant difference in the intergroup analysis was the outcome evaluated by HIT-6 in the post treatment result. Our results provide the first therapeutic evidence of mindfulness practices associated with left DLPFC anodal tDCS with a consequent increase in the level of full attention and analgesic benefits in the clinical symptoms of patients with chronic migraine. (shrink)

A capoeira ou capoeiragem é uma expressão cultural brasileira que mistura jogo, esporte, arte marcial, cultura popular, tradição, dança e música. Desenvolvida no Brasil por descendentes de escravos africanos, a capoeira é caracterizada por golpes e movimentos ágeis e complexos, utilizando primariamente chutes e rasteiras, além de joelhadas e cabeçadas, cotoveladas, acrobacias aéreas ou em solo. Praticantes da capoeira aprendem não apenas a lutar e jogar, mas também a tocar os instrumentos típicos e cantar. Assim, os discentes do 6º ano (...) de uma escola estadual da cidade de Itabuna—BA, os quais apresentavam dificuldades para ler e escrever. Entretanto, nas aulas de capoeira, os alunos se mostravam mais motivados para ler. Então, surgiu o problema que norteou essa pesquisa, a saber: como o jogo de capoeira vem sendo trabalhado, para estimular a melhoria da aprendizagem em leitura dos alunos, do 6ºano, em um colégio estadual, na cidade de Itabuna – BA? Portanto, o objetivo geral desse artigo é analisar de que maneira o mestre usa o jogo da capoeira, como ferramenta motivacional, nas práticas pedagógicas, para a melhoria da aprendizagem da leitura, entre os alunos do 6º ano, do ensino fundamental II. Desse modo, a utilização de estratégias de leitura, partindo da diversidade dos gêneros textuais, de modo lúdico, através da capoeira, no processo de ensino-aprendizagem, é um assunto que é discutido nessa pesquisa, pois esta se justifica pela necessidade de contribuir para uma melhora do processo de ensino e aprendizagem, partindo de pressupostos presentes na BNCC. Palavras-chave: Capoeira, Fomento à Leitura, Gêneros Textuais, Lúdico. (shrink)

Natura 2000 is a network of natural sites whose aim is to preserve species and habitats of relevance in the European Union. The policy underlying Natura 2000 has faced widespread opposition from land users and received extensive support from environmentalists. This paper addresses the ethical framework for Natura 2000 and the probable moral assumptions of its main stakeholders. Arguments for and against Natura 2000 were analyzed and classified according to “strong” or “weak” versions of the three main theories of environmental (...) ethics – anthropocentrism, biocentrism, and ecocentrism. Weak (intergenerational) anthropocentrism was found to underlie the Natura 2000 network itself and the positions of environmentalists, while strong (traditional) anthropocentrism pervaded the positions of economic developers. Land users seemed to fall somewhere between weak and strong anthropocentrism. The paper discusses the relation between ethics and different attitudes towards Natura 2000, highlighting some of the implications for the network’s ongoing implementation. It is shown that Natura 2000 achieves a strong reversal of the burden of proof from conservation to economic development and land use change under anthropocentrism. It is argued that the alleged theoretical divide between anthropocentrism and non-anthropocentrism in relation to the burden of proof does not seem to hold in practice. Finally, it is predicted that the weak versions of anthropocentrism, biocentrism, and ecocentrism, are likely to converge extensively in respect to nature conservation policy measures. (shrink)

Livro-texto de introdução à lógica, com (mais do que) pitadas de filosofia da lógica, produzido como uma versão revista e ampliada do livro Forallx: Calgary. Trata-se da versão de 13 de outubro de 2022. Comentários, críticas, correções e sugestões são muito bem-vindos.

This book offers both theoretical overviews and practical approaches for educators, academics, education students and parents who are interested in transforming schools. It encourages reinvigorating approaches to learning and teaching that can easily be integrated into both public and private K-12 school classrooms, with many ideas also applicable to higher education. It supports an educational system based on the beliefs that heart and spirit are intertwined with mind and intellect, and that inner peace, wisdom, compassion, and conscience can be developed (...) together with academic content and skills. (shrink)

Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment.Methods: Multilevel multinomial regression analysis controlling for age, gender, ethnicity, and (...) referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; meanAge = 13.66 years] using anonymised administrative data from young people's mental health services.Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement. Similarly, they were less likely to transfer or end treatment for other reasons than by case closure due to mutual agreement.Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services. (shrink)