Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

Is God's foreknowledge compatible with human freedom? One of the most attractive attempts to reconcile the two is the Ockhamistic view, which subscribes not only to human freedom and divine omniscience, but retains our most fundamental intuitions concerning God and time: that the past is immutable, that God exists and acts in time, and that there is no backward causation. In order to achieve all that, Ockhamists distinguish ‘hard facts’ about the past which cannot possibly be altered from ‘soft facts’ (...) about the past which are alterable, and argue that God's prior beliefs about human actions are soft facts about the past. (shrink)

Das Grab des Königs Ninetjer in Saqqara: Architektonische Entwicklung frühzeitlicher Grabanlagen in Ägypten. By Claudia M. Lacher-Raschdorff. Deutsches Archäologisches Institut Kairo, Archäologische Veröffentlichungen, vol. 125. Wiesbaden: Harrassowitz Verlag, 2014. Pp. 295, 44 pls., plans. €247.

This paper examines the reasons for the high level of unmet needfor contraception in rural Egypt, using data from the individual survey andservice availability module of the 1988Ð89 Egypt Demographic and HealthSurvey. Two broad sets of potential factors are considered: characteristics ofa woman which influence her desire for children and thus her propensity touse contraception, and factors relating to the family planning serviceenvironment in which she lives. The results from a multivariate analysis showthat certain individual characteristics, such as family composition (...) andeducation, have a strong impact on the level of contraceptive use and on theproportion of total demand for spacing or limiting childbearing that is metby use of family planning. Unmet need, however, remains fairly constantacross demographic and socioeconomic subgroups of the population. Thelargest variations in unmet need are regional, but elements of the familyplanning services, namely the provision of a community-based nurse whodistributes family planning and female doctors at clinics, also play animportant role. (shrink)

The extended reduced Kies distribution, which is an asymmetric flexible extension of the reduced Kies distribution, is the subject of this research. Some of its most basic mathematical properties are deduced from its formal definitions. We computed the ExRKD parameters using eight well-known methods. A full simulation analysis was done that allows the study of these estimators’ asymptotic behavior. The efficiency and applicability of the ExRKD are investigated via the modeling of COVID-19 and milk data sets, which demonstrates that the (...) ExRKD delivers a better match to the data sets when compared to competing models. (shrink)

Tumor progression involves the transition from normal to malignant cells, through a series of cumulative alterations. During this process, invasive and migratory properties are acquired, enabling cells to metastasize (reach and grow in tissues far from their origin). Numerous cellular changes take place during epithelial malignancy, and disruption of E‐cadherin based cell‐cell adhesion is a major event. The small Rho GTPases (Rho, Rac and Cdc42) have been implicated in multiple steps during cellular transformation, including alterations on the adhesion status of (...) the tumor cells. This review focuses on recent in vivo evidence that implicates RhoGTPases in epithelial tumor progression. In addition, we discuss different hypotheses to explain disruption of cadherin‐mediated cell–cell adhesion, directly or indirectly, through activation of Rho GTPases. Understanding the molecular mechanism of how cadherin adhesion and RhoGTPases interplay in normal cells and how this balance is altered during cellular transformation will provide clues as to how to interfere with tumor progression. © 2003 Wiley Periodicals, Inc. BioEssays 25:452–463, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

Liberty is central to the republican ideal. Typically the set of rights and liberties of republican citizens will include rights to political participation as well as civil and quasi-political rights and liberties. Republican thinkers have sought to protect citizens' rights, often by institutional arrangements. They have also been concerned to train citizens in the qualities essential to preserve the republic. It should be noted that the status of ‘citizen’ has often not been universally available to those who live in republics. (...) A number of qualifications have usually restricted the right to full citizenship. (shrink)

The essays assembled here are all very early and differ in a number of ways from Bakhtin's previously published work.

Rescued in 1972 from a storeroom in which rats and seeping water had severely damaged the fifty-year-old manuscript, this text is the earliest major work (1919-1921) of the great Russian philosopher M. M. Bakhtin. Toward a Philosophy of the Act contains the first occurrences of themes that occupied Bakhtin throughout his long career. The topics of authoring, responsibility, self and other, the moral significance of "outsideness," participatory thinking, the implications for the individual subject of having "no-alibi in existence," the difference (...) between the world as experienced in actions and the world as represented in discourse--all are broached here in the heat of discovery. This is the "heart of the heart" of Bakhtin, the center of the dialogue between being and language, the world and mind, "the given" and "the created" that forms the core of Bakhtin's distinctive dialogism. A special feature of this work is Bakhtin's struggle with the philosophy of Immanuel Kant. Put very simply, this text is an attempt to go beyond Kant's formulation of the ethical imperative. Toward a Philosophy of the Act will be important for scholars across the humanities as they grapple with the increasingly vexed relationship between aesthetics and ethics. (shrink)

In Australia and other countries, certain groups of women have traditionally been denied access to assisted reproductive technologies . These typically are single heterosexual women, lesbians, poor women, and those whose ability to rear children is questioned, particularly women with certain disabilities or who are older. The arguments used to justify selection of women for ARTs are most often based on issues such as scarcity of resources, and absence of infertility , or on social concerns: that it “goes against nature”; (...) particular women might not make good mothers; unconventional families are not socially acceptable; or that children of older mothers might be orphaned at an early age. The social, medical, legal, and ethical reasoning that has traditionally promoted this lack of equity in access to ARTs, and whether the criteria used for client deselection are ethically appropriate in any particular case, are explored by this review. In addition, the issues of distribution and just “gatekeeping” practices associated with these sensitive medical services are examined. (shrink)

My title links together kings, war, and the economy, and the linkage is deliberate. I do not of course wish to suggest that Hellenistic kings did nothing but fight wars, that they were responsible for all the wars in the period, that royal wars were nothing but a form of economic activity, or that the economy of the kings was dependent purely on the fruits of military success, though there would be an element of truth in all these propositions. But (...) I wish to react against the frequent tendency to separate topics that are related, the tendency to treat notions relating to what kings were or should be as something distinct from what they actually did, and the tendency to treat political and military history on the one hand as something separate from economic and social history on the other.A number of provisos should be made at the outset. The title promises more than the paper can deliver; in particular, more will be said about kings and war than about kings and the economy. The subject is handled at a probably excessive level of generalization and abstraction. I talk about Hellenistic kings in general, but in practice it would obviously be necessary to draw distinctions between different dynasties, different times and places, and individual rulers, and some of those distinctions I shall indicate. Conclusions are provisional and subject to modification and considerable expansion in detail. Finally, two points of terminology. I use the word ‘Hellenistic’ for no better reason than out of the force of acquired habit, but of course the word and the concept are modern inventions that were unknown to the ancient world. (shrink)