Christian development agencies have been the primary vehicle of choice for holistic involvement and witness. This has played straight into an Enlightenment manner of thinking that compartmentalizes values, limiting the opportunities for explaining the theological and conceptual foundations for development practice and for public witness concerning religious faith. New institutional models appropriate to witness and holistic Christian service need to be considered. An `S4' type organization, explored in practice in Indonesia in an interfaith setting, allows for a more effective sharing (...) of the gospel and robust development work. (shrink)

Background Victoria was the first Australian state to legalize voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). Some institutions indicated they would not participate in voluntary assisted dying. The Victorian government issued policy approaches for institutions to consider Objective To describe and analyse publicly available policy documents articulating an institutional objection to voluntary assisted dying in Victoria. Methods Policies were identified using a range of strategies, and those disclosing and discussing the nature of an institutional objection were thematically (...) analysed using the framework method. Results The study identified fifteen policies from nine policymakers and developed four themes: (1) extent of refusal to participate in VAD, (2) justification for refusal to provide VAD, (3) responding to requests for VAD, and (4) appeals to state-sanctioned regulatory mechanisms. While institutional objections were stated clearly, there was very little practical detail in most documents to enable patients to effectively navigate objections in practice. Conclusion This study demonstrates that despite having clear governance pathways developed by centralized bodies (namely, the Victorian government and Catholic Health Australia), many institutions’ public-facing policies do not reflect this guidance. Since VAD is contentious, laws governing institutional objection could provide greater clarity and regulatory force than policies alone to better balance the interests of patients and non-participating institutions. (shrink)

Existing regulation of end-of-life care is flawed. Problems include poorly-designed laws, policies, ethical codes, training, and funding programs, which often are neither effective nor helpful in guiding decision-making. This leads to adverse outcomes for patients, families, health professionals, and the health system as a whole. A key factor contributing to the harms of current regulation is a siloed approach to regulating end-of-life care. Existing approaches to regulation, and research into how that regulation could be improved, have tended to focus on (...) a single regulatory instrument (e.g., just law or just ethical codes). As a result, there has been a failure to capture holistically the various forces that guide end-of-life care. This article proposes a response to address this, identifying “regulatory space” theory as a candidate to provide the much-needed holistic insight into improving regulation of end-of-life care. The article concludes with practical implications of this approach for regulators and researchers. (shrink)

Urban agriculture is an important source of food and income throughout Africa. The majority of cultivators on the continent are women who use urban agriculture to provide for their family. Much research on urban agriculture in Africa focuses on the material benefits of urban agriculture for women, but a smaller body of literature considers its social and psychological empowering effects. The present study seeks to contribute to this debate by looking at the ways in which urban agriculture empowers women on (...) the Cape Flats, a region of Cape Town where urban agriculture is supported by nongovernmental organisations. Based on interviews with cultivators, the findings show that NGO-run urban agriculture projects not only aid food security, but also help women to develop supportive networks that unlock benefits across the personal, social and economic spectrum. (shrink)

The importance of graduating ethical health professionals is indisputable. Yet evaluating the quality of ethics education programs remains problematic for educators. A divide between learning and integrating ethics in everyday professional practice lies at the heart of this issue. The Ethics in Professional Practice (EPP) project addresses health professions' students’ self-efficacy for ethical practice. Students are cast as central characters in authentic vignettes and complete guided learning activities to facilitate their ethical reasoning skills. A design-based research approach was utilised to (...) create EPP resources and this study focuses on the analysis phase of the design process. The aim was to investigate EPP learning outcomes by developing innovative measures based upon Kirkpatrick’s ( 2006 ) evaluation model: namely, reaction, learning, behaviour and effects. Health professions students from Exercise and Sports Science, Rehabilitation Counselling and Speech Pathology (n = 58) participated in the EPP. Qualitative content analysis of reflective statements demonstrated their ethical sensitivity in four categories: Expectations and Empathy in Quality Care; Managing Overwhelming Demands; Informed, Engaged and Empowered; Access to Flexible Models of Service Delivery. Findings from the Rehabilitation Counselling cohort (n = 16) were explored in-depth using Semantic Differential Scales and demonstrated positive ethical reasoning outcomes. Participants also developed individual, ethical practice goals for professional practica. Qualitative content analysis of these goals demonstrated clear ethical reasoning learning effects. Participants integrated concepts of becoming an ethical professional with effective communication, collaboration, empowerment and quality care. Study outcome measures are critiqued and findings may inform redesign of future ethics education resources. (shrink)

У статті розглянуто недосліджену в науці проблему виявлення та елімінації пам’яток. Практичний досвід у цій царині є досить багатим, але досі ніким не узагальнений. Мета статті – сформулювати емпіричні правила виявлення пам’яток, які роблять їх стійкими до штучних елімінацій. Основні правила: брати до уваги ефект Лінді, «менше – означає більше», опціональність, збереженість шарів автентичності, природно сформований комплекс; не брати велику кількість одиничних розрізнених пам’яток, не шукати вигоди від виявлення пам’яток. При відборі пам’яток згідно із емпіричними правилами до уваги не беруть (...) конкретні цілі репрезентації та інтерпретації минулого тут і зараз. І саме це дає змогу уникнути негативних наслідків штучних елімінацій. (shrink)

Objective Futile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment that they consider to be futile is sometimes provided at the end of a patient9s life. Design Semistructured in-depth interviews. Setting Three large tertiary public hospitals in Brisbane, Australia. Participants 96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine and medical administration departments. Participants were recruited using purposive maximum variation sampling. (...) Results Doctors attributed the provision of futile treatment to a wide range of inter-related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk and poor communication skills. Second, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty and lack of information about patient wishes. Third, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the _main_ reasons for futile care. Conclusions Doctors believe that a range of factors contribute to the provision of futile treatment. A combination of strategies is necessary to reduce futile treatment, including better training for doctors who treat patients at the end of life, educating the community about the limits of medicine and the need to plan for death and dying, and structural reform at the hospital level. (shrink)

Robert Putnam's work was a double-edged sword for social capital scholars. It brought unprecedented attention to the research agenda but also created conceptual confusion. Many scholars have tried to disentangle Coleman's concept of social capital from what some described as Putnam's “fuzzy psychological notion” of civic culture values. Despite the rigour of these efforts, Putnam's influence remains, because scholars and policy makers are drawn to the benefits his work promised. This article takes a different tack, and seeks to extricate Putnam's (...) early ideas from the social capital debates by offering an alternate theorization of his original findings. It returns to Making Democracy Work and argues that Putnam mis-stepped when he took the rational choice route and invoked Coleman's concept of social capital. It takes an ideational approach to explaining civic culture. The resulting “ideational social capital” suggests a different research agenda, which just might deliver on Putnam's early promise. (shrink)

The aim of this thematic literature review is to explore nurses' perceptions of ethical issues in the care of older people. Electronic databases were searched from September 1997 to September 2007 using specific key words with tight inclusion criteria, which revealed 17 primary research reports. The data analysis involved repeated reading of the findings and sorting of those findings into four themes. These themes are: sources of ethical issues for nurses; differences in perceptions between nurses and patients/relatives; nurses' personal responses (...) to ethical issues; and the patient—nurse relationship. The findings reveal that ageism is one of the major sources of the ethical issues that arise for nurses caring for older people. Education and organizational change can combat ageist attitudes. Wider training is required in the care of older people, workplace skills, palliative care and pain management for older people. The demands of a changing global demography will necessitate further research in this field. (shrink)

Since the mid-twentieth century, the ‘Scientific Revolution’ has arguably occupied centre stage in most Westerners’, and many non-Westerners’, conceptions of science history. Yet among history of science specialists that position has been profoundly contested. Most radically, historians Andrew Cunningham and Perry Williams in 1993 proposed to demolish the prevailing ‘big picture’ which posited that the Scientific Revolution marked the origin of modern science. They proposed a new big picture in which science is seen as a distinctly modern, western phenomenon rather (...) than a human universal, that it was invented in the Age of Revolutions 1760–1848, and that science be de-centred within the new big picture: treated as just one of many forms of human knowledge-seeking activity. Their paper is one of the most highly cited in the history of science field, and has the potential to transform the way that science educators, science communicators, science policy-makers and scientists view science. Yet the paper and historians’ scholarly response to it are not well-known outside the history discipline. Here I attempt to bridge that disciplinary gap with a review of scholarly papers published 1994–2014 that cited Cunningham and Williams or otherwise discussed the Scientific Revolution, to gauge the extent of support for the old and new big pictures. I find that the old big picture is disintegrating and lacks active defenders, while many scholars support aspects of the new big picture. I discuss the significance of this for scholars in ‘applied’ fields of science studies such as education, communication and policy. (shrink)

Objectives To determine the role played by law in medical specialists9 decision-making about withholding and withdrawing life-sustaining treatment from adults who lack capacity, and the extent to which legal knowledge affects whether law is followed. Design Cross-sectional postal survey of medical specialists. Setting The two largest Australian states by population. Participants 649 medical specialists from seven specialties most likely to be involved in end-of-life decision-making in the acute setting. Main outcome measures Compliance with law and the impact of legal knowledge (...) on compliance. Results 649 medical specialists (of 2104 potential participants) completed the survey (response rate 31%). Responses to a hypothetical scenario found a potential low rate of legal compliance, 32% (95% CI 28% to 36%). Knowledge of the law and legal compliance were associated: within compliers, 86% (95% CI 83% to 91%) had specific knowledge of the relevant aspect of the law, compared with 60% (95% CI 55% to 65%) within non-compliers. However, the reasons medical specialists gave for making decisions did not vary according to legal knowledge. Conclusions Medical specialists prioritise patient-related clinical factors over law when confronted with a scenario where legal compliance is inconsistent with what they believe is clinically indicated. Although legally knowledgeable specialists were more likely to comply with the law, compliance in the scenario was not motivated by an intention to follow law. Ethical considerations (which are different from, but often align with, law) are suggested as a more important influence in clinical decision-making. More education and training of doctors is needed to demonstrate the role, relevance and utility of law in end-of-life care. (shrink)

Many of the negative connotations of corporate social responsibility (CSR) are linked to its perceived role as a public relations exercise. Following on calls for more positive engagement by public relations professionals in organisational strategic planning and given the rapidly increasing interest in CSR as a business strategy, this article addresses the question of how the theory and practice of public relations can provide direction and support for CSR. To this end, this article explores leadership styles and motivations of a (...) sample of corporate leaden from prominent Australian-based corporations in relation to their chosen CSR activities to examine the current position of, and potential for, professional communicators' impact in shaping CSR-driven policies at a strategic level. We find that while public relations theory has evolved, many leaders still see public relations professionals only as a source of positive publicity. Our findings suggest that the model of distributive leadership has more relevance to an emerging idea of public relations involvement in CSR than more traditional understandings of leadership. We conclude that the public relations profession needs to develop a greater understanding of senior management approaches to the development and dissemination of CSR activities to support organisational leadership as it currently operates with respect to CSR. (shrink)

Over several decades, ethics and law have been applied to medical education and practice in a way that reflects the continuation during the twentieth century of the strong distinction between facts and values. We explain the development of applied ethics and applied medical law and report selected results that reflect this applied model from an empirical project examining doctors’ decisions on withdrawing/withholding treatment from patients who lack decision-making capacity. The model is critiqued, and an alternative “constitutive” model is supported on (...) the basis that medicine, medical law, and medical ethics exemplify the inevitable entanglement of facts and values. The model requires that ethics and law be taught across the medical education curriculum and integrated with the basic and clinical sciences and that they be perceived as an integral component of medical evidence and practice. Law, in particular, would rank as equal in normative authority to the relevant clinical scientific “facts” of the case, with graduating doctors having as strong a basic command of each category as the other. The normalization of legal knowledge as part of the clinician’s evidence base to be utilized in practice may provide adequate consolation for clinicians who may initially resent further perceived incursions on their traditional independence and discretion. (shrink)

Much of the commentary in the wake of the Charlie Gard litigation was aimed at apparent shortcomings of the law. These include concerns about the perceived inability of the law to consider resourcing issues, the vagueness of the best interests test and the delays and costs of having disputes about potentially life-sustaining medical treatment resolved by the courts. These concerns are perennial ones that arise in response to difficult cases. Despite their persistence, we argue that many of these criticisms are (...) unfounded. The first part of this paper sets out the basic legal framework that operates when parents seek potentially life-sustaining treatment that doctors believe is against a child’s best interests, and describes the criticisms of that framework. The second part of the paper suggests an alternative approach that would give decision-making power to parents, and remove doctors’ ability to unilaterally withhold or withdraw life-sustaining treatment that they regard is futile. This proposal is grounded in several values that we argue should guide these regulatory choices. We also contend that the best interests test is justifiable and since the courts show no sign of departing from it, the focus should be on how to better elucidate the underlying values driving decisions. We discuss the advantages of our proposed approach and how it would address some of the criticisms aimed at the law. Finally, we defend the current role that the judiciary plays, as an independent state-sanctioned process with a precedent-setting function. (shrink)

However, the barriers and facilitators of such changes - law reform perspectives - have been virtually ignored. Why do so many attempts to change the law fail but others are successful? International Perspectives on End-of-Life Law Reform aims to address this question by drawing on ten case studies of end-of-life law reform from the United Kingdom, the United States, Canada, the Netherlands, Belgium and Australia. Written by leading end-of-life scholars, the book's chapters blend perspectives from law, medicine, bioethics and sociology (...) to examine sustained reform efforts to permit assisted dying and change the law about withholding and withdrawing life-sustaining treatment. Findings from this book not only shed light on changing end-of-life law but also provide insight more generally into how and why law reform succeeds in complex and controversial social policy areas. (shrink)

In this article we offer a single case study using an action research method for gathering and analysing data offering insights valuable to both design and research supervision practice. We do not attempt to generalise from this single case, but offer it as an instance that can improve our understanding of research supervision practice. We question the conventional ‘dyadic’ models of research supervision and outline a more collaborative model, based on the signature pedagogy of architecture: the design studio. A novel (...) approach to the supervision of creatively oriented postgraduate students is proposed, including new approaches to design methods and participatory supervision that draw on established design studio practices. This model collapses the distance between design and research activities. Our case study involving Master's Research Students supervision in the discipline of Architecture, shows how ‘connected learning’ emerges from this approach. This type of learning builds strong elements of creativity and fun, which promote and enhance student engagement. The results of our action research suggest that students learn to research more easily in such an environment and supervisory practices are enhanced when we apply the techniques and characteristics of design studio pedagogy to the more conventional research pedagogies imported from the humanities. We believe that other creative disciplines can apply similar tactics to enrich both the creative practice of research and the supervision of HDR students. (shrink)

On Vedanta philosophy; study based on Vedic literature.

Background Voluntary assisted dying became lawful in Victoria, the first Australian state to permit this practice, in 2019 via the Voluntary Assisted Dying Act 2017 (Vic). While conscientious objection by individual health professionals is protected by the Victorian legislation, objections by institutions are governed by policy. No research has been conducted in Victoria, and very little research conducted internationally, on how institutional objection is experienced by patients seeking assisted dying. Methods 28 semi-structured interviews were conducted with 32 family caregivers and (...) one patient about the experience of 28 patients who sought assisted dying. Participants were interviewed during August-November 2021. Data from the 17 interviews (all with family caregivers) which reported institutional objection were analysed thematically. Results Participants reported institutional objection affecting eligibility assessments, medication access, and taking the medication or having it administered. Institutional objection occurred across health settings and was sometimes communicated obliquely. These objections resulted in delays, transfers, and choices between progressing an assisted dying application and receiving palliative or other care. Participants also reported objections causing adverse emotional experiences and distrust of objecting institutions. Six mediating influences on institutional objections were identified: staff views within objecting institutions; support of external medical practitioners and pharmacists providing assisted dying services; nature of a patient’s illness; progression or state of a patient’s illness; patient’s geographical location; and the capability and assertiveness of a patient and/or caregiver. Conclusions Institutional objection to assisted dying is much-debated yet empirically understudied. This research found that in Victoria, objections were regularly reported by participants and adversely affected access to assisted dying and the wider end-of-life experience for patients and caregivers. This barrier arises in an assisted dying system that is already procedurally challenging, particularly given the limited window patients have to apply. Better regulation may be needed as Victoria’s existing policy approach appears to preference institutional positions over patient’s choice given existing power dynamics. (shrink)

In 2017, Victoria became the first state in Australia to pass legislation permitting voluntary assisted dying. Under this law, only those people who are near the end of their lives may access voluntary assisted dying, and because many of these people require nursing care to manage the progression of their illness or their symptoms, it will invariably have an impact on nursing practice. The Victorian law includes a series of procedural steps as safeguards to ensure that the law operates as (...) intended. To support people who choose voluntary assisted dying and to practice safely within boundaries of the law, nurses must be aware of these requirements and how they operate. However, there are often gaps in nurses’ legal knowledge. This was demonstrated in an article that aimed to inform nurses about the operation of Voluntary Assisted Dying Act 2017 (Vic) but contained several errors and misstatements of the law. Our article corrects these errors and discusses how the law is intended to be applied by revisiting the fictional case of Chloe – a woman with a terminal illness who is seeking voluntary assisted dying. As the Voluntary Assisted Dying Act 2017 (Vic) also protects nurses from liability if they act in accordance with its provisions, we conclude that sound knowledge and understanding of its operation support nurses to provide the safe, comprehensive and compassionate care their patients deserve at the end of life. (shrink)

In jurisdictions where voluntary assisted dying is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this (...) protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture. There are no data in this work. (shrink)

ObjectiveTo increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility.SettingThree tertiary hospitals in metropolitan Brisbane, Australia.DesignQualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic (...) analysis.ResultsDoctors’ perceptions of whether resource limitations were relevant to their practice varied, and doctors were more comfortable with explicit rather than implicit rationing. Several doctors incorporated resource limitations into their definition of futility. For some, availability of resources was one factor of many in assessing futility, secondary to patient considerations, but a few doctors indicated that the concept of futility concealed rationing. Doctors experienced moral distress due to the resource implications of providing futile treatment and the lack of administrative supports for bedside rationing.ConclusionsDoctors’ ability to distinguish between futility and rationing would be enhanced through regulatory support for explicit rationing and strategies to support doctors’ role in rationing at the bedside. Medical policies should address the distinction between resource limitations and futility to promote legitimacy in end-of-life decision making. (shrink)

BackgroundThis paper investigates the content of Australian policies that address withholding or withdrawing life-sustaining treatment to analyse the guidance they provide to doctors about the allocation of resources.MethodsAll publicly available non-institutional policies on withholding and withdrawing life-sustaining treatment were identified, including codes of conduct and government and professional organization guidelines. The policies that referred to resource allocation were isolated and analysed using qualitative thematic analysis. Eight Australian policies addressed both withholding and withdrawing life-sustaining treatment and resource allocation.ResultsFour resource-related themes were (...) identified: doctors’ ethical duties to consider resource allocation; balancing ethical obligations to patient and society; fair process and transparent resource allocation; and legal guidance on distributive justice as a rationale to limit life-sustaining treatment.ConclusionOf the policies that addressed resource allocation, this review found broad agreement about the existence of doctors’ duties to consider the stewardship of scarce resources in decision-making. However, there was disparity in the guidance about how to reconcile competing duties to patient and society. There is a need to better address the difficult and confronting issue of the role of scarce resources in decisions about life-sustaining treatment. (shrink)

Background: Studies have established that negative perceptions of people living with HIV/AIDS exist among nursing students throughout the world, perceptions which can be detrimental to the delivery of high-quality nursing care. Objectives: The purpose of this research was to explore socio-cultural influences on the perceptions of nursing students towards caring for people living with HIV/AIDS. Research design: The study was guided by stigma theory, a qualitative descriptive research approach was adopted. Data collected via semi-structured interviews were thematically analysed. Participants and (...) research context: Participants were 21 international and Australian undergraduate nursing students enrolled in a Bachelor of Nursing programme at an Australian university. Ethical considerations: Ethical approval was granted by the Social and Behavioural Research Ethics Committee at the study university. Participation was entirely voluntary; informed consent was obtained before the study commenced; confidentiality and anonymity were assured. Findings: Three major themes were found: blame, othering and values. Complex and interrelated factors constructed participant perceptions of people living with HIV/AIDS, perceptions underscored by the prevailing culturally construed blame and othering associated with HIV/AIDS. The study found discordance between the negative personal beliefs and perceptions some nursing students have towards people living with HIV/AIDS, and the professional values expected of them as Registered Nurses. Discussion: There was considerable commonality between this and previous studies on how homosexuality and illicit drug use were perceived and stigmatised, correlating with the blame directed towards people living with HIV/AIDS. These perceptions indicated some nursing students potentially risked not fulfilling the ethical and professional obligations the Registered Nurse. Conclusion: Nursing curriculum should be strengthened in relation to comprehending the meaning of being stigmatised by society. Educational institutions need to work towards enhancing strategies that assist nursing students to reconcile any incongruity between their personal beliefs and requisite professional nursing values. (shrink)

BackgroundJunior medical doctors have a key role in discussions and decisions about treatment and end-of-life care for people with dementia in hospital. Little is known about junior doctors’ decision-making processes when treating people with dementia who have advance care directives, or the factors that influence their decisions. To describe among junior doctors in relation to two hypothetical vignettes involving patients with dementia: their legal compliance and decision-making process related to treatment decisions; the factors influencing their clinical decision-making; and the factors (...) associated with accurate responses to one hypothetical vignette. MethodA cross-sectional survey of junior doctors, including trainees, interns, registrars and residents, on clinical rotation in five public hospitals located in one Australian state. The anonymous, investigator-developed survey was conducted between August 2018 and June 2019. Two hypothetical vignettes describing patients with dementia presenting to hospital with an ACD and either: bacterial pneumonia; or suspected stroke were presented in the survey. Participants were asked to indicate whether they would commence treatment, given the ACD instructions described in each vignette.ResultsOverall, 116 junior doctors responded. In Vignette 1, 58% of respondents selected the legally compliant option. Participants who chose the legally compliant option perceived ‘following patient wishes’ and ‘legal requirements to follow ACDs’ as equally important reasons for complying with the ACD. The most common reason for not selecting the legally compliant option in Vignette 1 was the ‘ACD is relevant in my decision-making process, but other factors are more relevant’. In Vignette 2, 72% of respondents indicated they would commence treatment and 18% selected they would not commence treatment.. Similar reasons influenced participant decision-making in Vignette 2, a less legally certain scenario.ConclusionsThere are critical gaps in junior doctors’ compliance with the law as it relates to the implementation of ACDs. Despite there being differences in relation to the legal answer and its certainty, clinical and ethical factors guided decision-making over and above the law in both vignettes. More education and training to guide junior doctors’ clinical decision-making and ensure compliance with the law is required. (shrink)

The aim of this study was to conduct an interpretative phenomenological analysis exploring the experiences of differently abled first-year students from a psychofortological perspective. Ryff’s psychological well-being model was used as a theoretical underpinning. Through the course of an academic year, three male participants completed semi-structured interviews and reflective writing exercises. Data were analysed using interpretative phenomenological analysis. A cross-case analysis yielded themes related to participants’ dynamic processes of finding purpose, direction and independence, as well as belonging, positive relations, self-acceptance (...) and mastery. Collectively, the findings demonstrated how the participants moved from viewing themselves as disabled to differently abled, and that, despite numerous challenges, psychological well-being can be facilitated through the first-year higher education experience. (shrink)

Background In June 2016, Canada legalized medical assistance in dying (MAiD). From the outset, some healthcare institutions (including faith-based and non-faith-based hospitals, hospices, and residential aged care facilities) have refused to allow aspects of MAiD onsite, resulting in patient transfers for MAiD assessments and provision. There have been media reports highlighting the negative consequences of these “institutional objections”, however, very little research has examined their nature and impact. Methods This study reports on findings from 48 semi-structured qualitative interviews conducted with (...) MAiD assessors and providers, MAiD team members (working to coordinate care and lead MAiD programs in institutions and health authorities), and family caregivers on their experiences with institutional objection. Participants were recruited from the Canadian provinces of British Columbia, Ontario, and Nova Scotia. Data were analyzed using inductive thematic analysis. Results Themes identified were: (1) basis for institutional objection (with objections commonly rooted in religious values and a particular philosophy of palliative care); (2) scope of objection (demonstrating a wide range of practices objected to); (3) lack of transparency regarding institutional position; (4) impacts on patients; (5) impacts on health practitioners; and (6) catalysts for change. Participants reported that many institutions’ objections had softened over time, lessening barriers to MAiD access and adverse impacts on patients and health practitioners. Participants attributed this positive change to a range of catalysts including advocacy by health practitioners and family members, policymaking by local health authorities, education, and relationship building. Nevertheless, some institutions, particularly faith-based ones, retained strong objections to MAiD, resulting in forced transfers and negative emotional and psychological impacts on patients, family members, and health practitioners. Conclusions This paper adds to the limited evidence base about the impacts of institutional objection and can inform practical and regulatory solutions in Canada and abroad. Reform is needed to minimize the negative impacts on patients, their caregivers, and health practitioners involved in MAiD practice. (shrink)

Cooperative innovation has become a critical method for freight logistics firms in supply chain management. The previous study has proved that relational embeddedness has a positive effect on service innovation performance. However, the influence of organizational learning capacity has been widely ignored. This study focuses on explaining the mechanism of OLC on the relationship between RE and innovation performance of freight logistics service. Firstly, a theoretical model is constructed based on Social Network Theory, and four research hypotheses are presented. (...) Secondly, a sample of 236 respondents from freight logistics firms in China is analyzed to test the hypotheses. Finally, several management implications and recommendations are suggested. The research results demonstrate that both RE and OLC have positive effects on IPFLS. Meanwhile, OLC partially mediates the relationship between RE and IPFLS. The findings provide practical guidance for managers to strengthen the relationship with partners and enhance OLC. (shrink)

Objectives: Athlete burnout is a crucial concern affecting the development and athletic performance of young weightlifters. To reduce or relieve the prevalence of athlete burnout, this study examined the relationship across social support, sports motivation, mental toughness, and athlete burnout in weightlifters.Methods: A total of 315 weightlifters aged 17–28 years old from Sichuan, Chongqing, and Shanxi in China participated in this survey. The Perceived Available Support in Sport Questionnaire, Sports Motivation Questionnaire, Sports Mental Toughness Questionnaire, and Athlete Burnout Questionnaire were (...) used in this study. SPSS Statistics 19.0, AMOS 21.0, and PROCESS 3.0 macro were used to analyze the collected data.Results: The results indicated that weightlifters’ social support could negatively significantly affect athlete burnout [beta = −0.398; 95% confidence interval : −0.3699, −0.2184; P < 0.05) via mental toughness and sports motivation. The mediation analysis revealed that they had partial mediating effect, including three paths: First, social support had a direct effect on athlete burnout ; second, sport mental toughness had a mediating effect on athlete burnout ; and finally, sports motivation had a mediating effect on athlete burnout.Conclusion: The findings revealed that social support could inhibit or prevent athlete burnout via mental toughness and sports motivation; thus, to decrease or relieve the prevalence of burnout in weightlifters, it is an important solution to enhance their social support. (shrink)

The doctrine of double effect, together with other moral principles that appeal to the intentions of moral agents, has come under attack from many directions in recent years, as have a variety of rationales that have been given in favor of it. In this paper, our aim is to develop, defend, and provide a new theoretical rationale for a secular version of the doctrine. Following Quinn (1989), we distinguish between Harmful Direct Agency and Harmful Indirect Agency. We propose the (...) following version of the doctrine: that in cases in which harm must come to some in order to achieve a good (and is the least costly of possible harms necessary), the agent foresees the harm, and all other things are equal, a stronger case is needed to justify Harmful Direct Agency than to justify Harmful Indirect Agency. We distinguish between two Kantian rationales that might be given for the doctrine, a “dependent right” rationale, defended by Quinn, and an “independent right” rationale, which we defend. We argue that the doctrine and the “independent right” rationale for it are not vulnerable to counterexamples or counterproposals, and conclude by drawing implications for the larger debate over whether agents' intentions are in any way relevant to permissibility and obligation. (shrink)

BackgroundThe healthcare system is among the institutions operating under the most challenging conditions during the period of outbreaks like pandemic which affects the whole world and leads to deaths. During pandemics that affect the society in terms of socioeconomic and mental aspects, the mental health of healthcare teams, who undertake a heavy social and work load, is affected by this situation.AimThis research was conducted with the aim of determining the effect of stress, anxiety, and burnout levels of healthcare professionals (...) caring for COVID-19 patients on their quality of life.MethodThe sample of the study consisted of a total of 240 healthcare professionals, determined by random sampling method among the healthcare professionals working in pandemic hospitals in Tokat city center, Turkey. Perceived Stress Scale, Spielberger State-Trait Anxiety Inventory, Maslach Burnout Inventory and Quality of Life Scale were used in the study conducted in the relational screening model.FindingsWhile the stress, trait anxiety, and quality of life mean scores of healthcare professionals who were female, married and had children were higher than the other groups, high, moderate, negative, and positive correlations were found among all variables.ConclusionThe research concluded that the stress, anxiety, and burnout of healthcare workers caring for COVID-19 patients affected their quality of life. (shrink)

In the current study, we aimed at understanding the effect of exposure to complex input on speech sound development, by conducting a systematic meta-analysis review of the existing treatment-based studies employing complex input in children with speech sound disorders. In the meta-analysis review, using a list of inclusion criteria, we narrowed 280 studies down to 12 studies. Data from these studies were extracted to calculate effect sizes that were plotted as forest plots to determine the efficacy of complexity-based (...) treatment approaches. The outcome variables of interest were improvement on the treated and generalization to the untreated sounds. Meta-analysis revealed that the exposure to complex input not only promoted improvement in production of complex speech sounds but also facilitated the production of untreated simple speech sounds. Overall, the current findings revealed that the exposure to complex input promotes acquisition of both complex and simple speech sounds. The current findings are in line with the models of language learnability. The current findings have implications in the treatment of speech sound disorders. (shrink)

This paper examines the influence of internal barriers on the relationship between the organizational capability of stakeholder integration and proactive environmental strategies. We adopt a moderate hierarchical regression model to test the hypotheses using data from a sample of 73 managers in the business education industry. The paper contributes to stakeholder theory by showing that stakeholder integration positively influences the development of proactive environmental strategies when managers perceive internal barriers to the development of such strategies. This article also explores an (...) ethical dilemma—managers may use the stakeholder integration capability to support their own interests rather than to benefit stakeholders. (shrink)

This paper investigates how environmental structure, given the innate properties of a population, affects the degree to which this population can adapt to the environment. The model we explore involves simple agents in a 2-d world which can sense a local food distribution and, as specified by their genomes, move to a new location and ingest the food there. Adaptation in this model consists of improving the genomic sensorimotor mapping so as to maximally exploit the environmental resources. We vary environmental (...) structure to see its specific effect on adaptive success. In our investigation, two properties of environmental structure, conditioned by the sensorimotor capacities of the agents, have emerged as significant factors in determining adaptive success: (1) the information content of the environment which quantifies the diversity of conditions sensed, and (2) the expected utility for optimal action. These correspond to the syntactic and pragmatic aspects of environmental information, respectively. We find that the ratio of expected utility to information content predicts adaptive success measured by population gain and information content alone predicts the fraction of ideal utility achieved. These quantitative methods and specific conclusions should aid in understanding the effects of environmental structure on evolutionary adaptation in a wide range of evolving systems, both artificial and natural. (shrink)

Source: Author: Mohsen Mehrara, Yazdan Gudarzi Farahani, Farzan Faninam, Abbas Rezazadeh Karsalari This paper examines the relationship between stock market index and macroeconomic policies on Iran's economy using quarterly data in the period 1999-2013. This study employed cointegration test and vector autoregressive models to examine relationships between the stock market index and the macroeconomic variables. The empirical results reveal that a positive money shock can increase stocks return. According to impulse responses, the government expenditure had a slight impact on stocks (...) return in the short term. But the government expenditure has a positive effect on exchange index in long run. Also the effect of taxes on the stock's price index is negative, so that it reaches its maximum level after the third lag and then alleviates. The GDP shock has positive effect on the stock's price index. Increase in production level leads to increase in earnings and profitability, leading to a positive response from stocks index. Therefore the results showed that the macroeconomic variables such as inflation, exchange rate and GDP have significant effects on Tehran exchange price index. So the hypothesis that the improving economic factors can have a useful role in the booming capital market is confirmed. Also the effect of fiscal policy factors such as tax revenues and government expenditures is more than monetary policy factors on stock returns. ]]>. (shrink)

The aim of the present research was to assess elite student-athletes’ perception of the dual career during the lockdown caused by the coronavirus disease 2019 pandemic, compared with a group of elite student-athletes who could develop their dual career under normal conditions. A total of 150 elite athletes who were also undergraduate or postgraduate students self-completed the “Perceptions of dual career student-athletes ” questionnaire. From them, 78 did it during the mandatory lockdown period due to the state of emergency caused (...) by COVID-19 and 72 completed it in the previous year to Rio 2016 Olympic Games. The COVID-19 group was found to spend a significantly higher number of hours per week studying, while no significant differences were observed between groups in any training time variable. Student-athletes of the COVID-19 group showed better perception of whether their sport career could help them cope with their academic career and better general perception of remote learning and the use of tasks and videoconferencing as learning support tools. A lower percentage of athletes of the COVID-19 group than of the control group wished to continue with their sport career once they finished their studies. To conclude, student-athletes of the COVID-19 group show adaptations with regard to the organization of their studies and the importance they give to them and to the services provided by dual-career programs, compared with student-athletes from an ordinary pre-Olympic year. In general, student-athletes’ perception of the dual career is very positive. (shrink)

During the outbreak of COVID-19, information on the epidemic inundated people’s lives and led to negative emotions in many people. This study aims to explore the effect of various emotions on prosocial tendencies during the COVID-19 outbreak and the moderating effect of the severity of the epidemic. We explore these effects by conducting a text analysis of the content of posts by 387,730 Weibo users. The results show that the severity of the epidemic promotes prosocial tendencies; anger motivates (...) prosocial tendencies significantly; and the severity of the epidemic moderates the effects of three emotions—anger, sadness, and surprise—on prosocial tendencies. These findings provide a reference for exploring the positive significance of major disasters. (shrink)