The aim of this article is to reveal how care workers in the home-help services handle the process when older people’s relocation to a residential home is under consideration. Since the care workers are engaged daily in defining care receivers’ needs and yet have no formal influence on care decisions in Sweden, the focus is on how they solve this dilemma. In this inductive study, the theoretical framework is based on occupational alliances, relationship-based practice, and discretion. (...) Thirty-three care workers in home-help services are included in open semi-structured interviews. Prominent features in the findings are that the care workers take their stand at the borderland of care management, when they know or try to find out what is right. The conclusions drawn are that care workers find ways to informally influence the decision-making process, quite contrary to the idea of approaches referred to as purchaser/provider models. The implications for social work policy and practice are that a distinction between assessment and intervention may not benefit the field of eldercare and should therefore be regarded as an area in need of thorough reconsideration. (shrink)

Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients’ homes. This greatly impacts nurses’ work in home care, making their work increasingly diverse and demanding. In this study, we explore home‐care nursing through a critical discourse analysis of focus group interviews with home‐care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of contextual changes. (...) Nurses hold a crucial position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home‐care nurses’ work. Changes have made nurses’ work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses’ work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses’ work to help shape the further development of home‐care nursing. (shrink)

The number of homebound individuals in the United States is on the rise, causing health-care professionals to expand in-home health services to help meet the increased demand. Due to the prevalence of feelings of isolation and depression in this population, it is imperative that mental health professionals join this effort to increase access to mental health services. Delivering psychotherapy in clients’ homes presents many advantages to these homebound individuals, but there is a dearth of literature addressing (...) how therapists should handle unique ethical issues that arise in this type of setting. This article addresses ethical considerations and guidelines for in-home provision of mental health services. General ethical issues related to home-based psychotherapy include boundaries, confidentiality and privacy, competency, insurance coverage, and autonomy. Issues pertaining to different categories of homebound individuals, including persons with agoraphobia, chronic illnesses, and older adults, are then discussed in turn. Recommendations on how to best manage these issues by applying the American Psychological Association’s, the American Counseling Association’s, and the National Association of Social Workers’ Ethics Codes are provided. (shrink)

Little is known about older persons’ expectancies (or anticipations) about the possible actions of home-care professionals, although such data have implications for the ethics of home care and home-care policies. From a longitudinal study of older women’s experience of home care, findings are reported concerning their expectancies of professional home-care providers. A descriptive phenomenological method was used to detail the structure of the experience and its context. Data were analyzed from a series of interviews with (...) 13 women aged 82 to 96 years. Among the five key structures of experience were ‘finding that someone has the job of helping me here’ and ‘determining where the helper’s field lies’. Two subsets within a category of expectancies were differentiated: speculations about helpers’ possible actions and expectancies about outcomes of helpers’ actions. As parameters of relational ethics, clients’ speculations and expectancies are appropriate bases for dialogue about older widows’ relationships with home-care professionals and the foci of home-care policies. (shrink)

Sometimes the majority of individuals accepting a service regret their decision, and we can predict that future recipients will feel similarly. For example, a hospital might learn that the majority of patients regret accepting a given medical intervention, and a UN agency might learn that most refugees it has helped repatriate regret returning home. I argue that agents providing services that lead to likely regret have one pro tanto reason to discontinue their services, and this reason is (...) weighty if the service is epistemically transformative. (shrink)

Background Nurse leaders increasingly need effective tools that facilitate the prioritisation of ethics and help staff navigate ethical challenges and prevent moral distress. This study examined experiences with a new digital tool for ethical reflection, tailored to improve the capabilities of both leaders and employees in the context of municipal long-term care. Aim The aim was to explore the experiences of nurse leaders and nurses in using Digital Ethical Reflection as a tool for ethics work in home nursing (...) care. Research design The study employed a qualitative design, incorporating individual and focus group interviews for data collection. Qualitative content analysis was used to analyse the data. Participants and research context The participants comprised six nurse leaders and 13 nurses, representing six home care zones across two Norwegian municipalities. Ethical considerations The study involved informed, voluntary participation and was approved by the Norwegian Agency for Shared Services in Education and Research. Findings Four themes were developed: a constant walk on the edge between engagement and discouragement and lost in translation describe the process, while tuning in to the ethical dimension and navigating ethical uncertainties illuminate the experienced significance of Digital Ethical Reflection. Conclusion Success with Digital Ethical Reflection in home nursing care depends on clear leadership planning, nurses’ understanding of the tool’s purpose, and active use of digital registrations. Support from ethically interested nurses enhances overall engagement. Further research is needed to explore the potential of Digital Ethical Reflection as an additional tool in long-term care ethics work. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Please Help Me”Rebecca L. VolpeTwo–year–old Jay was born prematurely at 26 weeks gestation, addicted to opiates. After several months in the Neonatal ICU, he was sent home, ventilator–dependent but with a high likelihood of survival and a low chance of severe, lasting disability. When Jay was 1½, he had a cardiopulmonary arrest at home. The parents of children who are on ventilators at home receive (...) extensive education and training about how to respond to something like an arrest. They are taught that a quick response is often critical to their child’s long–term prognosis. And yet, Jay’s parents took such a long time to respond to his code that Jay now has severe hypoxic ischemic encephalopathy: his brain was deprived of oxygen for so long that he has no higher cortical function, and will never think, speak, walk, or play.Currently, Jay is ventilator–dependent and has a very poor prognosis. Jay goes back and forth between a nursing home and the hospital. During one of his many hospitalizations, the ICU team decided to call an ethics consultation, because they felt that continued aggressive intervention was no longer in Jay’s best interests. I was the person on the other end of the line when the medical team called. After having a brief conversation with the attending physician, I left my office and walked to the Pediatric ICU to visit Jay. I arrived at the bedside—really just a large crib—and saw a baby with dark hair lying flat on his back. His tongue was swollen and protruding from his mouth, his eyes were puffy and closed, and his limbs were limp. On his belly was a piece of paper with the words, “BECKY PLEASE HELP ME” typed in huge, bold font. I looked up, into the eyes of the attending physician and said, “Did you type that?” The physician nodded yes. Much could be said about this physician’s behavior. But the bottom line—from a clinical perspective, at least—is that this ICU team was desperate, and that they had significant expectations that I would be able to help them.I began the work of the consultation. I reviewed the medical record, spoke with members of the treating team, and set up a time to talk to the family. During the family meeting, I learned that Jay’s parents wanted to continue to treat aggressively, and that they believed it was not their place to decide when it was their son’s time to die. That was [End Page 122] God’s decision. They could not fathom removing interventions that were maintaining their son’s life. They acknowledged that his quality of life was not high, but, still, it was life.The preferences of the treating team were in stark contrast to the parents’ preferences. The neurologists believed Jay did not have the capacity to experience physical pain, but the ICU team believed that continuing to treat Jay was cruel. Although the ICU team acknowledged that Jay was probably not suffering, they noted that we could not know for sure, and that sometimes Jay grimaced and withdrew—signs that are often interpreted as suffering. The ICU team also argued that given all the sick children in the world, and the scarcity of healthcare resources, it didn’t make sense to invest hundreds of thousands of dollars into prolonging Jay’s life. Additionally, they discovered that Jay had osteopenia (weak, brittle bones)—which was causing multiple bone fractures. The ICU team anguished over the thought of Jay’s small, soft bones continuing to break despite their best efforts.The bioethicist in me knows that, as long as the patient isn’t suffering and the parents aren’t demanding futile interventions (they weren’t), our role as providers was not to judge the parents’ value system. I told the ICU team over and over that different people place different value on Jay’s type of life, and that it wasn’t for us to tell them that their value structure was wrong. I talked with other members of the clinical ethics consultation service. Then I brought the case to the entire institutional... (shrink)

Aging has become a serious social problem in China. Traditional informal long-term care is hard to sustain because of the reduction in family size and elders’ children migration to big cities. The institution offering services for the disabled elders has been a tendency. There exists a strange phenomenon: some nursing homes are difficult to enter for most disabled elders, while the other ones must search for elders to maintain operation. Therefore, for the evaluation of nursing homes, two problems should (...) be considered: selecting suitable nursing homes for disabled elders; obtaining the key factors influencing the selection of elders and helping nursing homes improve their services based on the key factors. First, we propose a new DEMATEL method for PLTSs to solve the second problem. Then, we present a novel PROMETHEE method to rank the alternatives and make a sensitivity analysis for criteria. Finally, we illustrate our proposed methods to an evaluation problem in Zhenjiang City by a case study. Based on the case study, we can obtain that our proposed methods are effective and practicable. (shrink)

Background: Most older people wish to live in the familiar surroundings of their own home until they die. Knowledge concerning dignity and dignity loss of home-dwelling older women living with incurable cancer should be a foundation for quality of care within municipal healthcare services. The informal caregivers of these women can help increase the understanding of sources related to dignity and dignity loss Aim: The aim of this study was to explore informal caregivers’ perceptions of sources (...) related to dignity and dignity loss in end-of-life of older home-dwelling women with incurable cancer. Research design and method: The study was founded upon Gadamer’s philosophical hermeneutics. In-depth interviews with 13 informal caregivers were carried out, and four participant observations were performed during home meetings. Ethical consideration: The study was based on voluntary participation, informed consent, confidentiality and the opportunity to withdraw at any time. The Norwegian Social Science Data Services approved the study. Results: Three main sources important in preserving the older women’s dignity were identified: maintaining one’s self-concept, remaining hopeful and sustaining freedom of choice. We also identified three main sources that lead to dignity loss: Sensing loss of human value, experiencing absence of gentleness and feelings of being treated as an object. Discussion and final considerations: On the individual level, the opportunity to maintain one’s self-concept and control in life, preserved dignity, while feelings of existential loneliness led to dignity loss. On the relational level, being confirmed as worthy human beings promoted the women’s dignity, whereas dignity loss was related to uncaring behaviours from healthcare professionals. On the societal level, individual decisions concerning travel situations and the place to stay when nearing end-of-life were of crucial importance. Constituting these women’s living space, these perspectives should be emphasized in healthcare professionals’ educational training and in the municipal end-of-life care of these patients. (shrink)

This paper examines the ethics of using assistive technology such as video surveillance in the homes of people living with dementia. Ideation and concept elaboration around the introduction of a camera-based surveillance service in the homes of people with dementia, typically living alone, is explored. The paper reviews relevant literature on surveillance of people living with dementia, and summarises the findings from ideation and concept elaboration workshops, designed to capture the views of those involved in the care of people living (...) with dementia at home. The research question relates to the ethical considerations of using assistive technologies that include video surveillance in the homes of people living with dementia, and the implications for a person living with dementia whenever video surveillance is used in their home and access to the camera is given to the person’s family. The review of related work indicated that such video surveillance may result in loss of autonomy or freedom for the person with dementia. The workshops reflected the findings from the related work, and revealed useful information to inform the service design, in particular in fine-tuning the service to find the best relationship between privacy and usefulness. Those who took part in the workshops supported the concept of the use of camera in the homes of people living with dementia, with some significant caveats around privacy. The research carried out in this work is small in scale but points towards an acceptance by many caregivers of people living with dementia of surveillance technologies. This paper indicates that those who care for people living with dementia at home are willing to make use of camera technology and therefore the value of this work is to help shed light on the direction for future research. (shrink)

BackgroundIn Palliative Care, family and close people are an essential part of provision of care. They assume highly complex tasks for which they are not prepared, with considerable physical, psychological, social and economic impact. Informal Caregivers often falter in the final stage of life and develop distress, enhancing emotional burden and complicated grief. The lack of available and accessible in-person counselling resources is often reported by ICs. Online resources can promote early access to help and support for patient-IC dyads (...) in palliative care. The primary aim of this research is to co-design, develop and test the feasibility of the Help2Care-PAL mHealth app that addresses the needs of ICs of palliative patients cared for at home. This Digital Health Intervention in palliative care will be used for education, symptom management, communication and decision-making, to enhance Quality of Life of patients and ICs, fostering anticipatory grief and the reach and efficiency of services.MethodsThis study will use an iterative co-design process and convergent mixed-methods design, following the MORECare consensus for developing a complex intervention. Construction of the DHI will follow four main phases: a needs assessment ; design and co-production of mHealth materials and interventions to support ICs; the development of a mHealth app; and usability and feasibility of the mHealth app. The Help2Care-PAL platform seeks to build resources from the perspectives and needs of both family dyads and nursing professionals working in the field of community palliative care. User-centeredness will be ensured by the active participation of patient-IC dyads and professionals of the palliative care community.DiscussionThis mixed-method study will offer new insights on needs and expectations of patient-IC dyads and nurses in community palliative care regarding caregiving preparedness and online health resources. Through the implementation of an adaptive digital tool, we aim to improve access to palliative care family support, which is highly linked with the wellbeing of patients and especially new ICs. (shrink)

THE GREAT GUIDE What David Hume can teach us about being human and living well 328pp. Princeton University Press. £20 (US $24.95). Julian Baggini "... The most successful aspect of The Great Guide is the “Hop-On Hop-Off” intellectual tour that it offers. The reader is taken around the various locations where Hume’s life and ideas developed, moving from country to country, city to city, and stopping off at a few stately homes en route. This tour begins with Hume’s birthplace and (...) early education in Edinburgh and the Scottish Borders, moves on to La Flèche in France (where Hume composed much of his Treatise of Human Nature), then back to London and England, and carries on from there. As we travel around with Hume, Baggini provides his readers with a steady commentary and description of his subject’s various friendships and controversies, along with brief sketches of Hume’s core ideas and contributions. All this is lively and engaging. But there are limitations to Baggini’s method and approach. ... Perhaps the most unsatisfactory aspect of Baggini’s book is his effort to turn Hume’s life and philosophy into a self-help manual. It is true that there is much about both Hume’s character and philosophy to admire, but it is not obvious that this is usefully packaged into a set of 145 'maxims' guiding us towards 'the good life'. ... It does Hume little service to present his thought like this.". (shrink)

BackgroundThe present study examined the efficacy of the Michigan Model of Infant Mental Health-Home Visiting infant mental health treatment to promote the socioemotional wellbeing of infants and young children. Science illuminates the role of parental “co-regulation” of infant emotion as a pathway to young children’s capacity for self-regulation. The synchrony of parent–infant interaction begins to shape the infant’s own nascent regulatory capacities. Parents with a history of childhood adversity, such as maltreatment or witnessing family violence, and who struggle with (...) symptoms of post-traumatic stress may have greater challenges in co-regulating their infant, thus increasing the risk of their children exhibiting social and emotional problems such as anxiety, aggression, and depression. Early intervention that targets the infant–parent relationship may help buffer the effect of parental risk on child outcomes.MethodsParticipants were 58 mother–infant/toddler dyads enrolled in a longitudinal randomized control trial testing the efficacy of the relationship-based IMH-HV treatment model. Families were eligible based on child age and endorsement of at least two of four socio-demographic factors commonly endorsed in community mental health settings: elevated depression symptoms, three or more Adverse Childhood Experiences parenting stress, and/or child behavior or development concerns. This study included dyads whose children were born at the time of study enrollment and completed 12-month post-baseline follow-up visits. Parents reported on their own history of ACEs and current posttraumatic stress disorder symptoms, as well as their toddler’s socioemotional development.ResultsMaternal ACEs predicted more toddler emotional problems through their effect on maternal PTSD symptoms. Parents who received IMH-HV treatment reported more positive toddler socioemotional wellbeing at follow-up relative to the control condition. The most positive socioemotional outcomes were for toddlers of mothers with low to moderate PTSD symptoms who received IMH-HV treatment.ConclusionResults indicate the efficacy of IMH-HV services in promoting more optimal child socioemotional wellbeing even when mothers reported mild to moderate PTSD symptoms. Results also highlight the need to assess parental trauma when infants and young children present with socioemotional difficulties. (shrink)

Objectives: To assess whether according to healthcare providers, the creation of an ethics service responds to a need; assess the importance of an ethics service for healthcare providers; determine what ethics services should be offered and the preferred formats of delivery; and identify key issues to be initially dealt with by the ethics service.Design: A survey of healthcare providers in Québec’s Centre Local de Services Communautaires , healthcare institutions dedicated to community health and social services.Findings: 96 respondents (...) agreed that an ethics service was needed, and on average the ethics service project was judged to be very important. Preferred formats for ethics consultation and education were identified, as well as key concerns such as the need of respect for the patient as a person, elder abuse and ethical issues in home care.Conclusion: This survey is helping in the implementation of an ethics service and can guide others in similar healthcare institutions. (shrink)

The main purpose of this study is to investigate the effect of after sales service, brand equity, environmental awareness, and product pricing towards consumer purchase intention of green home appliance. Data were collected from 150 Penang, Malaysia citizen who were age from 18 to 60 via convenient sampling method analysed using partial least square structure equation modelling. Results indicated that BE, EA, and PP has significant effect on CPI of green home appliance brand. However, ASS do not have (...) significant effect on CPI on green home appliance brand. This research helps home appliance manufacturer to better design marketing promotions, considering the consumers focus on BE, EA, and pricing. In addition, this study provides consumer insight for the government agency to construct better policy in order to increase the green home appliance penetration rate among citizens. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.4 (2003) 373-378 [Access article in PDF] The Forgotten Self:Training Mental Health and Social Care Workers to Work With Service Users Kim Woodbridge Keywords self, workers perspective, them and us, win-win situation The three main papers and the case studies presented in this issue of Philosophy, Psychiatry, & Psychology all focus on the service user perspective in relation to the self as illustrated by different (...) aspects of philosophy. This is also in the context of the service user looking for help during a time when they are experiencing levels of distress and difficulty.Important as this is, evident by the substantial clinical and philosophical literature in this area, what has been overlooked is the perspective of the mental health and social care worker responsible for the care of individuals whose sense of self is disturbed. The significance of this omission has been brought home to me through my experiences in running training workshops for workers working with service users with a diagnosis of personality disorder. (From here on, in this paper, the terms worker and trainee are used interchangeably to refer to the mental health and social care worker).During these workshops challenges to the worker's sense of self have been revealed emotionally ("this doesn't feel like me"), ideologically ("I am not a bad person"), and/or practically ("I don't usually behave like this") when discussing their work with service users. This paper draws from the workshop experiences to explore and consider the workers perspective in relation to the self in more detail.There follows a descriptive account of three workshop sessions which include the trainees responses. With each activity the responses are considered within the context of the self, particularly from the worker's perspective. In the conclusion the argument is made, as evidenced by these illustrations, for the importance of including the workers' perspective when attempting to understand the self. The Trainees and Service Users Workers from various professional and nonprofessional backgrounds attend the workshops. They include psychiatrists, nurses, social workers, support workers, and occupational therapists who work in both in-patient and community settings. They usually have several years of clinical experience working with people with a [End Page 373] diagnosis of personality disorder, but rarely have they had any formal education or training in the area. Discussing their experiences of working with this service user group generates strong and highly emotionally charged personal responses during training.It is their experiences of the relationships with service users whose sense of self is absent, inconsistent, or unstable, that make a substantial contribution to the content of the workshops.Often service users are struggling with fragmented, distorted, or threatening perceptions of the world, themselves, and others. The worker, while embedded within their own sense of self, is engaged in a relationship with the service user. The issues that arise as a part of this relationship can be challenging and distressing for the workers. There are two main areas:The impact the service user's chaotic, fragmented, and unstable sense of self has on the worker's own sense of self.The response of the workers when their sense of self is challenged, and the impact that response has on the service user. These can be seen in more detail in the examples taken from the training sessions presented later in this paper. The Training Sessions The training sessions are either run alone or form part of a 1- or 2-day workshop. As mentioned, the groups are composed of a variety of professionally and nonprofessionally qualified staff. The experiences they share mainly relate to people with a diagnosis of Borderline Personality Disorder, although other subcategories are mentioned occasionally. Information regarding these and other related sessions can be found in two recent publications: Making positive connections (Duff, Meredith, & Woodbridge,2003) and "Whose good practice?" (Woodbridge & Fulford, 2003). The First Activity: Revealing Internal Models Given the lack of available evidence, even the best-informed trainees are likely to have to fill in the knowledge gaps with their own interpretations of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Lives Saved, With a Little Help from FriendsPrasanta TripathyIn November 2000, Jharkhand was carved out of Bihar, a state in eastern India, to be a separate state to fulfill the aspirations of its people and [End Page 109] allay their feeling of alienation. It was a good time for me to reflect on how best I could contribute. In 2002 Ekjut, a registered development organization, was set up (...) by myself and other like-minded colleagues. Ekjut, which means "togetherness," was the outcome of a longstanding desire to do something on our own, something that was close to my heart—doing something for and with the people I had grown up with. An invisible cord kept me attached to this region of India and after stints with a few development organizations within and outside the state, my wife, Nirmala, and I decided to relocate to a village near my hometown, Chakradharpur.Chakradharpur is a small railway township in South Bihar where I spent all my childhood and days of schooling. Beyond the periphery of this township and its satellite market place, live indigenous people, the Adivasi, in villages and hamlets. Even as children we could appreciate the government policy that protected them in the sense that their ancestral lands could not be acquired by Dikus, the non-tribal people living in the towns and cities. The un-spoilt bounties of nature protected and preserved by the original inhabitants of the land—the Adivasi people—was there for all of us to see and enjoy.A rumor that a doctor couple was building a nursing home led to a regular flow of men, women and children to our unfinished home with all kinds of ailments, including medical emergencies. It was becoming increasingly difficult to cope with the workload of constructing the house and at the same time—overwhelming to see children dying in our home, which was never meant to be the hospital that the villagers thought it to be. They were reluctant to visit the government hospitals, which were primarily meant to serve poor people and their attitude could be summarized in just one word—fatalism. We wanted this to change—they somehow needed to understand their rights and entitlements. The public health care system had to be strengthened and Nitmala and I wondered how our work could make this happen.The Adivasi people were soon to become partnering communities with Ekjut. It did not take us long to realize how unprotected they were. We had a vague idea that we wanted to build healthier communities. Providing full-time curative care was not an option; it was also beyond our means. Knowing that strengthening the health system would take time, we hoped that our community-based work would strengthen the demand side, since even the minimum services that were available were grossly under-utilized.India is home to about 10 million tribal people. We had seen and also knew that their health status was poor and that tribal people have the disproportionate burden of child mortality, malnutrition, malaria and death in childbirth. But we could not find a reliable existing data base that could guide our work. The health status of women and children soon became Ekjut's main concern.We wanted our work to generate knowledge that would be relevant in a wider context. Adivasis are not a monolithic entity and our evidence needed to grow from working with several different tribal groups. We needed to build our research capabilities and willingness to work with several different indigenous groups, as well as, the poor people living alongside them in different districts. A collaboration with University College of London was soon to follow. Professor Anthony Costello who was my teacher more than a decade back, invited me to partner with his department and jointly bid for a grant. This grant was likely to come at the confluence of several interesting developments. First, the self-help group movement in India had made a substantial jump and such groups existed in almost every village. Second, a grassroots organization called PRADAN was working with women's groups to strengthen their livelihoods in several states of India including our district. PRADAN shared with... (shrink)

Innovative organizing strategies in the labor movement are being driven by the realization that labor law is of virtually no help in helping workers exercise their rights. Unions are increasingly designing strategies that go beyond traditional workplace tactics and draw on a wide range of social actors and relationships in an effort to find and harness new leverage sources. Service Employees International Union Local 1199 Florida provides one such example. 1199 Florida has a multilayered, multifaceted organizing strategy that attempts (...) to surmount the obstacles of employer resistance and weak labor laws by mobilizing a range of allies and engaging political and regulatory actors. (shrink)

Straipsnyje siekiama įvertinti pagalbos namuose paslaugas teikiančių darbuotojų darbo vietos kokybę Lietuvoje ir išryškinti veiksnius, kurie leistų šią kokybę pagerinti – tai ypač aktualu didėjant šių paslaugų poreikiui tiek visoje Europos Sąjungoje (toliau – ES), tiek Lietuvoje. Apžvelgiamos darbo vietos kokybės tendencijos globos sektoriuje ES šalyse, aptariama teorinė darbo vietos kokybės samprata bei jos pagrindu analizuojami 2016 m. Lietuvoje atliktos lankomosios priežiūros darbuotojų (LPD) anketinės apklausos rezultatai. Tyrimo rezultatai leidžia teigti, kad LPD darbo vietos kokybė nėra patraukli. Tai lemia nuolatinės (...) darbo vietos neturėjimas, emocinis darbo pobūdis, sukeliantis stresą, paplitęs fiziškai sunkus darbas, nepakankamas bendradarbiavimas tarp sveikatos ir socialinės pagalbos specialistų. Be to, pagalbos namuose paslaugų sektoriuje dominuoja netipinės užimtumo formos ir menkas darbo užmokestis, nepasinaudojama šio sektoriaus galimybėmis lanksčiai organizuoti darbą ir darbo laiką, nors tai prisidėtų prie darbo vietų kokybės gerinimo. Tyrimo išvados leidžia teigti – jeigu organizuojant paslaugas nebus kreipiamas dėmesys į darbo ypatumus šiame sektoriuje, užimtumo kokybės gerinimo veiksnius, ateityje susidursime su darbo jėgos senėjimo socialinių paslaugų sektoriuje problema ir darbuotojų šiame sektoriuje trūkumu. (shrink)

This essay examines a special program developed by the international Canadian mining firm, Placer Dome, to help recently laid-off workers find remunerative work in southern Africa. Shortly after it bought a 50% interest in the Deep South gold mine in South Africa, the mine laid off nearly 2600 workers. The firm gave redundant miners token serverance pay and offered them opportunity to participate in training and counseling services at the mine site. Overwhelmingly, the miners came from homes all (...) over southern Africa at great distance from the mine to which homes they chose to return. In addition, many had become ill from the HIV virus. Placer Dome soon realized that something more was required, given the very high rates of unemployment in the region. After securing grants from USAID and CIDA, and working with NGOs representing both the unions and mining companies in South Africa, the firm developed Project CARE. The project contacted workers where they lived and offered them or another proxy member of their households a variety of training, coaching, and consultative services. Within 2 years 65% of those contacted had either found new employment or started their own business. The project helped those households with HIV-affected ex-miners care for their affected family members. While describing the case, the essay raises more general ethical questions about the responsibilities of mining firms in particular for their redundant workers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 21.1 (2001) 33-36 [Access article in PDF] How I, a Christian, Have Learned from Buddhist Practice, or "The Frog Sat on the Lily Pad... Not Waiting" Frances S. Adeney Louisville Presbyterian Theological Seminary As a Christian, I have practiced various forms of silent meditation. I remember sitting under the grand piano as a child of three, watching the sun flit through white curtains during our one-hour (...) class='Hi'>home communion service of the Plymouth Brethren. Most of the hour was spent in communal silence, gathered around a small table upon which was placed wine and bread. My memories of these meetings are filled with a sense of awe and presence.I practiced a different kind of silent meditation as a young adult when I spent six weeks living on a beach in Greece. I saw few people apart from my two companions and the shepherdess who brought her flock to the meadow each day. I spent hours watching the waves or studying the grains of sand at my feet. I never missed a sunset.At certain times of my life, there were more intentional, prayer-filled kinds of silent meditation. Wordless yearnings and grievings were brought to those meditations as I sought understanding and peace during times of illness, loss, and confusion. I wouldn't call any of those experiences Buddhist meditation. They were intentionally focused on either worshiping Christ or experiencing nature. There was no attempt to leave behind desires, no longing for emptiness, no intentional focus on being in the present moment, qualities that I associate with Buddhist meditation.The first time I joined a group of people practicing Buddhist sitting was in 1997. Yet I felt like I had been doing this kind of silent meditating for years. Here is how that convergence came about.During the early 1990s, while living in Indonesia, I frequently visited a Trappist monastery in central Java. The nuns there didn't practice Buddhism, but my spiritual director, a German priest who lived down the mountain, said to me, "Come and see." Father Hamma introduced me to sitting in a gentle non-technique-oriented way. He called it "contemplative prayer." I took up this practice daily during a difficult time of loss in my life. Spiritual retreats at the monastery up the mountain helped me learn to let go of what I could not hold onto in life. It was there that I began to experience the delight and calm that comes from a practice of meditative silence. [End Page 33]This silent meditation differed from other practices of silence that I had known in significant ways: (1) It was not focused on an interchange between God and myself. I was not listening for God's voice. I was not bringing my concerns to God. I was simply entering a place of silence. (2) It was not predicated on specific ideas about God or thoughts from writings in the Bible. I did not need to frame this time of silence with religious meanings. (3) It was not focused on an outcome. I neither expected nor did I ask for any changes in myself or the world.Yet there were ways in which this practice of meditative silence was framed by my Christian faith. In taking up this practice, I felt I was intentionally entering God's presence. While not looking for spiritual experiences, I was somehow seeking life, and I did believe that God met me in those silent moments. More than once I had experiences that were "sightings" if not meetings with the Divine. During the seven years that I have practiced entering silence, the space that I enter has grown larger, and the conviction that I am entering and becoming part of God's presence deepens. The frog sat on the lily pad not waiting. This Haiku poem resulted from one such experience. I had taken the bus out from the city. It dropped me at the foot of one of hundreds of small mountains in Java covered by... (shrink)

Background: To place a dependent with severe dementia in a nursing home is a painful and difficult decision to make. In collectivistic oriented societies or families, children tend to be socialised to care for ageing parents and to experience guilt and shame if they violate this principle. Leaving the care to professional caregivers does not conform with the cultural expectations of many ethnic groups and becomes a sign of the family’s moral failure. Research design: Qualitative design with individual in-depth (...) interviews with nurses, family members and dementia care coordinators in Norway, Montenegro, Serbia and South Africa. Braun and Clarke’s six analytic phases were used. Ethical considerations: The project was approved by the Regional Committee for Research, South-Eastern Norway; the Norwegian Centre for Research Data; the Ethics Committee; University of Limpopo, MEDUNSA Campus, South Africa; and by the local heads of the respective nursing homes or home care services. Interviewees were informed orally and in writing and signed an informed consent form. Findings: Healthcare professionals tend to be contacted only when the situation becomes unmanageable. Interviewees talked about feelings of obligation, shame and stigma in their societies regarding dementia, particularly in connection with institutionalisation of family members. Many lacked support during the decision-making process and were in a squeeze between their own needs and the patients’ need of professional care, and the feeling of duty and worry about being stigmatised by their surroundings. This conflict may be a source of pre-decision regret. Conclusion: Family caregivers need help to understand the behaviours of persons with dementia and how to access the formal and informal services available. Thus, they may provide effective support to patients and family carers alike. Supportive interventions for caregivers need to be tailored to meet the individual needs of both the caregiver and the persons with dementia. (shrink)

PurposeThe main purpose of this study is to assess the effects of COVID-19 on the restaurant businesses of Bangladesh. It examines the socio-economic impacts of the humanitarian disaster of the COVID-19 pandemic from the perspective of restaurant owners. The study also intends to provide recommendations to mitigate effects on the restaurant business.Design/Methodology/ApproachA qualitative research approach was adopted to explore the effects of the COVID-19 pandemic on the restaurant businesses of Bangladesh. A total of 22 in-depth interviews were conducted with the (...) top-ranked restaurant owners in the Rajshahi City Corporation area of Bangladesh. Thematic analysis technique was applied for analyzing the collected data.FindingsThe study found that the restaurant owners were compelled to reduce their number of employees, and forced to ensure social distancing and proper sanitization which increased the expenses. Although online orders and home delivery services have increased significantly, restaurant business operation is gradually turning critical owing to the lack of financial support. Thus, restaurant owners urge the govenrment for financial assistance.Research Limitations/ImplicationsSince this research only focused on one city in Bangladesh, the outcomes of study may have a dearth of generalizability. Hence, the investigators are encouraged to extend the study area.Practical ImplicationsThis study will help restaurant owners and policymakers in formulating contemporary business policies and strategies. Thus, it will be supportive of improving the present condition of the restaurant businesses in developing countries like Bangladesh.Originality/ValueThis paper identified the truculent scenario of the restaurant business during the COVID-19 pandemic. (shrink)

OBJECTIVES: To analyse the attitudes of medical personnel towards terminally ill patients and their right to be fully informed. DESIGN: Self-administered questionnaire composed of 56 closed questions. SETTING: Three general hospitals and eleven health centres in Granada (Spain). The sample comprised 168 doctors and 207 nurses. RESULTS: A high percentage of medical personnel (24.1%) do not think that informing the terminally ill would help them face their illness with greater serenity. Eighty-four per cent think the patient's own home (...) is the best place to die: 8.9% of the subjects questioned state that the would not like to be informed of an incurable illness. CONCLUSION: In our opinion any information given should depend on the patient's personality, the stage of the illness and family circumstances. Our study confirms that a hospital is not the ideal environment for attending to the needs of the terminally ill and their families. (shrink)

Special purpose service robots have already entered the market and their users’ homes. Also the idea of the general purpose service robot or personal robot companion is increasingly discussed and investigated. To probe human–robot interaction with a mobile robot in arbitrary domestic settings, we conducted a study in eight different homes. Based on previous results from laboratory studies we identified particular interaction situations which should be studied thoroughly in real home settings. Based upon the collected sensory data from the (...) robot we found that the different environments influenced the spatial management observable during our subjects’ interaction with the robot. We also validated empirically that the concept of spatial prompting can aid spatial management and communication, and assume this concept to be helpful for Human–Robot Interaction design. In this article we report on our exploratory field study and our findings regarding, in particular, the spatial management observed during show episodes and movement through narrow passages. Keywords: COGNIRON, Domestic Service Robotics, Robot Field Trial, Human Augmented Mapping, Human–Robot Interaction, Spatial Management, Spatial Prompting. (shrink)

Background Healthy aging is one of the essential aspects of a health promotion program in the elderly. Aim Exploring ethical challenges in healthy elderly care from the perspective of nurses, older adults, and families in the Iranian context. Research Design This qualitative study was conducted using a content analysis approach in 4 health centers in northeastern Iran from 2017 to 2019. Semi-structured interviews, observation, review of elderly files, and focus groups were used to collect data. Ethical considerations The ethics committee (...) of the university approved this study in Iran. This study adhered to the principles of the Helsinki Declaration. Ethical principles autonomy, confidentiality, and anonymity were considered for the participants. Participants were informed about the purpose of the study and submitted written informed consent regarding their participation. Findings The central theme was: An unfair approach to caring for healthy older adults. The three categories were as follows: Forgotten human care, disrespect, and lack of a meaningful and trustworthy relationship. The 14 subcategories highlighted the ethical challenges of healthy aging care in health centers. Discussion The findings showed that due to nurses’ unfamiliarity with the concept of healthy aging, older adults are discriminated against in care centers. Creating a standard care program for healthy older adults ensures that ethical principles are followed for these clients. Conclusion Various individual and organizational factors lead to an unfair approach to caring for healthy elderly in health centers. The following factors can help improve the care of healthy aging and reduce ethical challenges in this area: Introducing nurses to the concept of healthy old age and its dimensions, creating a community-based approach in health centers, prioritizing health issues over health issues, Involvement of families and older adults in needs assessment-goal setting-implementation and evaluation of health services, and design of home visit programs to provide services to healthy elderly. (shrink)

ABSTRACT Global biodiversity declines are increasingly recognized as profound ecological and social crises. In areas subject to colonialization, these declines have advanced in lockstep with settler colonialism and imposition of centralized resource management by settler states. Many have suggested that resurgent Indigenous-led governance systems could help arrest these trends while advancing effective and socially just approaches to environmental interactions that benefit people and places alike. However, how dominant management and conservation approaches might be decolonized (i.e., how their underlying colonial (...) structure might be addressed, transformed, and replaced) is not always clear. Here, we describe a ‘Decolonial Model of Environmental Management and Conservation’ as an alternative paradigm to dominant approaches of conservation and management. The tenets of the model describe characteristics that might be expected of decolonized management, contrasted with those of dominant state-led approaches such as those embedded in the North American Model of Wildlife Conservation. The model does not prescribe how Indigenous governments or communities ought to govern their own territories, but instead offers insights into how external management and conservation agencies and practitioners might support (or stop impeding) Indigenous-led governance. We illustrate the model with a conservation ‘bright spot’: grizzly bear stewardship in the area now referred to as the Great Bear Rainforest in British Columbia, Canada, with a focus on work led by or in collaboration with, and within the territories of, the Haíɫzaqv, Kitasoo/xai’xais, Nuxalk, and Wuikinuxv First Nations. While acknowledging the important context-specific variability among place-based management and conservation applications, we also discuss the model’s broader applicability. (shrink)

Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making. Methods/DesignDyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments. DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system. Trial RegistrationISRCTN89993391. (shrink)

Aesthetics is a crucial ecosystem service provided by biodiversity, which is believed to help improve humans’ quality of life and is linked to environmental consciousness and pro-environmental behaviors. However, how aesthetic experience induced by plants/animals influences the belief in the occurrence and significance of biodiversity loss among urban residents remains understudied. Thus, the current study aimed to examine how the diversity of pets and in-house plants affect urban residents’ belief in biodiversity loss in different scenarios of aesthetic experiences (positive (...) and negative aesthetic experiences at home due to plants/animals). Using the Bayesian Mindsponge Framework (BMF) analytics on a dataset of 535 Vietnamese urban residents, we found that the people’s aesthetic feeling about their house induced by plants/animals is positively associated with their belief in the occurrence and significance of biodiversity loss. The diversity of plants and pets is also positively associated with the level of biodiversity loss belief, but the effect is conditional on the aesthetic experience of the urban residents. Specifically, the positive association between species diversity and the belief only appears when urban residents feel that their houses’ aesthetics are negatively affected by plants/animals. Moreover, the association between pet diversity and biodiversity loss belief is less significant and reliable than that of plant diversity. These findings suggest that raising the houses’ aesthetics through in-house planting or pet ownership can potentially enhance biodiversity loss belief and subsequently build an eco-surplus culture among urban residents. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:I Saw My ReflectionAdrienne Feller NovickI saw my reflection as I looked through the window of the isolation room. The image caused me to pause and look again. The reflection of sunlight had merged my image and the patient's together. For a moment, we seemed to be one person.She was pale with translucent skin, her bald head obscured under a colorful scarf. Her three children sat as still as (...) statues, staring at their mother wordlessly. Then, I realized her children appeared to be the same ages as my children. I felt a surge of emotions jumbled together, a mother should not die like this, leaving her young children motherless. She and I shared the exact same birthday; it could have been me in that hospital bed. However, I did not have a terminal diagnosis and my children were safe at home, complaining about doing homework. In the blink of an eye, without even recognizing what had just happened, I was face to face with my mortality.I tampered my emotions and held them back. I collected myself, and remembered the reason I was there. My professionalism took charge. I am a member of the Medical Ethics consultation service at a large healthcare system. A request was made to help with the ethical dilemma of a patient with a grave prognosis unwilling to discuss a hospice referral. The dilemma here represented two issues in conflict: patient autonomy and provider beneficence versus non-maleficence. Respect for autonomy allows each person the right to make informed decisions about their care that respect their values and personal beliefs. Provider beneficence is balanced by non-maleficence: beneficence is the expectation that physicians make treatment decisions in the best interest of the patient and non-maleficence guides physicians to minimize harm. This case called for analyzing the balance of autonomy with proportionality, weighing the risks versus the benefits of treatment decisions.I knocked on the door and they all turned and looked in my direction. The patient signaled me to enter. Although she was smiling, the sadness in the room was palpable. I introduced myself to the patient and her children and diplomatically explained the reason for my visit. I turned to the children and asked if there was anything I could get for them. I got three weak "no thanks." I asked the patient if I could stop by later. Then, I went to see my next patient. When I returned, I listened with rapt attention as she described the mosaic of her life story. When she finished, we sat together for a long time, neither of us speaking. Out of the blue, she told me she was not afraid of dying. She said she would welcome death to end her pain. She continued, explaining that her fear was that her children were not ready to accept her death. She was worried about how her death would hurt them, and all she wanted to do was to protect them. She reiterated her wish to be kept alive with all aggressive medical treatment possible. She communicated [End Page E6] that she understood and appreciated the severity of her condition. Her reason for continuing treatment was to give her children precious time. She said, "I would lie in front of a car to protect my children." As I was heading towards the door, her eyes welled up with tears. She thanked me for listening and for my kindness. We said our goodbyes. She remained full code and died four days later during cardiopulmonary resuscitation. I walked past her empty room later that day and kept walking.I was not prepared for how her death changed me. Throughout my career as a healthcare professional, I have primarily worked with patients at the end of their lives. I have seen many empty rooms following the death of a patient and helped countless people journey through their stages of grief towards acceptance. After I complete a consultation, I move on to the next patient. I do this every day. This time, something was different. After she died, I was not sleeping well, I had a hard time concentrating, I was not eating well, and I was... (shrink)

Leakage of employment income is a pressing issue in the economic development of regional and remote communities. It can draw income away from regional economies but also inject new revenue from outside. Using Australian Bureau of Statistics 2011 census employment data by place of usual residence and place of work, we identify for all 17 Local Government Areas (LGAs) of the Northern Territory (NT), workers commuting out of and into each LGA. Using summary graphs and geospatial visualizations we find that (...) while there is substantial leakage out of most LGAs there are also gains from those leaving an LGA to work and then returning home with their income. Overall, for most LGAs and all remote LGAs there is net leakage. In contrast, Wagait, Palmerston, Litchfield and Alice Springs experience net gains from work commuting. Core-Periphery staples theory (Carson 2011) helps explain these net gaining LGAs, but cannot be used to consistently explain net leakage or net gain for population centers and nearby periphery LGAs. Darwin, including parts of Unincorporated NT, together act as a net leakage core to surrounding commuter LGAs such as Palmerston, Litchfield and Wagait. Katherine also acts as a net leakage core for surrounding peripheral LGAs despite receiving some offsetting employment income gains through mining. In addition to Katherine, Mining and the supporting Construction industry are also delivering net employment income gains to the core centers of Darwin, Palmerston, and Litchfield from periphery and typically remote LGAs. For remote mining commuters, these core centers offer preferred places to live. In contrast to Darwin and Katherine, Alice Springs acts as an employment income sink drawing on net employment gains from periphery remote LGAs. Our geospatial visualizations also help to identify the leakage vulnerability of remote LGAs dependent on mining like Central Desert and East Arnhem. Of all the remote LGAs, East Arnhem has the highest average net leakage of income across the most diversified distribution of industries, primarily derived from mining and its supporting construction and upstream manufacturing industries. Combined, these factors make East Arnhem particularly vulnerable to mining related downturns. Also, Alice Springs and Coomalie are highly vulnerable to commuting in Business Services and Public and Personal Services respectively. However, these vulnerabilities also cloak hidden flexibilities to deal with job losses during downturns. Undertaking our analysis for a number of census years could help decision makers build scenarios for future economic development and employment. (shrink)

Mrs. Smith's eyes filled with tears as she said, “I feel like I've done something wrong. Are they punishing me because I've been refusing therapy and won't go to a nursing home?” She acknowledged that she hadn't always listened to her doctors but said that she knew better now and wanted to go home and see if she could make it work. Many staff members at our rehabilitation hospital had explained their safety concerns to her, and some had (...) enlisted her adult daughter, with whom she lived, to convince her too. The rehabilitation team had called on the ethics consultation service, of which I am a part, to help figure out whether Mrs. Smith had the capacity to make an informed refusal of discharge recommendations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Cracked ArmorJoanne AlfredDisclaimers. Names have been changed to protect the privacy of the patient and the patient's family.After three weeks of night shifts, I had built a routine of driving home in darkness and watching the sunrise. It had become my way to push back against a quiet melancholy, the accumulation of loss over time, by remembering that light gently returning each morning. Heading into my last stretch (...) of ten nights in a row, I was intent to hold to this practice, to anchor myself for the challenge. The one-and-a-half years of residency training had prepared me for these moments, opportunities to grow and persist. The first six days of the stretch passed as I had expected, and the confidence and autonomy I had cultivated carried me through. It always had. I had shouldered our neurosurgery service, solitary night shifts at community hospitals, the NICU. I had pronounced a newborn dead on Good Friday, heartbroken by the juxtaposition of life and death. My experiences allowed tears and doubts, but I had always rebounded, chin up and looking onward for the next thing.I had just received sign out, and needed to check on Nate, a young man I'd known since he was first diagnosed with T-cell acute lymphoblastic leukemia (T-Cell ALL). I remembered our first meeting, a new diagnosis with a white cell count in the thousands requiring PICU admission for plasma exchange, all the way to reassuring him his EKG was normal after an incidental finding of hyperkalemia. He had returned to the hospital with abdominal swelling, and dread filled me as I rounded the corner to his room. Looking down at him and back up at his mother, my own distress reflected in their eyes. We needed help. I quickly found the oncology fellow and attending, and we put our heads together, deciding a blood gas and X-ray would be the next best steps. The results confirmed our suspicions.Nate was transferred to the PICU shortly. I watched his mother console him, remembering how much they both disliked the PICU. It was not a [End Page 85] place of pleasant memories, especially as Nate had been working toward remission therapy rather than returning to the intensive care unit, where he fought through his initial diagnosis. While reassuring him and his mother externally, internally my own dread welled further, because my first night in the PICU loomed two days away. To bolster myself for my seventh night shift, I rounded with the PICU team to learn as much as I could. Nate was on BIPAP now, and the decision inexorably moved to intubation. It was all happening rapidly, and the dread started feeling more like panic. Nate's eyes were squeezed shut, his stomach taut, and his breathing shallow. I truly worried for Nate now. I had hoped the PICU would be a temporary stay, a place where we could make a diagnosis and fill the gap. However, when I joined the private conversation the PICU attending had with Nate's mother and she said, "He may never come off the ventilator. He may never speak again," the finality in her voice had more certainty.The "never" struck my brittle residency armor and it cracked. I was not ready to believe it. I could sense his mother felt the same, so we walked along the silent halls of the hospital while she remembered Nate with me as a teenage boy beyond the hospital, not as his ascites and acidosis. Maybe to make his turn for the worse untrue. But I knew something awful was going to happen.On my eighth night, I entered the PICU with trepidation. All I could think about was Nate. He was now on dialysis, struggling with true hyperkalemia. Turning the corner to the unit, my heart racing, begging please don't let him die. It was hard to sense in the moment, but the cumulative melancholy, the sense that it could be held back, was not holding true. So, I defaulted to my splintering armor of persistence, picking apart his labs, discussing his dialysis with the nephrology fellow. I put my head down... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 45, no. 1. © 2019 by Feminist Studies, Inc. 235 Vivyan Adair Stigmata: A Memoir of Pain and Resistance For some of us poverty is not experienced from a distance or from the position of an audience member or critic, but as the most pressing truth of our existence, past or present and our core sense of identity. —Roxanne Rimstead, Remnants of Nation: On Poverty Narratives by (...) Women Shame My own mother—with four children under the age of seven by the time she was twenty five—taught, nurtured, and loved us ferociously but struggled and utterly failed to keep us fed, sheltered, and safe. We clung desperately to her fragile dignity, grace, and laughter, against all the forces of a cruel and indifferent world. Yet, in the end she was crushed by the weight of our shame and our raw, unrelenting pain as my brothers and sister and I were bent and broken and taken from her; with scars that never faded; injuries, infections, and ailments for which we found neither respite nor repair; with feet mangled by cheap, used Salvation Army shoes; the gnawing void of hunger and insecurity clawing at our tender backs; public indignities and humiliations for which I still can find no words. With access to neither medical insurance nor care, when my already fragile, toddling sister’s forehead was split open by a car door slammed in frustration, my brother and I had to pin her tiny body to the ground as 236 Vivyan Adair my mother sewed the angry gash together with needle and thread, practicing the meticulous dressmaker’s stitches for which she had received a modicum of acclaim, but so little reward. My sister somehow endured, but registered the pain, the terror, and the trauma with a brand, a stigmata, an angry and frightening scar as an indelible sign of our poverty, visually cleaving her very forehead in two, for the remainder of her life. In our school cafeteria “free lunchers” were reminded with a large and colorful sign to “line up last.” In that auditorium each fall we were coerced up onto a makeshift stage, with the promise of first dibs on free milk. There, our pristine school nurse sat upright and sucked air through her teeth as she donned surgical gloves to cautiously check only the hair of poor hungry children, one by one, for lice. I burned and choked and raged with shame, as our far more decent working-class colleagues and friends, in color-coordinated Sears sweater sets and matching tartan knee high socks, averted their eyes from our reluctant genuflections, while silently spooning their mac and cheese and sipping their Tree Top from tiny Dixie cups. In dilapidated and unsafe housing often without heat, hot water, or lights and with access to only public bathrooms, I developed a stubborn case of ringworm, scabies, and a series of painful urinary tract infections. When my second grade teacher would not excuse me every hour or so—because, as she said I was “willful”—I could not help but wet my pants in class. My schoolmates guffawed at my flea bitten legs, my ducttaped shoes, my crooked and ill-serviced teeth, and the way my siblings and I stank. Kids, teachers, and strangers stepped away from us intuitively and then, with great shows of distress, feigned concern and then outrage and disgust. Regularly our teachers excoriated us for our inability to concentrate in school and our refusal to come to class with proper school supplies, calling us out as greedy when we tried to take more than our share of free lunch. Whenever backpacks or library books came up missing, we were publicly interrogated and sent home to think about our offenses, often accompanied by notes that reminded my bewildered mother that she should be working twice as hard to make up for the discipline and order that had supposedly walked out the door with my father. And when occasionally we cried foul and lashed out, our behavior was used to justify even more elaborate punishment that exacerbated the effect of our growing anomie. Vivyan Adair 237 Guilt As children, our disheveled and unkempt bodies were produced as... (shrink)

Users are increasingly turning to the internet to acquire and consume goods. Online purchasing builds demand between customers in modern years. E-commerce is a business strategy that allows individuals and businesses to buy and sell goods and services through the Internet. Ecommerce can be used on computers, tablets, cellphones, and other smart devices, and it operates in four key market categories. The way individuals buy and consume goods and services has changed as a result of e-commerce. People are (...) increasingly using their computers and smart devices to place orders for things that can be delivered quickly to their homes. In the 1960s, ecommerce made use of an electronic system called electronic data interchange to help in document conversion. In the world of e-commerce, Amazon is a monster. It is, in reality, the world's largest online store, and it is still growing. As a result, it has become a significant roadblock in the retail industry, prompting some major merchants to rethink their plans and adjust their focus. This article is based on literary reviews. Developing a research framework for consumer trends, particularly in terms of purchasing behavior, is very much necessary. The sample size for this investigation was determined using a simple rule of thumb for successful partial least squares structural equation modeling estimation. Consumer sentiment tendencies play a major role in this research. This research's most valuable factors include a promotion, price, brand loyalty, product review, and product quality. We looked into how these aspects analyzed a customer's tendency. These are the primary topics of discussion in this study. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Growing Up With Autism: Challenges and Opportunities of Parenting Young Adult Children with Autism Spectrum DisordersKayhan Parsi and Nanette ElsterAs the parent and stepparent of a child with autism, we witness a world that is quite different from parents with only neurotypical children. Tantrums don’t vanish after the age of three. Aggression is a way of life. Simple communication is a constant challenge. And dreams of a child’s future (...) have to be altered and adapted. In the narratives that accompany this commentary, we see that the challenges of raising a child with autism do not necessarily diminish with age; they may, however, change because children with autism become adults with autism and this presents a new set of both challenges and opportunities.The current epidemic of young children with autism is giving rise to yet another epidemic—the rising number of young adults who are autistic. As one of the authors here mentioned, “the system is in for a tsunami of new individuals needing medical care of all types, needing continued supports for housing and vocational training, communication, occupational and physical therapy” (Cornell). According to a recent study published in Pediatrics, “[y]outh with an ASD have poor postsecondary employment and education outcomes, especially in the first 2 years after high school” (Shattuck, 2012). With the rising number of children being diagnosed with autism, this employment disparity is likely to be exacerbated until or unless the workforce adapts to and accommodates the needs and skills of persons with autism.The needs of young adults with autism are only recently beginning to receive more attention from the media. But for these children’s parents, this issue has always been personal. The emotions on display in these narratives are heartfelt—even raw at times—and seem to swell like the wave of a tsunami itself as parents are now confronting what should be the independence of adulthood. With barriers to employment, health care and housing, young adults with autism remain largely dependent upon their parents. While the topic of transition to adulthood for those with autism is a vast one, implicating the need for wide scale policy change, certain themes emerge in these personal narratives that we wish to focus on here, which may well serve as a guide for that change.The Advocate MotherThe Advocate Mother is a common theme in many narratives of autism and the ones presented here are not different. In fact, nearly all of the narratives presented are written by mothers. Mothers in these narratives exemplify sacrifice, dashed hopes, and even heartbreak. Although there is steely determination in many of these narratives, there is also [End Page 207] self–doubt, anxiety and guilt. As Laura Shumaker recounts the story of taking her adult son to Washington, DC, she experiences great anxiety when her son is mocked. She speaks of “the heavy feeling in [her] chest that mothers get when people laugh at their children.”The advocate mother can easily become the overly consumed mother. Take, for example, the powerful narrative of Nancy Coughlin. She confesses that her daughter’s autism took over her life and the life of her family: “my own mental health was disintegrating, as was my marriage, and in our family’s last–ditch effort to ease the burden we bought a second home; a cheap little place just a few blocks down the road from where we lived. We called it our ‘respite house’.”Others confess that raising a child with autism becomes a “full time job.” (Van der Poel). And the demands of this job do not diminish simply because the child reaches adulthood; it may, in fact, become not only a personal job for some parents but their vocation as well. For instance, Anonymous Four states, “I felt so strongly that parents and young adults needed to know about CIP [College Internship Program], that I applied for a part time job there where I could utilize my background in marketing to help parents like me find the services their son or daughter may desperately need.”While the inability to express appropriate emotions is a hallmark feature of autism, it seems that mothers in particular compensate by... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Who Tells the StoryCindy BitterThirty years later, I do not remember her name, but I definitely remember her face, and this is how I remember her story.She came into the office for her flu shot. She was in her 70s and had a mild case of COPD attributed [End Page 87] to years of exposure to pesticides on the family farm. She said she was trying to stay healthy, (...) as the grandkids were due for a visit, and everyone had gotten a cold after Thanksgiving the year before. I was a sub-intern doing a required rural medicine rotation and diligently did an exam, finding asymptomatic new-onset atrial fibrillation of uncertain duration. We admitted her to the hospital and started anticoagulation. My attending also ordered a calcium channel blocker to slow her pulse, which was running 90–100 while she was at rest. The attending insisted that it would convert her back to sinus rhythm. The nurses were not experienced with the medication and were uncomfortable giving it. I was pretty sure the calcium channel blocker was not indicated, and a quick check of my pocket manual confirmed the drug would lower her heart rate and maybe her blood pressure but that it would not fix the abnormal rhythm. I refused to administer it. The attending came in, pushed the medication, and returned home. A few minutes later, the patient was struggling to speak. Her pulse fell to in the 30s, and her blood pressure had dropped dangerously low. I asked for the crash cart and calcium, and my attending, then started CPR when she lost her pulse. Half an hour later, my attending called her time of death.Hers was not the first death I'd witnessed, but it was the first time I felt like my patient would have been better off without our interventions. As a medical student hundreds of miles from the main hospital campus, I felt powerless to contradict the attending, and did not know where to turn for support in the moment. I rationalized it by saying that I had not actively contributed to her death by pushing the medication, but I held myself morally culpable for doing the exam and finding an asymptomatic abnormality that started her down that path. I felt I should have known the pathophysiology and medication side effects better, or been more assertive, or called for help.One could argue whether I was suffering from a grief reaction or falling into depression, but I questioned my calling to medicine and seriously considered leaving the field. But I was quite certain that I did not want another patient to be put at risk, or a student to feel cornered into taking actions against their better judgment. After returning to the main hospital, I met with the clerkship director and helped develop a pathway for students to raise safety concerns in real-time. Now I recognize the feeling I experienced as moral injury, but we weren't using that term at the time, or talking about Six Sigma safety, or stopping the line.Ultimately, I continued through medical school and trained as an emergency physician. My prior reverence for my attendings moderated to a healthier respect that had to be earned. I read voraciously, trying to prepare myself for unexpected situations. I became an advocate for patient safety and was an early adopter of shared decision-making. I strive to be a physician who welcomes questions and respects the concerns of all team members. Many of the principles that ground my career in medicine grew out of my exposure to this patient.It was always my least favorite of the tropes common to television medical dramas—the circumstances of the patient-of-the-week illuminated some aspect of our main characters' lives, providing a very important life lesson. I felt it positioned patients to be in service of the physician's aims, using patients as a means to our ends, when we should be using our knowledge and experience to further the patient's goals. Very un-Kantian, in addition to transgressing against multiple other philosophers and medical ethicists. As medicine learns more about the power of... (shrink)

International medical travel occurs when patients cross national borders to purchase medical goods and services. On occasion, physicians in home countries will be the last point of domestic contact for patients seeking healthcare information before they travel abroad for care. When this is the case, physicians have a unique opportunity to inform patients about their options and help guide them towards ethical practices. This opportunity brings to the fore an important question: What role should physicians in more-developed (...) home countries play in promoting or constraining international medical travel towards less-developed destination countries? In our view, critical attention to the decision spaces of patients—defined by the personal circumstances, socio-cultural cues, and legal constraints that inform decision-making—is a useful starting point for evaluating the proper response of physicians to various forms of international medical travel. (shrink)

This study aims to examine key attributes affecting Airbnb users' satisfaction and dissatisfaction through the analysis of online reviews. A corpus that comprises 59,766 Airbnb reviews form 27,980 listings located in 12 different cities is analyzed by using both Latent Dirichlet Allocation and supervised LDA approach. Unlike previous LDA based Airbnb studies, this study examines positive and negative Airbnb reviews separately, and results reveal the heterogeneity of satisfaction and dissatisfaction attributes in Airbnb accommodation. In particular, the emergence of the topic (...) “guest conflicts” in this study leads to a new direction in future sharing economy accommodation research, which is to study the interactions of different guests in a highly shared environment. The results of topic distribution analysis show that in different types of Airbnb properties, Airbnb users attach different importance to the same service attributes. The topic correlation analysis reveals that home like experience and help from the host are associated with Airbnb users' revisit intention. We determine attributes that have the strongest predictive power to Airbnb users' satisfaction and dissatisfaction through the sLDA analysis, which provides valuable managerial insights into priority setting when developing strategies to increase Airbnb users' satisfaction. Methodologically, this study contributes by illustrating how to employ novel approaches to transform social media data into useful knowledge about customer satisfaction, and the findings can provide valuable managerial implications for Airbnb practitioners. (shrink)

Home-based service jobs have developed considerably across Western societies. In fact, chances are high that a working-class woman in France today will, at some point in her life, be a house cleaner, home-based child care provider, or home aide for the elderly. Going against political, scholarly, and everyday discourses that, saturated with the double prejudices of gender and class, treat all these home service occupations, which require little prior training, the same, this article illuminates the variability (...) of the forms of subordination experienced by women practicing these occupations in France. Comparing these jobs with the ensemble of low-skill jobs and with each other exposes what is specific to the particular form of subordination each job type entails, in terms of the extent of job supervision and the nature of the home where it is practiced, the presence or absence of relations with coworkers and/or a “public,” and the nature of this “public.” It mobilizes nationwide statistical data in a new way to shift attention to these numerous ordinary work situations, which are much less studied than those of the domestic workers of the wealthiest cities of the Western world. (shrink)

In Michael Stingl argues that the legalization of euthanasia can be made reasonable social policy only in the context of healthcare reform to deliver primary- and community-based care. Stingl accepts that euthanasia and that includes not only pain, but He is not worried The failure of the healthcare system to adequately respond to the needs of people who are suffering with chronic or terminal conditions may lead competent people to elect euthanasia. Stingl argues that it is the institutionalization of care (...) for dying people that reduces their ability to find meaning in prolonged life, and thereby makes it more attractive to consider ending one's life sooner. Options such as palliative care at home that significantly improve quality of life and make euthanasia less attractive are currently only available to those who can privately subsidize healthcare services. If an emphasis is placed on community-based initiatives and well-supported self-help, then there would be less inequality of healthcare and the voluntariness of choices, including euthanasia, would be more equal for all people under the healthcare system. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Witnessing Trauma:Emotional Challenges in Medical InterpretationMaja Milkowska-ShibataHaving a background in public health but no clinical experience, I never expected to be given the opportunity to work directly with patients. This changed when I became involved in medical interpretation. During my first year of service, I mostly assisted with primary care appointments until I was assigned to my first appointment in a cancer treatment center. The moment I stepped into (...) the distinctive atmosphere of that place, the gravity of the patients' circumstances became strikingly apparent. Each individual was [End Page E8] suffering from a life-threatening condition, which was unlike anything I was used to witnessing.The staff seemed to know each and every patient. I noticed a patient in a wheelchair accompanied by a relative carrying an oxygen tank. Someone brought gifts for the receptionists. A Christmas tree sat in the corner of the waiting area, ready for the holidays. The facility clearly conveyed an effort to resemble a home-like environment. "They must be regulars," I thought grimly.After completing a routine appointment with an elderly patient who was feeling weak, the patient requested an IV drip. My official assignment was over, and I could have gone home at that point, but something compelled me to stay. As I interpreted the nurse's instructions for setting up the drip, I could not help but notice the vulnerability of the patient, who had a thin and frail physique. The patient seemed grateful for my presence, so I settled into a chair in the corner and waited patiently.Soon, the patient drifted off to sleep, and I checked on them every now and again to make sure they were fine. The room became quiet, and I hoped the patient would not be disturbed by the sound of an ambulance or another patient seeking treatment. Although they were in capable hands, I found myself standing guard, metaphorically speaking. During the two hours it took for the drip to finish, I reflected on the emotions growing within me.It suddenly dawned on me: I had not been there for my own father during his battle with cancer. I felt obligated to stay by the patient's side as if fulfilling a debt owed for my absence at that important time. Offering companionship to the patient was the very least I could do.Working as medical interpreters and interacting with patients in varied life and health circumstances will expose us to a wide range of emotions. As we gain experience, helping patients teaches us humility and cultivates a stronger sense of empathy. Although not explicitly outlined in the standards of practice, we have the choice to utilize the powerful virtues of compassion and kindness to positively impact the life of a struggling patient. However, we also run the risk of becoming emotionally detached and losing the ability to act with compassion over time.Alongside my on-site commitments, I also work remotely for an organization managing a high volume of calls in numerous languages. In this role, medical consultations occur via phone or video. This environment can make you feel somewhat isolated, reminiscent of working in a call center where strict protocols dictate the ways calls begin and end. In this setting, I am exposed to slightly different emotional challenges. Shielded by a screen and physical distance, I often feel disconnected when interpreting, even for highly emotional situations.Yet, some interactions are hard to forget. I vividly remember a recent call during which I had to interpret for a victim of sexual assault. I felt deeply moved by their distraught voice and frightening details. For me, as an interpreter, the challenge became even more difficult as it was unreasonable to request the other party articulate their thoughts in short segments for effective communication. To keep up with the speaker, I had to jump into simultaneous interpreting, which many interpreters, including myself, find difficult. At the same time, I was slowed down by the police officer taking meticulous notes. I sympathized with the speaker but was also becoming impatient and angry with myself for experiencing these conflicting emotions. I wanted this call to end as soon as possible because it was... (shrink)

Feminist research on community care and ‘informal carers’ identified this as a women's issue but failed to address the interests and experiences of older and disabled women – those who received ‘care’ One consequence is that such feminist research has implicitly, and sometimes explicitly, undermined disabled women's rights to a home, children and personal relationships. Using qualitative research, the article highlights the actual experience of women whose physical impairment means that they need help with daily living activities, looking (...) at the different circumstances in which such help is received. The disability movement's concept of ‘independent living’ raises particular issues for disabled women. ‘Independent living’ is about having choice and control over the assistance needed, rather than necessarily doing everything for yourself. However, gender inequalities may also inhibit the choice and control that women have in their lives. Assistance can be given within a personal relationship as an expression of love, but disabled women may also experience abusive, restrictive or exploitative relationships. Public services do not generally provide assistance in a way which enables a woman to have choice and control in her life, or even to carry out child-caring or homemaking tasks. The research on the various ways of receiving personal assistance found that those women who were able to purchase their own help were most likely to be living independently, in the sense of exerting choice and control in their lives. Feminist research can help to create a space for disabled women's absent voices, and add to the pressure for change in the way that personal assistance needs are met. This is a human and civil rights issue which has a key impact on the control that disabled women have over their lives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Tiny Person, Big ImpactT.S. MoranI met J on a Tuesday, the second day of my new job as the pediatric oncology social worker. Five days later, he died.Although J was 8 months old, he seemed tiny, like a preemie. When I saw him, he was snuggled into the shoulder of the attending physician. It was evident that one of his diagnoses was failure to thrive. He also had what (...) was thought to be a low-grade glioma of the optic pathway, and despite months of treatment, he was declining. It was clear that the team cared for J very much. They visited him, held him, played with him, and sang lullabies to him in Spanish. I was so impressed by their compassion.J had spent about half of his short life at the hospital. He was born prematurely to a young mother, herself in foster care. His mother had numerous obstacles preventing her from visiting often and it did not seem that she bonded well with him. J's mother stated that her boyfriend discouraged her from visiting. She did not have transportation and declined offers of hospital-funded Uber rides. She had little prenatal care or education about becoming a mother.J's mother seemed guarded in her interactions; hesitant to reveal anything that might show her vulnerability. The team was frustrated as it seemed she was not receptive to their efforts. The team was also concerned that she did not fully understand J's condition due to her poor health literacy, despite the use of a certified language interpreter. Still, when she did visit, she was kind and caring and stated that she did not want her foster mother involved in providing J's care.Part of my job was to help prepare the family for discharge to home. I had been speaking to their caseworker from Child Protective Services. She was a strong advocate for both mother and baby. After several meetings with the team that included J's mother and the caseworker, J's mother accepted his prognosis. She was willing to provide care at home with hospice support. She came to the unit several times that week to receive training about his care needs. The hospice nursing visit was scheduled, and J and his mother left the hospital on a Friday.The caseworker called on Monday to tell us that J had passed away peacefully on Sunday. The reaction on the unit was palpable. New residents and seasoned chiefs were teary-eyed and sighing. To some, it seemed like a relief. Given the team's extraordinary care and concern shown to this family, I was not surprised by their emotions.What surprised me was my level of grief. I had spent the 12 years prior serving adult hospice patients; I understood end-of-life care and death's eventuality. I thought I was well prepared. This experience was different from my past. I was able to cope with an adult patient's passing without much distress, accepting that most adults had lived a full life.I felt grief for the team who had invested in J, and for his short life filled with illness and pain. I felt grief for his mother, who had experienced a horrific childhood, had lost her innocence too young, and had been robbed of the opportunity to experience joyful parenting. [End Page 82]The chief recognized the team's need for support and quickly organized a "debriefing." A lot of the team participated, even those who only had brief contact with J. Everyone had a chance to reflect on their experience in caring for this child. Because of my hospice training, I was included. I validated their loss, their efforts, and their love for J. I provided basic grief education, enumerating their possible reactions of sadness, anger, frustration, fatigue, confusion, or numbness, and this helped me to feel like I also contributed to his care. I encouraged self-care—from taking time off, to lingering over an extra cup of tea, to speaking about their experience with me or another social worker.When I spoke about my feelings to my coworkers, they were understanding and acknowledged... (shrink)

Publishers love titles that begin How or Why. Better still, How and Why, combining edification with utility. The target group is that overlap between the self-help audience and the idly curious—which is to say, most of us. And since emotions are very much about self-help and self-harm, they offer rich pickings in a burgeoning market. Flanagan's How to Do things with Emotions is a philosopher's take on moral emotions, the allusion to J. L. Austin's How to Do Things (...) with Words chiming with the self-help milieu. Reviewing cases, Flanagan points out that most scientific work in this field derives from experiments on psychology students, about as unrepresentative a slice of humanity as you could find. For Flanagan, they are too WEIRD (Western, Educated, Industrialized, Rich, Democratic) to tell us much about the non-weird majority. To learn to “do emotions better,” he argues, we have to look farther afield. Although the emotional lives of cultural others are surely different from those taking Psychology 101, at some functional level they might be similar. Work out the conceptual logic and practical rationale of culturally elaborated emotions—Minangkabau “shame,” Ifaluk “righteous anger,” American “road rage”—and there is scope for comparison. Indeed, anthropology has shown as much, and it is from anthropology that Flanagan takes his cues. To mention two famous cases, what can we learn about anger management from Utku igloo-dwellers and Ilongot headhunters? Mutually dependent for survival in their snowy isolation, the Utku cannot risk getting angry. (They mercilessly tease their children into learning the futility of anger.) In the jungles of Luzon, Ilongot youths cast away their anger in externally directed violence: headhunting as cathartic sport. We can think of parallels closer to home.Flanagan's vigorously argued book, a tour de force of its kind, is both an anatomizing of anger and shame—two moral emotions we tend to “do badly”—and a proposal to “change how we do these emotions.” Indignation is fine, but anger that is vengeful or “pain-passing,” rather than righteous, is irrational and socially harmful. Shame can be incapacitating and cruel (the undeserved burn of a Twitter pile-on). What we need is reflective anger directed at injustice and a “mature sense of shame” that reminds us of the social contract and stops us misbehaving.In its How-and-Why format, the book combines theory and practice, metaethics with moralism. Here is how a prof should do self-help. But if the diagnosis is well made, the remedy is hard to imagine. As Flanagan recognizes, moral sentiments and practices are embedded in intricate forms of life and not readily detachable. Anger Utku-style is not a transferable skill, nor are educative routines forged in social ecologies remote from our own. Lacking serviceable models, Flanagan falls back on the anthropological justification that knowledge of cultural diversity expands our sense of human possibility, of other roads taken. In a globalizing world, difference is its own reward. For me, an anthropologist, that maxim is enough. Yet difference bedevils comparison, jinxing the units, warping criteria. Most languages lack a word for emotion or an equivalent umbrella concept; nor do emotion words translate well across languages. Emotion may be an incoherent notion, or at best a heuristic.Flanagan's use of the WEIRD tag makes things a bit too easy. Does it cover farmhands and factory workers? Are we so democratic, anyway? More damagingly, a typological approach blurs the circumstances of family, community, and biography that define an emotional episode and shape its phenomenology, the way it is felt and experienced—what a violent outburst or fearful exit means in the context of a life. Take Joseph Conrad's Lord Jim, who flees a scene of failure and derails his life. It requires a long narrative to unravel the implications of his jumping ship and the paralyzing shame he experiences before the judgment of society. Or consider the scene in Anna Karenina in which the dignified and self-important Karenin, apprised of Anna's adulterous liaison, agonizes over the threat to his existence. To call his response jealousy would not scratch the surface. Characteristically for Tolstoy, the emotions go unnamed. Instead, we witness Karenin's fervid deliberations (emotions involve thoughts), vacillations (emotions have action tendencies), anguished calculations of impending scandal (emotions are appraisals), and bodily changes (emotions are cognized feelings). We shudder at the brutal metaphors through which he grasps his predicament and its cure: like rooting out a bad tooth, he decides. That welter of particularities escapes the theorist who needs clear-cut, comparable units, formulaic instances of jealousy or anger. But what are you left with if you omit the details? What would remain of Karenin's existential crisis?The novelist's privileged access to subjectivity is, of course, unavailable to the scientist, but the larger context of plot and character—a history of relations that gives emotional episodes their shape and power—has its analog in the ethnographic domain. Emotions are public as well as private events, their meanings and effects depending on a fit with social reality, a clash of perspectives. In thought and feeling, we are never really alone. All of which suggests that narrative, fictional or nonfictional, can capture the ongoing moment in a way that eludes other methods. If what we are after is living emotion, it is the movie, not the snapshot, that surely matters. No point in comparing “emotions” no one ever really experienced outside of an experiment.But there's the rub. In generalization—the goal of emotion theory—an emotion's social meaning, personal significance, pragmatic function, and narrative context get stripped out. All that makes it what it is! Even in doggedly empirical anthropology, detailed emotional episodes are rare (Jean Briggs's Utku ethnography Never in Anger, published in 1970, is still unsurpassed). Instead we get recollections and summary examples, lacking the constitutive detail, real-time evolutions, and consequences of the real thing. Yet these must serve for comparison, fodder for countless theoretical speculations. Are we at risk of analyzing faux emotions and building theories on cardboard constructions?An empty Arctic stage, a handful of characters, life simplified to survival: Briggs is a hard act to follow. Bare life does not make for basic emotions. On the white set, emotions prove hard to parse. That gruff hesitation, that flashing glint—are they tokens of anger? Empathy will not suffice. As Briggs shows, narrative context is all. And in our more cluttered emotional worlds, the value of backstory, interwoven biographies, and emotional plots is all the greater. Flanagan is right; we must do emotions better. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 81-85 [Access article in PDF] "What's in the Box Then, Mum?"—Death, Disability, and Dogma Sheila Colman OVERHEARD IN AN EXCHANGE between a bereaved woman and her son outside the church just prior to a funeral service: "What's in the box, then?" "Daddy." The son is in his late 30s and has a learning disability. His mother had prepared him as well as she (...) could; his father had been ill for some time and was not expected to recover. Death, and the rituals surrounding it, had been explained and it was not the first family funeral he had attended.Trying to field such childlike questions is typical of living with a person with a learning disability; trying to find the right words is difficult enough without the added pressure of personal emotional distress.The generally accepted norm in life is that a child is parented within the home until adulthood and then independence is attained. Roles may well be reversed in later life in that the "child" may find responsibilities in caring for, and making decisions for, elderly parents. Few people can stop parenting when their offspring are fledged—even though it is at arms length and any advice may be ignored. Life with a child with a learning disability is unbalanced in this respect; as carers we do not lead lives considered to be normal because our children continue to be childlike for the rest of their, and our, lives. Some of us know that our sons and daughters do not have "apparently limitless potential... to develop skills and autonomy if only they are given the right help" (but try, as a parent or carer, saying that to a professional working in the field of learning disability!) and know that the best we can hope for is mature, rather than immature, dependence.No one tells parents of a learning disabled child—or any other, for that matter—what their responsibilities to that child are. Food, warmth, love, support, and so on are givens, but it takes a conscious effort to move a child toward adulthood when it involves changes in life, for example, moving away from the family home. The debate rages; is it letting go or getting rid of?We all delight in the pleasures our children experience in childhood; we know the magic has gone from the family Christmas once realisation dawns on the youngest child. If you consider that your son or daughter has been dealt a very poor hand in life, the temptation to prolong and promote that innocence is very tempting. It is much easier to prevaricate than to admit that life has its unpleasant sides; that failure and disappointment exist: my son was a great fan of Thomas the Tank engine videos until he was in his early teens, long after it was age appropriate. I passed them onto a younger child, having told him the videos were lost. The fall-out was spectacular [End Page 81] (but fortunately short lived!) and he eventually became very interested in Formula 1 motor racing. I had to push him to grow up.For all of us, the transition from childhood to adulthood is a process, not an event. Although I agree with the professionals that the child with a learning disability should be part of any discussions concerning his or her future, if that child does not have the intellectual capacity to make informed choices, someone else has to do it. That someone else is usually a parent, but is it a parent who is prepared to let go to help that person become an adult with his or her own life away from the family home, or is it a parent who has protected and coddled the child by promising they will never have to go?Lest you think I am a particularly hard, confrontational, and unfeeling mother, I would point out that I have almost 50 years of experience of living with learning disability in the immediate family; my son is 20 but my brother... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:More Is Required of Us: Complicating an Ontology of Experience at the Heart of Community-Based ResearchJerry Rosiekit is both unsurprising and reassuring that the Society for the Advancement of American Philosophy would host an invited lecture on community-university research collaborations. One of the most distinctive features of the tradition of philosophy on this continent has been the insistence that lived experience is the ultimate source of knowledge, and, more (...) importantly, amelioration of individual and collective community experience is the ultimate criterion for validation of knowledge relations. Dr. Ira Harkavy and the Netter Center at which he works represent a version of that ideal made institutionally manifest.In his 2022 Coss Lecture, Harkavy offers a vision for how the ideal of knowledge generation grounded in community experience and serving community priorities could be institutionalized in major US research universities. Furthermore, he makes the case that this transformation of research universities would revitalize our collective commitment to democratic citizenship and governance. It is an appealing vision, earnestly offered. In what follows, I celebrate the merits of this vision but raise concerns that it does not adequately consider questions about the ontology of experience. I review some of those questions and offer suggestions about what an updated ontology of experience, one that could revitalize democracy in the manner Harkavy says is needed, would look like.Experiential Basis for My ResponseA short personal introduction will provide context for (and perhaps lend credibility to) my response comments. I am a Professor of Education at the University of Oregon with affiliate appointments in the Department of Philosophy and in the Department of Ethnic Studies. My empirical research [End Page 81] focuses on how we prepare anti-racist educators to work in public schools (Pratt and Rosiek; Rosiek, “School Segregation”; Mitchell and Rosiek; Sconiers and Rosiek). My area of theoretical specialization is the development of new qualitative methodologies for research on educational equity. The latter involves working out the implications of different epistemologies and ontologies for educational inquiry and practice. Specifically, I have spent most of my career looking at the way teachers’ classroom experiences can be a valid source of general knowledge about educational practice and policy (Rosiek and Atkinson; Rosiek and Gleason).Both branches of my scholarship exist in a dialectic with my community activism around educational equity issues. My largest project to date was a ten-year study of the racial resegregation of a public school district, looking at how students and teachers navigated its aftermath (Rosiek and Kinslow). My most recent project involved two years of working with teachers all over the world to identify the ways they addressed equity challenges during the pandemic and to identify the institutional conditions that helped or hindered such work (DeRosia et al.). In a less academic context, I have worked with local educational activist organizations in my home community to support the needs of immigrant families and students, to create safer spaces for LGBTQIA students, and to get more equity-minded school board members elected.I share all of this just to clarify that I am familiar with the challenge of putting university expertise in the service of community improvement and, more specifically, promoting equity in educational institutions. I am familiar with approaching research in a manner that respects practitioners and non-academic community members as sources of knowledge, not just objects of knowledge.Praise for the Work at the Netter CenterFrom the vantage point that experience provides me, I want to offer energetic praise for the work that Harkavy and the Netter Center have been doing these last three decades. We should all recognize the difficulty of integrating the university’s knowledge-producing role with local education and service work (Brewer; Harkavy et al.). It is even more difficult to do so when aspiring to the ideal of collaborative knowledge production with the community in a manner that genuinely commits to epistemic egalitarianism. Service learning can be trivialized and can become the exploitative enlistment of unpaid labor in the service of an agenda exogenous to both the participants and the community (Santiago-Ortiz; Stoecker). [End Page 82]Sharing the power of designing the focus and means of service projects... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Striving To Do Good:Well-Springs, Realities, and Paradoxes of Medical Humanitarian WorkRenée C. FoxThe voices that speak from the pages of these testimonial narratives are those of physicians who are engaged in medical humanitarian work. The preponderance of them are based in U.S. academic medical centers where they have clinical, teaching, and research responsibilities from which they regularly "commute" to care for patients in what the euphemistic language of "global (...) health" terms "resource-limited," rather than "poor" countries." This "hybrid life," as one of the physicians (Robert Riviello) refers to it, has transported them periodically to numerous African societies (to Algeria, Ethiopia, Gabon, Morocco, Rwanda, Sudan, Tanzania, and Uganda), to Haiti, to India and Nepal, and to Guatemala and Mexico. Three of the "stories" are written by physicians at work in the countries where they were born (Prasanta Tripathy in Eastern India, Sridevi Seetharam and colleagues in Southern India, and Paul Pierre, in Haiti).Only one group of physician-coauthors (Maricruz Merino, Jonathan Iralu, and Sonya Shin) write about their experiences in practicing medicine among poor and socially disadvantaged patients on the American mainland—in the setting of the Navajo Indian reservation in Gallup, New Mexico.All these physicians describe their involvement in humanitarian medicine as emanating from their commitment to "social justice," to "saving lives," and to "caring for the poor"; to their universalistic convictions about "human solidarity," and the non- otherness of others; to their indignation about the inequities and injustices of the world, particularly with regard to access to health care (in the words of Jeffrey Deal, "[They] deserve better. They all do"); and to their "passionate" desire, not just their "sense of duty," to help rectify these wrongs (Richard Keiden). I was struck by the fact that none of them uses the word "suffering" to describe the plight of the persons whom they feel they have been called to medically assist.Three of the physicians express the wellsprings of their motivation in religious terms. Richard Keiden refers to a "guiding principle of Judaism" on which his medical humanitarian work has been founded—"tzedakah"—which "translates as charity but actually means righteousness," is based on a "concept of social justice," and is "an obligation, not a choice." Robert Riveillo says that at the time of his graduation from high school he envisioned his "life's work as a long-term missionary surgeon"; he invokes "loving mercy," as well as justice, "in this work of solidarity" that he has undertaken; and he poignantly admits that "most days I still long to pack my things, my family, and our efforts and move to Africa for a life of direct service." What Jeffrey Deal writes is the most explicitly and ardently religious of all. He identifies his work as a physician in Sudan with Jesus's "desire for us to care [End Page 115] for the poor and downtrodden in His stead." He is haunted by his "failure" to deliver alive a "partially born" baby girl who for him incarnated "the least of the least" of whom Jesus "spoke passionately." And in touching "ever so briefly... [that] one, tiny being [he] encountered... [on ] that hot morning in Sudan," he attests, he "touched Jesus."Jeffrey Deal is not the only one who was so stricken by the death of a baby or a child. For a number of these physicians (Sadath Sayeed, Maneesh Batra, and for Sridevi Seetharam, Lisa Adams and their colleagues), it was a tragedy that they found hard to bear with "detached enlightenment" (Sayeed), or to accept. The most demonstrably heartbroken and morally outraged among them is Sadath Sayeed, who "wept uncontrollably" over the death of a baby boy, born "at home" in Haiti, "probably in one of the hundreds of make-shift tent cities." The baby was not breathing continuously, and was "handed" to him to care for. At the close of the "story " about this experience that he recounts, Sayeed lashes out with fury and angst at those who were likely to ask him, "How was it in Haiti?" Do you want to hear "my real answer?" he replies:... [L]et me summarize my last patient for you: Good luck Dad... (shrink)

Multi-level marketing companies such as Amway, Herbalife, or Tupperware differ from most other companies. They market their products and services by means of self-employed distributors who typically work from home, sell products to end consumers, and recruit, motivate, and educate new distributors to do the same. Although the industry’s growth seems to illustrate the attractiveness of MLMs, the industry has been facing several legal and ethical problems. In this paper, we focus on these problems and argue that an (...) extended MLM model may help us to understand why such problems continue to occur, despite the countermeasures that have been implemented. By explicating how problems relate to a specific but often overlooked characteristic of MLMs, i.e., the so-called distributor network, we provide an extended understanding of MLMs’ mode of operation, the sources of their legal and ethical problems, and the reason that currently implemented and suggested countermeasures may not suffice. Moreover, based on our extended understanding of MLMs and their problems, we propose additional countermeasures. (shrink)