1-2. Charyo p'yŏn, 1-2 -- [3]. Nonmun p'yŏn.

[1]. Nonmun p'yŏn -- [2-3]. Charyo p'yŏn, 1-2.

The purpose of the article is to reveal the scientific approach that substantiates the impact of the creation of strategic alliances (SA) on the digital transformation of business and the development of their innovative power based on identified success factors. The aim was achieved using the following methods: abstract logic and typification (for classification of SA's success factors), generalization (to determine the peculiarities of SA's influence on their innovation development), analytical and ranking method (to determine the relationship between the dynamics (...) creating of SA and the degree of acceleration of digital transformation), expert evaluation (to determine the degree of influence of SA success factors by business areas). Implementing a business-integrated approach to understanding digital transformation will accelerate implementation of innovation and organizational change, identifies future prospects for market, customer and business relationships, highlighting the importance of researching the factors that ensure their success. An alternative vision of SA’s success factors is suggested, which are determined by the possibilities the organization of partnerships and organizational culture, integration of business sectors, compatibility of management goals, external relevance, obtaining synergies. Innovation is considered by the authors as an integration factor that reconciles all groups of SA success factors, giving them the necessary focus to solve business problems. The results of the study show that the creation of SA has a significant impact on accelerating and changes priority of digital transformation of business areas involved in strategic partnerships, and the impact of SA on the development of their innovation power is crucial. (shrink)

• We define a notion of order of indiscernibility type of a structure by analogy with Mitchell order on measures; we use this to define a hierarchy of strong axioms of infinity defined through normal filters, the α-weakly Erdős hierarchy. The filters in this hierarchy can be seen to be generated by sets of ordinals where these indiscernibility orders on structures dominate the canonical functions.• The limit axiom of this is that of greatly Erdős and we use it to calibrate (...) some strengthenings of the Chang property, one of which, CC+, is equiconsistent with a Ramsey cardinal, and implies that where K is the core model built with non-overlapping extenders — if it is rigid, and others which are a little weaker. As one corollary we have:TheoremIf then there is an inner model with a strong cardinal. • We define an α-Jónsson hierarchy to parallel the α-Ramsey hierarchy, and show that κ being α-Jónsson implies that it is α-Ramsey in the core model. (shrink)

Progressive supranuclear palsy is a movement disorder with prominent tau neuropathology. Brain diseases with abnormal tau deposits are called tauopathies, the most common of which is Alzheimer's disease. Environmental causes of tauopathies include repetitive head trauma associated with some sports. To identify common genetic variation contributing to risk for tauopathies, we carried out a genome-wide association study of 1,114 individuals with PSP and 3,247 controls followed by a second stage in which we genotyped 1,051 cases and 3,560 controls for the (...) stage 1 SNPs that yielded P ≤ 10-3. We found significant previously unidentified signals associated with PSP risk at STX6, EIF2AK3 and MOBP. We confirmed two independent variants in MAPT affecting risk for PSP, one of which influences MAPT brain expression. The genes implicated encode proteins for vesicle-membrane fusion at the Golgi-endosomal interface, for the endoplasmic reticulum unfolded protein response and for a myelin structural component. © 2011 Nature America, Inc. All rights reserved. (shrink)

The ethics of hastened death are complex. Studies on physicians’ opinions about assisted dying exist, but changes in physicians’ attitudes towards hastened death in clinical decision-making and the background factors explaining this remain unclear. The aim of this study was to explore the changes in these attitudes among Finnish physicians. A questionnaire including hypothetical patient scenarios was sent to 1182 and 1258 Finnish physicians in 1999 and 2015, respectively. Two scenarios of patients with advanced cancer were presented: one requesting an (...) increase in his morphine dose to a potentially lethal level and another suffering a cardiac arrest. Physicians’ attitudes towards assisted death, life values and other background factors were queried as well. The response rate was 56%. The morphine dose was increased by 25% and 34% of the physicians in 1999 and 2015, respectively. Oncologists approved the increase most infrequently without a significant change between the study years. Oncological specialty, faith in God, female gender and younger age were independent factors associated with the reluctance to increase the morphine dose. Euthanasia, but not assisted suicide, was considered less reprehensible in 2015. In both years, most physicians withheld cardiopulmonary resuscitation. Finnish physicians accepted the risk of hastening death more often in 2015 than in 1999. The physicians’ specialty and many other background factors influenced this acceptance. They also regarded euthanasia as less reprehensible now than they did 16 years ago. (shrink)

As a psychologist working with individuals, couples, and groups over the past 25 years, I have become convinced that group therapy holds effective possibilities for treatment that neither individual nor couples therapy can match. In theorizing about why group work holds such potency for changing lives, I have come to place it in a Sartrean context. I believe that group therapy offers a greater possibility for revolutionary praxis than individual or couples therapy. In saying this, I am not talking about (...) political or social revolution, but rather the possibility for radical change in a person's orientation toward the world, which groups tend to provoke and reinforce in a way that is more difficult in other forms of therapy. Sartre's concept of groups in his later philosophy, especially in Search for a Method and the Critique of Dialectical Reason, can help us to understand better this transformative power of groups. Such power is not always positive, of course, as Sartre himself recognizes—and as social and political history so amply demonstrates. But the nature of therapy groups is such that they at least have the potential for positive results. (shrink)

© 2015, Springer-Verlag Berlin Heidelberg.Genetic studies have identified single nucleotide polymorphisms associated with the risk of prostate cancer. It remains unclear whether such genetic variants are associated with disease aggressiveness. The NCI-SPORE Genetics Working Group retrospectively collected clinicopathologic information and genotype data for 36 SNPs which at the time had been validated to be associated with PC risk from 25,674 cases with PC. Cases were grouped according to race, Gleason score and aggressiveness. Statistical analyses were used to compare the frequency (...) of the SNPs between different disease cohorts. After adjusting for multiple testing, only PC-risk SNP rs2735839 was significantly and inversely associated with aggressive and high-grade disease in European men. Similar associations with aggressive and high-grade disease were documented in African-American subjects. The G allele of rs2735839 was associated with disease aggressiveness even at low PSA levels in both European and African-American men. Our results provide further support that a PC-risk SNP rs2735839 near the KLK3 gene on chromosome 19q13 may be associated with aggressive and high-grade PC. Future prospectively designed, case-case GWAS are needed to identify additional SNPs associated with PC aggressiveness. (shrink)

It is well established that single crystals of B2-structured Fe-Al change from paramagnetic to ferromagnetic upon plastic deformation. This strain-induced ferromagnetism arises mostly from Fe atoms which have three or more like nearest neighbours in antiphase-boundary tubes. Such Fe atoms carry magnetic moments according to their local environment. In this study, the saturation magnetizations, M S , of cold-rolled Fe-34 at.% Al, Fe-40 at.% Al and Fe-43 at.% Al single crystals were measured in a vibrating-sample magnetometer from 77 K to (...) room temperature and transmission electron microscopy was used to confirm the presence of APB tubes. After magnetic measurements, rolled single crystals were heated in a differential scanning calorimeter at 20 K min m 1 to 973 K and the enthalpy associated with the removal of the APB tubes measured. From the enthalpy measurement, the APB tube density and the number of Fe NNs were estimated. Hence, the M S values at 0 K were calculated. These were in good agreement with the experimentally determined values. (shrink)

Purpose of the study is to shed light on the role of psychophysiology in the creative process, namely, the style corrections connected with pathological changes in the artist’s organism, deviating from empirical-descriptive methods. Theoretical basis of the study implies the interpretation of the notions style and disease not in their narrow professional limitation but from the standpoint of expanding the parameters of these concepts to philosophical dimensions. Based on the principle of analogy, the research findings prove that non-mimetic creative process (...) manifests itself exclusively in connection with a human from a bodily viewpoint through anthropological mimesis, which can program the propensity to certain capabilities of the individual organism. C. G. Jung was the first who pointed to the productivity of this method in his work "Theoretical Reflections on the Nature of the Psyche". The creativity phenomenon reflects not only "pure" psychology and the intellectual and spiritual component but also its relation to the artist as a physical being. It, outside its belonging to and being conditioned by transcendent factors, includes a quantitative aspect related to the moment of intensity. The disease acts to some extent as a stimulator of the production/change of aesthetic enzyme. In this context, the dialectic method is also effective because the subject of study cannot be comprehensively argued using naturalistic approaches only and requires a semantic explanation too. The essence of it is the logic of contradictions. In this case, the antinomy of matter-spirit plays a conceptual role in the projection on the plane of word-formation. Originality of the research findings is in the expansion of the causal relationship range of the creative process, namely the inclusion of the factor of psycho-physiological pathology into the system artist-work. This factor performs important stylistic functions. Conclusions. In contrast to scientific studies, where 1) style is analyzed separately and 2) the figure of the artist, this study argues the need to correlate these issues, taking them beyond descriptiveness to avoid schematics and one-dimensionality. (shrink)

Recent research has shown that a phase transformation of diamond to a different form of carbon is involved when diamonds are polished in the traditional fashion. The question as to how this phase transformation is activated and maintained to produce high wear rates is of great technological interest since it may radically change the way we view the processing of diamond. This paper describes the use of Raman spectroscopy to examine debris produced on the diamond polishing wheel, both during its (...) preparation and during polishing. In addition, polished diamond surfaces were examined for the possible existence of non-diamond surface layers in an attempt to identify material removal mechanisms. Raman spectroscopy proves ideal for these analyses because its relatively high spatial resolution is well suited to the analysis of small wear features and debris particles, and because of the wealth of information it reveals about chemical structure. This level of structural information has been lacking in previous analyses of diamond polishing debris. In addition to the non-diamond carbon found in the wear debris, significant quantities of two iron oxides, magnetite (Fe3O4) and haematite (α-Fe2O3), were also found. An interesting observation was that a transformation from magnetite to haematite could be induced either by using high power laser excitation or by frictional heating during polishing. It is suggested that some of the Raman peaks previously attributed to lonsdaleite might better be explained by the presence of these oxides. (shrink)

Nudges have become a popular tool for behaviour change; but, some interventions fail to replicate, even when the identical, previously successful intervention is used. One cause of this problem is that people default to using some of or all of the previously-successful existing nudges for any problem—the “kitchen sink” approach. We argue that the success of an intervention depends on understanding people’s current behaviour and beliefs to ensure that any nudge will actually “budge” them from their current beliefs. We introduce (...) the Beliefs–Barriers–Context model, with three components: understanding beliefs, barriers, and context to change behaviour through a budge. Designing a budge has the goal of identifying the psychological mechanism that drives a target behaviour, focusing on the psychology of the target population before attempting to change that behaviour. In contrast to the “kitchen sink” approach, budges are best complemented with mechanism experiments to identify what undergirds behaviour change. Moving away from simply nudging behaviour to budging minds—by understanding beliefs, barriers and context—has the potential to inform both the successes and failures of behavioural interventions. (shrink)

Abstract. In this article we developed scientific and applied foundations of commercialization of the nature-resource potential of anthropogenic objects, on the example of exhausted mines. It is determined that the category of “anthropogenic object” can be considered in a narrow-applied sense, as specific anthropogenic objects to ensure the target needs, and in a broad theoretical sense, meaning everything that is created and changed by human influence, that is the objects of both artificial and natural origin. It was determined that problems (...) of commercialization of the natural-resource potential of anthropogenic objects are most often considered by researchers for specific objects, without having complex methodological coverage from the point of view of combining environmental, technical, economic and managerial components. When studying the substantiation of the scientific base, the authors confirmed the feasibility of the commercialization of natural-resource potential of anthropogenic objects on the example of a number of theoretical scientific studies in reclamation, reconstruction, recreation, remediation, restoration of biological productivity and economic value of land disturbed by economic activity. The considered examples of exhausted mines in the 21st century in the USA, Canada, Germany, Romania, and Poland indicate a wide range of opportunities for their commercialization. The study of the potential for commercialization of exhausted mines in the post-Soviet countries testified to the underused reserves for the commercialization of their nature-resource potential and their high potential for further development. The authors proposed the identification of anthropogenic objects on the basic livelihood spheres of society. There were identified the main system (natural, biological, technical, economic, social, managerial) and structural (subjects, trends, threats, risks, problems, challenges) factors of diagnosing the state of an anthropogenic object. A set of measures has been developed for commercialization of an anthropogenic object in functional and production activities, product policy, financial and investment spheres, pricing and sales policies, promotion, management and determination of property rights. Recommendations were provided on optimizing the management decision-making process based on a set of positivistic development principles, methods, and management functions. The study allows international organizations, state and local authorities, territorial communities, owners and potential investors to see new opportunities and make mutually beneficial decisions on the rational use of the nature-resource potential of anthropogenic objects. (shrink)

Introduction, by J. D. Bettis.--An introduction to phenomenology: What is phenomenology? by M. Merleau-Ponty.--The phenomenology of religion: The meaning of religion, by W. B. Kristensen.--A naturalistic description: Religion in essence and manifestation, by G. van der Leeuw.--A supernaturalistic description: Approaches to God, by J. Maritain.--A projective description: The essence of Christianity, by L. Feuerbach.--Religion as a faculty: On religion, by F. Schleiermacher. The Christian faith, by F. Schleiermacher.--Religion as a dimension: Religion as a dimension in man's spiritual life, by P. (...) Tillich.--Religion as a social function: Magic, science, and religion, by B. Malinowski.--Religion as structure and archetype: The sacred and the profane, by M. Eliade.--Religion as encounter: I and thou, by M. Buber. (shrink)

Nucleation and motion of kink pairs on partial dislocations are examined by elasticity theory for materials with a high Peierls stress. Two approaches are used: one considers the change in average stacking-fault energy due to alloying elements and the other considers the change in local SFE due to a nearby solute atom. Both approaches highlight the role of SFE on kink nucleation, propagation and annihilation and both furnish strain rate as a function of stress, temperature and SFE. Model predictions are (...) compared with yield stress data for two systems: firstly, an intermetallic, MoSi 2 , which softens for alloying elements that decrease the SFE and hardens for Re additions that increase the SFE; secondly, a ceramic oxide, MgO-Al 2 O 3 spinel, which softens with increasing addition of excess alumina and at the same time exhibits a decrease in SFE. The average SFE approach agrees qualitatively with the data while quantitative agreement is obtained with the local SFE approach. The possibility is considered that the model applies to other materials, such as TiAl, HfV 2 and Fe 3 Al, which show softening with certain alloying additions. One requirement is that the dislocations are dissociated more than a few atomic distances; otherwise kink nucleation occurs on the perfect dislocation . Hence the model does not apply to materials such as bcc metals which only have a core dissociation. Normal hardening effects of solutes from size and modulus misfits are additive with any softening effects from a decrease in SFE and so may mask the latter, as occurs for W additions to MoSi 2. (shrink)

Joseph Beuys was one of the most significant artists of the 20th century. He was a gunner and radio operator in the German Air Force during World War II, and was severely injured several times. In March 1943 he had a life-changing experience after the dive bomber he was assigned to crashed in the Crimean peninsula. This trauma influenced Beuys' entire artistic career, and is known in art history as the ’Tartar Legend’ or ’Tartar Myth’. Profoundly affected by the crash, (...) the severe trauma, the near-death experience and his rescue, which he perceived as a “rebirth”, Beuys no longer saw himself, other people or society as a whole in the same way as previously. With his new consciousness, he ignored boundaries and created visions whereby all mankind could experience the healing he had undergone. Beuys did not bring society far enough for the turning point towards “the healing of the world” to be visible, yet today it is important to keep his work alive as a record of his extraordinary strength, which arose from trauma and severe injury, and was carried by a passionate commitment to mankind and to life itself. (shrink)

The nonstandard stroboscopy method links discrete-time ordinary difference equations of first-order and continuous-time, ordinary differential equations of first order. We extend this method to the second order, and also to an elementary, yet general class of partial difference/differential equations, both of first and second order. We thus obtain straightforward discretizations and continuizations, even avoiding change of variables. In fact, we create intermediary objects: partial difference equations with S-continuous solutions, which have both discrete and continuous properties.

This study aims to determine the motive that led to the establishment of Juche by Kim Il Sung amidst the influence of communism and its transformation into religion in North Korea. North Korea is a communist country dictated by Kim Jong-Un of the Kim dynasty and known for its cruelty. The country underwent several changes from Marxism-Leninism to familism to determine its strength in Juche. This ideology that acts as a religion was influenced and strengthened Kim Jong Il to Kim (...) Jong-Un and built by shifting the concept of marxism-Leninism to construct a new understanding of Juche. It will be demonstrated that this ideology was influenced by Confucianism, Christianity, Nationalism, Chinese Communism, and Russian Communism. In the modern era, imperialism was used as an ideological tool to restrict backwardness. This theory allegedly helped Kim Il-Sung establish a unitary, one-person rule over North Korea. ‘It will be examined whether Juche ideology is a tool the state has used to convince people of their government. Pronouncements, an intentional religion in which the people were to believe that their Ruler was a supreme human or an ideology that morphed into a religion’. It will be demonstrated that, when they started honoring Kim as their god, no other religion was permitted.Contribution: This research offers readers an understanding of the value of humanity in the binding ideology of Juche. However, the Juche Ideology can serve as a missiological bridge towards mission goals, which require the experience of spiritual, physical, and social liberation. (shrink)

ABSTRACT The paper gives an analytical synopsis of the problem of developing medical ethics in the early half of the 1990s in China, as perceived by Chinese scholars and medical professionals interested in medical ethics. The views captured and analyzed here were expressed in one of the two major journals on medical ethics in China: Chinese Medical Ethics. The economic reform unleashed profound changes in Chinese society, including in the medical field, creating irregularities and improprieties in the profession. Furthermore, the (...) market reform also created new values that were in tension with existing values. In this transitional period, Chinese medical ethicists saw the need to rebuild medical morality for the new era. Using the code of conduct promulgated by the Chinese Ministry of Health in 1989 as a basis, assessment and e ducation aspects of the institutionalization of medical ethics are dis‐ cussed. In addition to institutional problems of institutionalising ethics, there are philosophical and methodological issues that are not easy to solve. After all, to institutionalize medical ethics is no easy task for a country as old and as big as China. Chinese medical ethicists seem ready to confront these difficulties in their effort to develop medical ethics in Reform China. (shrink)

Perforation or gap formation in a vegetation is a major process in landscape transformation. The occurrence of gaps profoundly alters the microclimatical conditions in a vegetation. A method is proposed to quantify perforation by using the three main 2-D characteristics of the gaps: area, number and boundary length. New measures are developed by normalizing the observed values to the reference status of minimum and maximum perforation. As minimum perforation status, the presence of one single gap with area equal to the (...) map resolution is assumed. The new measures are combined using a 3-D Euclidean distance to visualize the process and to detect changes. The method is exemplified using a field case of gaps in a tropical terra firme rainforest at Tiputini, Ecuador. (shrink)

This article provides current Schwartz Values Survey (SVS) data from samples of business managers and professionals across 50 societies that are culturally and socioeconomically diverse. We report the society scores for SVS values dimensions for both individual- and societal-level analyses. At the individual-level, we report on the ten circumplex values sub-dimensions and two sets of values dimensions (collectivism and individualism; openness to change, conservation, self-enhancement, and self-transcendence). At the societal-level, we report on the values dimensions of embeddedness, hierarchy, mastery, affective (...) autonomy, intellectual autonomy, egalitarianism, and harmony. For each society, we report the Cronbach’s α statistics for each values dimension scale to assess their internal consistency (reliability) as well as report interrater agreement (IRA) analyses to assess the acceptability of using aggregated individual level values scores to represent country values. We also examined whether societal development level is related to systematic variation in the measurement and importance of values. Thus, the contributions of our evaluation of the SVS values dimensions are two-fold. First, we identify the SVS dimensions that have cross-culturally internally reliable structures and within-society agreement for business professionals. Second, we report the society cultural values scores developed from the twenty-first century data that can be used as macro-level predictors in multilevel and single-level international business research. (shrink)

In this article the perspective shifts to the “upstream” end of the agricultural knowledge and information system (AKIS). Because knowledge policy and strategic decision-making are not the prerogative of the public sector, organizations such as cooperative unions and multinational companies are included. After considering the influence of the changing environment on the nature of the AKIS, the role of knowledge management and policy in the emerging knowledge and information market is examined. Special attention is given to public and private R&D. (...) The article then looks where information technology (IT) fits in and what considerations determine strategic investment in IT projects and sustained services. Some of the European experiences with this strategic investment are evaluated. (shrink)

A lineage of prominent philosophers who have discussed the second-person relation can be regarded as advancing structural accounts. They posit that the second-person relation effects one transformative change to the structure of practical reasoning. In this paper, I criticise this orthodoxy and offer an alternative, substantive account. That is, I argue that entering into second-personal relations with others does indeed affect one's practical reasoning, but it does this not by altering the structure of one's agential thought, but by changing what (...) reasons can become available. The importance of second-personal thought for action is heterogenous. Second-person relations make possible the emergence of a wide variety of different kinds of practical reasons: creating some, revealing others. Recognising this diminishes the appeal of the traditional, structural accounts of the practical significance of such second-personal relations. Moving away from structural accounts facilitates a more thorough understanding of the intersubjective form of action. (shrink)

Objectives: The N2b is an event-related potential component thought to index higher-order executive function. While the impact of concussion on executive functioning is frequently discussed in the literature, limited research has been done on the role of N2b in evaluating executive functioning in patients with concussion. The aims of this review are to consolidate an understanding of the cognitive functions reflected by the N2b and to account for discrepancies in literature findings regarding the N2b and concussion.Methods: A scoping review was (...) conducted on studies that used the N2b to measure cognitive functioning in healthy control populations, as well as in people with concussions.Results: Sixty-six articles that met inclusion criteria demonstrated that the N2b effectively represents stimulus-response conflict management, response selection, and response inhibition. However, the 19 included articles investigating head injury found widely varied results: some studies found the amplitude of the N2b to be increased in the concussion group, while others found it to be decreased or unchanged.Conclusion: Based on the available evidence, differences in the amplitude of the N2b have been linked to response selection, conflict, and inhibition deficits in concussion. However, due to large variations in methodology across studies, findings about the directionality of this effect remain inconclusive. The results of this review suggest that future research should be conducted with greater standardization and consistency. (shrink)

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)

Upshot: Time constraints, locked curriculums, strict management, and possible anarchy in the classroom are some of the themes that originated from the commentaries. I argue that these challenges should be viewed holistically in the broader picture. I also question the educator’s role in mitigating these obstacles. My advice: Do it anyway.

Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires (...) researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. (shrink)

BackgroundHuntington’s disease has a poor prognosis. For HD patients in the Netherlands, one way of dealing with their poor prognosis is by drawing up an advance euthanasia directive. Little is known about the perspectives of HD patients on their AED.AimTo gain insight into patients’ views on and attitudes towards their AED, and changes over time.MethodsA longitudinal qualitative interview study using 1 to 6 semi-structured interviews over a period of maximum three years. Nine HD patients who either had an AED or (...) were thinking about drawing it up participated in this study.ResultsWe identified two themes that characterize patients’ perspectives on their AEDs: general character of the AED; uncertainty around their AED. Ad The conditions that the participants described in their AED were generally not very specific for the person. Mostly they were general notions of unbearable suffering. Familiarity with HD in the family could play a role in drawing up an AED. Ad Participants generally were aware of the tentative character of their AED and could have doubts concerning their own willingness or the willingness of others in the future. Sometimes these doubts were so great, that it prevented them from drawing up an AED. However, patients did not alter their AED during the follow-up period or changed in their view or attitude on their AED.ConclusionHD patients that draw up an AED usually describe general conditions for euthanasia and recognize that these conditions may change as the disease progresses. An AED or the wish to draw one up may be a good conversation starter for conversations about goals and preferences for future care. (shrink)