Next SectionObjective The purpose of this article is to investigate the need for ethics support in Dutch healthcare institutions in order to understand why ethics support is often not used in practice and which factors are relevant in this context. Methods This study had a mixed methods design integrating quantitative and qualitative research methods. Two survey questionnaires, two focus groups and 17 interviews were conducted among board members and ethics support staff in Dutch healthcare institutions. Findings Most respondents see a (...) need for ethics support. This need is related to the complexity of contemporary healthcare, the contribution of ethics support to the core business of the organisation and to the surplus value of paying structural attention to ethical issues. The need for ethics support is, however, not unconditional. Reasons for a lacking need include: aversion of innovations, negative associations with the notion of ethics support service, and organisational factors like resources and setting. Conclusion There is a conditioned need for ethics support in Dutch healthcare institutions. The promotion of ethics support in healthcare can be fostered by focusing on formats which fit the needs of (practitioners in) healthcare institutions. The emphasis should be on creating a (culture of) dialogue about the complex situations which emerge daily in contemporary healthcare practice. (shrink)

Moral Case Deliberations are reflective dialogues with a group of participants on their own moral dilemmas. Although MCD is successful as clinical ethics support, it also has limitations. 1. Lessons learned from individual MCDs are not shared in order to be used in other contexts 2. Moral learning stays limited to the participants of the MCD; 3. MCD requires quite some organisational effort, 4. MCD deals with one individual concrete case. It does not address other, similar cases. These limitations warrant (...) research into complementary ways of providing CES to healthcare professionals. Our research objective was therefore to develop a low threshold CES tool based on a series of MCDs on autonomy in long-term care. We used a qualitative research design in which we analyzed the process and content of a series of MCDs, combined with reflections on the theoretical background of MCD. In total 28 MCDs were analyzed by means of a thematic content analysis. In various rounds of development, the results of the analysis were combined with theoretical reflections on CES. Consequently, the tool was evaluated in three focus groups and adjusted. The CES tool, called ‘moral compass’, guides the users through a series of six subsequent questions in order to methodically reflect on their concrete moral dilemma, in the form of a booklet of 23 pages. It combines a methodical element that encourages and structures a reflection process with a substantive element, including norms, values, options, strategies, and insights regarding dealing with client autonomy. By using data from a series of MCDs, combined with theoretical reflections on MCD, ethics support and moral learning, we developed a thematic, low-threshold CES tool that supports healthcare professionals in daily practice in dealing with moral questions regarding client autonomy. It integrates examples and insights from earlier MCDs on the same topic. The moral compass is not a replacement of, but can be used complementary to MCD. The feasibility and impact of the moral compass need to be investigated in an evaluative follow-up study. The methodology presented in this paper may be used to develop moral compasses on different topics in various healthcare organizations. (shrink)

In this article, the authors study the problem of balance of trust and mistrust associated with the turbulence of modern society, redundancy, and heterogeneity of information and communication flows creating a contradictory picture of the world. Social networks are considered as one of the basic modern information resources creating previously unavailable opportunities for communication, interaction, information sharing, and commonality construction. Social networks users broadcast the experience of constructing communications in real daily life in the Internet community forming circles of (...) ‘friends‘, building a chain of weak social ties; but the problem of trusting ‘friends‘ remains not solved in global space. A survey of users of social networks, conducted as part of this study, demonstrates conflicting findings. The opinions of ‘friends‘ does not always have an impact on the degree of trusting events, information, groups, likes, and dislikes to other users. Users often trust strangers and less familiar people. The social networks demonstrates the demand for uniting ‘brige-building‘ trust. However, the trust remains extremely narrow throughout, leading to fragmentation and alienation of individuals from each other in an attempt to find their safe niche. Distrust of narrow and wide radius leads to far-reaching consequences and greater uncertainty in society, not creating the preconditions for openness and the vision of the future. (shrink)

Welfare science has built its foundations on veterinary medicine and thus measures of health. Since bottlenose dolphins (Tursiops truncatus) tend to mask symptoms of poor health, management in captivity would benefit from advanced understanding on the links between health and behavioural parameters, and few studies exist on the topic. In this study, four representative behavioural and health measures were chosen: health status (as qualified by veterinarians), percentage of daily food eaten, occurrences of new rake marks (proxy measure of social (...) activity), and willingness to participate (WtP) in Positive Reinforcement Training sessions as qualitatively measured by their caretakers. These data were collected multiple times a day, every day over the course of a year from a multi-facility, large sample size (ndolphins= 51), allowing powerful analyses of the relationships between measures. First, it was found that dolphins with a higher WtP score also had a significantly better health status, ate a higher percentage of their daily food, and a lower occurrence of new rake marks. In addition, the WtP score was significantly lower up to 3 days before the weekly veterinary diagnosis of a decrease in health state; the percentage of daily food eaten and new rake mark measures did not show any significant change before such a diagnosis. These results suggest that WtP in training sessions is a potential behavioural measure of dolphin welfare, and an indicator of early changes in the dolphins’ health state. We therefore suggest measurement of WtP as a more practical and non-invasive tool to support veterinary care and general management. More work needs to be conducted to elucidate the influence of social behaviour on health, and to identify other potential welfare indicators, but this long-term study has shown that qualitative measures can be both practical and valid when assessing dolphin welfare. (shrink)

The aim of this article is to give more insight into what ethical challenges clinicians in mental healthcare experience and discuss with a Clinical Ethics Committee in psychiatry in the Region of Southern Denmark. Ethical considerations are an important part of the daily decision-making processes and thereby for the quality of care in mental healthcare. However, such ethical challenges have been given little systematic attention – both in research and in practices. A qualitative content analysis of 55 written case-reports (...) from the Clinical Ethics Committee. The Committee offers clinicians in mental healthcare structured ethical analyses of ethical challenges and makes a thorough written case-report. The ethical challenges are grouped into three overarching topics: 1. Clinicians and their relation to patients and relatives. 2. Clinicians and institutional aspects of mental healthcare 3. Clinicians and mental healthcare in a wider social context. Through presentation of illustrative examples the complexity of daily clinical life in mental healthcare becomes evident, as well as typical interests, values and arguments. This qualitative study indicates that difficult ethical challenges are an inherent part of mental healthcare that requires time, space and competence to be dealt with adequately. (shrink)

BackgroundExtremely violent events such as terrorist attacks and mass shootings form a severe risk for the health and wellbeing of affected individuals. In this study based on a public health monitor, we focus on the health impact of the Utrecht tram shooting, which took place in the morning of March 18th 2019. A lone gunman opened fire on passengers within a moving tram. Four people died, and six people were injured in this attack. The attack resulted in nationwide commotion and (...) drew much media attention. Aim of this study was to increase insight into the health effects for the survivors, and whether they received the needed care and support.MethodsSemi-structured interviews with accompanying questionnaires were conducted at six and 18 months post-attack. Overall, 21 survivors participated in the first series of interviews, 15 in the second series. Qualitative data were analyzed using reflexive thematic analysis, quantitative data was only described because of the low sample size.ResultsAt both six and 18 months after the attack many survivors had been able to resume daily life, and most rated their overall health as good or excellent. At the same time, a substantial portion suffered from health problems such as posttraumatic stress symptoms and other complaints, and needed professional care. Furthermore, those in need did not always find their own way to appropriate care through the existing health system: half of the survivors still needed support in finding the right care 18 months later.ConclusionAlthough the design and implementation of this public health monitor were accompanied by multiple challenges, it was possible to track a portion of the survivors and gain insight in the considerable health burden of the attack. Also, it is clear in this study that the health impact of terrorism affects survivors in the long run and requires attention from health authorities and professionals, as survivors were not able to find the right care by themselves. (shrink)

BackgroundThe outbreak of novel coronavirus disease 2019 has caused a global panic and public concern due to its mortality ratio and lack of treatments/vaccines. Reduced levels of physical activity have been reported during the outbreak, affecting the normal daily pattern.ObjectiveTo investigate the relationship of physical activity level with sleep quality and the effects of reduction physical activity levels on sleep quality.MethodsA Google form was used to address personal information, COVID-19 personal care, physical activity, and mental health of 1,907 adult (...) volunteers. Binary logistic regression was used to verify the association of physical activity parameters and sleep quality.ResultsInsufficient physical activity levels were a risk factor to have disturbed sleep pattern [OR: 1.28, 95% CI ]; however, when the BMI was added to the analysis, there was no more statistical difference [OR: 1.23, 95% CI ]. On the other hand, we found that the reduction of physical activity levels was associated with negative changes in sleep quality [OR: 1.73, 95% CI ], regardless all the confounders [OR: 1.30, 95% CI ], unless when feeling of depression was added in Model 6 [OR: 1.28, 95% CI ].ConclusionDisruption in daily physical activity routine, rather than physical activity level, negatively influences sleep quality during the COVID-19 quarantine. (shrink)

The cornerstone of any system of livestock production is the stockpeople responsible for the welfare and productivity of the animals they work with. Nevertheless, it has been suggested that the industrialization of livestock production is breaking down the traditional relationship between stockpeople and their animals. Commercial livestock production creates a situation of structurally induced ambivalence for those working in these contexts. Besides, the scientific literature on stockpeople is limited, dispersed and specially focused on animals. Whereby, a review of current knowledge (...) about the compatibilities, contradictions, and unresolved ethical dilemmas faced by stockpeople in their daily work and their implications on farm animals’ welfare was carried out. The topics reviewed included: Attitudes and personality; Empathy towards animals; Workplace well-being; One-health issues; and Sustainability challenges. Understanding the stockpeople emotional relationship with animals, gender, ethnicity, occupational roles, educational backgrounds, culture, and generational differences can be valuable for technicians, advisors, scientists, consultants, and owners when developing training for sustainability programs. (shrink)

For a period of almost twenty years Aldous Huxley made use in his novels and biographies of the theories of physique and character developed by the psychometrist William Sheldon. This is most clearly seen in the novel Time must have a stop, whose characters follow Sheldon's theories in the most intricate and precise fashion. Huxley's use of Sheldon's work in this novel will be examined, and his motives for embarking on this relatively rare use of science in literature discussed.

At the beginning of the 1950s, Reinhold Niebuhr used the Christian concept of ‘irony’ to explain the difficult condition of the United States in the international system. In The Irony of American History the protestant theologian analyzed the ambiguity of American foreign policy during the first years of the Cold War. According to Niebuhr, the United States was involved in an ironic confutation of its sense of virtue, strength, security and wisdom. This confutation was due not only to its lack (...) of (Christian) realism but also to its false claim to dominate history. After the Fall of the Berlin Wall, when America became the most powerful nation of the international system, the irony of its history did not disappear. Even in a totally different situation for structure and distribution of power, compared to the one of sixty years ago, the ambiguous situation the United States is dealing with, can be spelt out trough irony again. This article discusses the lasting validity of the concept of ‘irony’ used to explain American present and, perhaps, future. (shrink)

Die Frequenzkurven, die die lebendige Substanz charakterisieren, können als eine statische Beschreibung oder als das Ergebnis einer Entwicklung betrachtet werden.Im ersten Falle akzeptiert man ohne weiteres die gegebenen Verteilungen und man versucht, ihnen durch mathematische Gleichungen, die keine unmittelbare Wirklich-keitsbedeutung haben, nahezukommen. Das kausale Denken wird hier ausgeschaltet oder man gibt sich wenigstens mit nur sehr groben Analogien zufrieden.Verschiedene Methoden über die Genese der Frequenzkurven werden besprochen; dabei wird gezeigt, dass die Mehrheit der Fälle auf Hypothesen beruht, die biologisch wenig (...) begründet sind. Eine Ausnahme davon macht die Theorie vonJ. C. Kapteyn, weil er den Vorgang des Wachstums in die Genese einbezieht. Seine Methode weiter ausbauend kann man sich vorstellen, dass die Genese einer Frequenzkurve in erblich homogenem Pflanzenmaterial durch Variation der Wachstumsgeschwindigkeit zustandekommt.Auf solche Weise kann man in einem Koordinatensystem mit Länge und Zeit als Koordinaten ein “Deviationsraster” konstruieren.In einem experimentell untersuchten Fall ergab die graphische Methode mit völlig ausreichender Genauigkeit die schon gefundene Frequenz.Les courbes de fréquence qui caractérisent la matière vivante, peuvent être considérées ou comme une description statique ou bien comme le produit d'un développement.Dans le premier cas on accepte les distributions obtenues et on essaie de s'en rapprocher par des équations mathématiques qui n'ont pas une réalité effective. On ne recherche plus la causalité ou alors on se contente le plus souvent d'analogies très grossières.Les auteurs traitent des diverses méthodes de la genèse des courbes de fréquence et démontrent que la plupart des cas reposent sur des hypothèses qui ont peu de fond biologique. La théorie deM. J. C. Kapteyn fait exception parcequ'il introduit le processus de croissance dans la genèse. En poursuivant plus loin dans sa méthode on peut se figurer que la genèse d'une courbe de fréquence de plantes homogènes par hérédité s'expliquerait par des variations de vitesse de croissance.De cette façon on peut construire une “grille de déviation” dans un système en prenant longueur et temps comme coordonnées.Dans un cas essayé expérimentalement ce graphique donnait avec une exactitude assez grande la distribution de fréquence déjà trouvée. (shrink)

On August 29, 1995, the United States District Court for the Northern District of Ohio ruled that certain practices of Blue Cross and Blue Shield of Ohio relating to the calculation of copayments on insurance claims violated provisions of ERISA, and thus BCBSO could be liable for unpaid benefits and breach of fiduciary duty ). According to BCBSO's Explanation of Benefits and Schedule of Benefits, beneficiaries were responsible for a 20 percent copayment for hospital charges, and the remaining 80 percent (...) of the Provider's Reasonable Charges would be paid by BCBSO. BCBSO negotiated with the hospitals to create discount agreements whereby the actual charge to BCBSO was less than 80 percent of the total amount of the hospital's charges. By this arrangement, BCBSO paid less than 80 percent of what patients were billed; concurrently, patients paid more than 20 percent of the amount ultimately paid to hospitals for their services. (shrink)

Обобщен опыт работы по диагностике микробиологических повреждений памятников искусства и культуры. Большой иллюстративный материал и конкретные примеры проведения микологических экспертиз памятников помогут разобраться в представленном материале.

Sur la toile de fond de la theologie negative, tissee par la discussion des apories que soulevent les notions de l'ineffable et de l'un, Damascius, le dernier diadoque de l'Ecole d'Athenes, elaboreson systeme metaphysique, sans se departir de la rigueur de sa methode aporetique, qui est une critique radicale du langage a l'interieur des coordonnees fixees par le Parmenide de Platon et par les Oracles Chaldaiques. Damascius, dans une enquete unique par son ampleur et son originalite questionne tour a tour (...) Porphyre, Jamblique, Syrianus et Proclus sur les principes; il examine les problemes que pose, en derivation de l'un, la formation de la trinite; de l'un-tout (la limite), du tout-un (l'infini) et de l'unifie (le mixte ou l'etre). Lien a priori entre l'un-tout et le tout-un, l'unifie est le principe de constitution de tout ordre et de toute realite. Damascius etudie sa nature de mixte originaire et autoconstituant, d'etre exemplaire et de premier intelligible. Cette notion lui permet de pas au crible, pour la mieux fonder, la problematique neoplatonicienne de la manence, de la procession et de la conversion. Les divers niveaux d'unification de la pluralite intelligible l'amenent a construire une theorie generale des elements, des parties et des formes Au passage, de nombreux textes, capitaux du point de vue de l'ontologie et de la doctrine de la connaissance, font regretter qu'ils aient ete inconnus du Moyen Age et qu'ils le demeurent pour beaucoup de nos contemporains. (shrink)

An extension of the hypothetical experiment of Szilard, which involved the action of a one-molecule gas in an isolated isothermal system, is developed to illustrate how irreversibility may arise out of Brownian motion. As this development requires a consideration of nonmolecular components such as wheels and pistons, the thought-experiment is remodeled in molecular terms and appears to function as a perpetuum mobile.

These essays use particular issues, thinkers and texts to engage the question of God in early Christianity.