BackgroundBurnout is a major societal issue adversely affecting employees’ health and performance, which over time results in high sick leave costs for organizations. Traditional rehabilitation therapies show suboptimal effects on reducing burnout and the return-to-work process. Based on the health-promoting effects of nature, taking clients outdoors into nature is increasingly being used as a complementary approach to traditional therapies, and evidence of their effectiveness is growing. Theories explaining how the combination of general psychological support and outdoor-specific elements can trigger the (...) rehabilitation process in outdoor therapy are often lacking, however, impeding its systematic research.AimThe study aims to develop an intervention and evaluation model for outdoor therapy to understand and empirically evaluate whether and how such an outdoor intervention may work for rehabilitation after burnout.Methodological ApproachWe build on the exemplary case of an outdoor intervention for rehabilitation after burnout, developed by outdoor clinical psychologists in Netherlands. We combined the generic context, process, and outcome evaluation model and the burnout recovery model as an overarching deductive frame. We then inductively specified the intervention and evaluation model of outdoor therapy, building on the following qualitative data: semi-structured interviews with outdoor clinical psychologists and former clients; a content analysis of the intervention protocol; and reflective meetings with the intervention developers and health promotion experts.ResultsWe identified six key outdoor intervention elements: physical activity; reconnecting body and mind; nature metaphors; creating relationships; observing natural interactions; and experiential learning. The results further showed that the implementation of these elements may facilitate the rehabilitation process after burnout in which proximal, intermediate, and distal outcomes emerge. Finally, the results suggested that this implementation process depends on the context of the therapist, therapy, and of the clients.ConclusionThe intervention and evaluation model for outdoor therapy shows how key outdoor intervention elements may contribute to the rehabilitation process after burnout. However, our model needs to be further tested among a larger group of clients to empirically evaluate whether and how outdoor therapy can support rehabilitation. (shrink)

While we often talk about time using spatial terms, experimental investigation of space-time associations has focused primarily on the space in front of the participant. This has had two consequences: the disregard of the space behind the participant and the creation of potential task demands produced by spatialized manual button-presses. We introduce and test a new paradigm that uses auditory stimuli and vocal responses to address these issues. Participants made temporal judgments about deictic or sequential relationships presented auditorily along a (...) body-centered sagittal or transversal axis. Results involving the transversal axis replicated previous work while sagittal axis results were surprising. Deictic judgments did not use the sagittal axis but sequential judgments did, in a previously undocumented way. Participants associated earlier judgments with the space in front of them and later judgments with the space behind them. These findings, using a new approach, p.. (shrink)

Galvanic vestibular stimulation is a non-invasive method of electrically stimulating the vestibular system. We investigated whether the application of GVS can alter the learning of new functional mobility and manual control tasks and whether learning can be retained following GVS application. In a between-subjects experiment design, 36 healthy subjects performed repeated trials, capturing the learning of either a functional mobility task, navigating an obstacle course on a compliant surface with degraded visual cues or a manual control task, using a joystick (...) to null self-roll tilt against a pseudo-random disturbance while seated in the dark. In the “learning” phase of trials, bilateral, bipolar GVS was applied continuously. The GVS waveform also differed between subjects in each task group: white noisy galvanic vestibular stimulation at 0.3 mA high-level random GVS at 0.7 mA, or with the absence of stimulation. Following the “learning” trials, all subjects were blindly transitioned to sham GVS, upon which they immediately completed another series of trials to assess any aftereffects. In the functional mobility task, we found nGVS significantly improved task learning. Further, improvements in learning the functional mobility task with nGVS were retained, even once the GVS application was stopped. The benefits in learning with nGVS were not observed in the manual control task. High level GVS tended to inhibit learning in both tasks, but not significantly so. Even once the high-level stimulation was stopped, the impaired performance remained. Improvements in learning with nGVS may be due to increased information throughput resulting from stochastic resonance. The benefit of nGVS for functional mobility, but not manual control nulling, may be due to the multisensory, strategic, motor coordination, or spatial awareness aspects of the former task. Learning improvements with nGVS have the potential to benefit individuals who perform functional mobility tasks, such as astronauts, firefighters, high performance athletes, and soldiers. (shrink)

BackgroundStructured, systematic methods to formulate consensus recommendations, such as the Delphi process or nominal group technique, among others, provide the opportunity to harness the knowledge of experts to support clinical decision making in areas of uncertainty. They are widely used in biomedical research, in particular where disease characteristics or resource limitations mean that high-quality evidence generation is difficult. However, poor reporting of methods used to reach a consensus – for example, not clearly explaining the definition of consensus, or not stating (...) how consensus group panellists were selected – can potentially undermine confidence in this type of research and hinder reproducibility. Our objective is therefore to systematically develop a reporting guideline to help the biomedical research and clinical practice community describe the methods or techniques used to reach consensus in a complete, transparent, and consistent manner.MethodsThe ACCORD project will take place in five stages and follow the EQUATOR Network guidance for the development of reporting guidelines. In Stage 1, a multidisciplinary Steering Committee has been established to lead and coordinate the guideline development process. In Stage 2, a systematic literature review will identify evidence on the quality of the reporting of consensus methodology, to obtain potential items for a reporting checklist. In Stage 3, Delphi methodology will be used to reach consensus regarding the checklist items, first among the Steering Committee, and then among a broader Delphi panel comprising participants with a range of expertise, including patient representatives. In Stage 4, the reporting guideline will be finalised in a consensus meeting, along with the production of an Explanation and Elaboration document. In Stage 5, we plan to publish the reporting guideline and E&E document in open-access journals, supported by presentations at appropriate events. Dissemination of the reporting guideline, including a website linked to social media channels, is crucial for the document to be implemented in practice.DiscussionThe ACCORD reporting guideline will provide a set of minimum items that should be reported about methods used to achieve consensus, including approaches ranging from simple unstructured opinion gatherings to highly structured processes. (shrink)

International business organizations are regularly addressed on their corporate social responsibility (CSR). As illustrated in this paper, it is not yet clear exactly what CSR means to organizations and how to deal with it. In this paper, the authors explore how a sensemaking approach helps to understand the business challenges of CSR within an organizational context. The theories of Karl Weick are applied to the experiences of CSR in Royal Dutch Shell. The authors argue that the key to CSR in (...) international business organizations is to engage stakeholders and start a process of joint sensemaking. Three main competencies are crucial in this: the competency to engage stakeholders through listening and understanding; the creation of an organizational language so that CSR makes sense to members of the organization; and recognizing the momentum of taking action. (shrink)

International business organizations are regularly addressed on their corporate social responsibility (CSR). As illustrated in this paper, it is not yet clear exactly what CSR means to organizations and how to deal with it. In this paper, the authors explore how a sensemaking approach helps to understand the business challenges of CSR within an organizational context. The theories of Karl Weick are applied to the experiences of CSR in Royal Dutch Shell. The authors argue that the key to CSR in (...) international business organizations is to engage stakeholders and start a process of joint sensemaking. Three main competencies are crucial in this: the competency to engage stakeholders through listening and understanding; the creation of an organizational language so that CSR makes sense to members of the organization; and recognizing the momentum of taking action. (shrink)

Multinational companies (MNCs) can have positive and negative impacts on the human rights situation of a country. More and more MNCs have made a commitment to respect human rights. So far, little research has been done on how MNCs can embed their commitment and which factors determine its success. This paper therefore aims to describe and learn from the process of embedding human rights in six subsidiaries of the multinational oil company Royal Dutch Shell (in short, Shell), operating in different (...) parts of the world. It develops an approach based on the model of Tatiana Kostova. Using a specific tool called the Human Rights Compliance Assessment, the paper concludes that, despite differences in local context, the process requirements of embedding global standardscan be the same. (shrink)

According to the logic of collective action, mere awareness of the causes of environmental degradation will not motivate rational agents to reduce pollution. Yet some government policies aim to enlist citizens in schemes of voluntary cooperation, drawing on an ethos of collective responsibility. Are such policies doomed to failure? This book provides a novel application of rational choice theory to a large-scale survey of environmental attitudes in The Netherlands. Its main findings are that rational citizens are motivated to cooperate towards (...) a less polluted environment to a large extent, but that their willingness to assume responsibility depends on the social context of the collective action problem they face. This empirical study is an important volume in the development of a more consistent foundation for rational choice theory in policy analysis, which seeks to clarify major theoretical issues concerning the role of moral commitment, self-interest and reciprocity in environmental behaviour. (shrink)

The purpose of this study is to examine whether United States -style regulatory intervention to encourage whistle-blowing can be immediately effective if transplanted into another country with a distinctly different historical cultural background and institutional system. A total of 98 U.S. and 84 German accountants participated in a laboratory experiment relating to a case of financial statement fraud. The provision of anti-retaliation protection and monetary rewards for whistle-blowing were manipulated and participants were asked to assume the role of an internal (...) auditor. We hypothesize and find that the provision of anti-retaliation protection and monetary rewards encourage U.S. accountants to blow the whistle. In contrast, among German accountants, where their country features a historical fear and distrust of whistle-blowers, U.S.-style regulatory interventions are less effective. Together, our findings provide strong support for the theory of path-dependence, suggesting that whistle-blowing regulation should not be uniformly transplanted without due consideration of the unique history and culture of a country. (shrink)

Previous studies have documented the fallibility of attempts by surrogates and physicians to act in a substituted judgment capacity and predict end-of-life treatment decisions on behalf of patients. We previously reported that physicians misperceive their patients' preferences and substitute their own preferences for those of their patients with respect to four treatments: cardiopulmonary resuscitation (CPR) in the event of cardiac arrest, ventilator for an indefinite period of time, medical nutrition and hydration for an indefinite period of time, and hospitalization in (...) the event of pneumonia. (shrink)

Previous studies have documented the fallibility of attempts by surrogates and physicians to act in a substituted judgment capacity and predict end-of-life treatment decisions on behalf of patients. We previously reported that physicians misperceive their patients' preferences and substitute their own preferences for those of their patients with respect to four treatments: cardiopulmonary resuscitation in the event of cardiac arrest, ventilator for an indefinite period of time, medical nutrition and hydration for an indefinite period of time, and hospitalization in the (...) event of pneumonia. (shrink)

In Anarchy, State, and Utopia, Robert Nozick contrasts entitlement theories of justice and “traditional” theories such as Rawls', utilitarianism or egalitarianism, and advocates the former against the latter. What exactly is an entitlement theory of justice? Nozick's book offers two distinct characterizations. On the one hand, he explicitly describes “the general outlines of the entitlement theory” as maintaining “that the holdings of a person are just if he is entitled to them by the principles of justice in acquisition and transfer, (...) or by the principle of rectification of injustice ”. On the other hand, his famous “Wilt Chamberlain” argument against alternative theories is first said to apply to “non-entitlement conceptions”, and later to any “end-state principle or distributional patterned principle of justice” — which amounts to an implicit characterization of an entitlement conception as a conception of justice which is neither end-state nor patterned. (shrink)

We conducted a study to review the consenting process in a vaginal Microbicide feasibility study conducted in Mazabuka, Zambia. Participants were drawn from those participating in the microbicide study. A questionnaire and focus group discussion were used to collect information on participants understanding of study aims, risks and benefits. Altogether, 200 participants took part in this study. The results of the study showed that while all participants signed or endorsed their thumbprints to the consent forms, full informed consent was not (...) attained from most of the participants since 77% of the participants had numerous questions about the study and 34% did not know who to get in touch with concerning the study. Study objectives were not fully understood by over 61% of the participants. Sixty four percent of the participants were not sure of the risks of taking part in the microbicide study. A significant number thought the study was all about determining their HIV status. Some participants were concerned that their partners were not on the trial as they were convinced that being on the study meant that that they had a lifetime protection from HIV infection. The process of obtaining consent was inadequate as various phases of the study were not fully understood. We recommend the need for researchers to reinforce the consenting process in all studies and more so when studies are conducted in low literacy populations. (shrink)

ObjectiveSome people experience post-traumatic growth, entailing positive changes such as a greater appreciation of life following traumatic events. We examined PTG in the context of the negative consequences of the COVID-19 pandemic, notably working from home and social distancing. We aimed to assess whether distinct sub-groups of individuals experiencing PTG could be identified by how they appraised and coped with the COVID-19 pandemic.MethodFor this cross-sectional study, we used convenience sampling. In total, 951 participants from the general population completed an online (...) questionnaire with items focusing on primary and secondary appraisal, positive reappraisal, rumination, and coping flexibility. For the latent profile analysis, we selected a sample of 392 individuals who had experienced moderate degrees of pandemic-related PTG, reporting at least two of the 10 positive changes in the PTG Inventory-Short Form.ResultsWe identified two distinct profiles among people experiencing PTG. The first was characterised by low levels of primary appraisal and stressfulness and higher levels of secondary appraisal, increased coping flexibility and greater use of positive reappraisal. The second was characterised by higher levels of stressfulness and primary appraisal and greater use of rumination.ConclusionThe two sub-groups evidently appraised and coped with the COVID-19 pandemic differently. Therefore, future research should account for these different profiles of people experiencing PTG. (shrink)

Background The European Union aims to optimize patient protection and efficiency of health-care research by harmonizing procedures across Member States. Nonetheless, further improvements are required to increase multicenter research efficiency. We investigated IRB procedures in a large prospective European multicenter study on traumatic brain injury, aiming to inform and stimulate initiatives to improve efficiency. Methods We reviewed relevant documents regarding IRB submission and IRB approval from European neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury. (...) Documents included detailed information on IRB procedures and the duration from IRB submission until approval. They were translated and analyzed to determine the level of harmonization of IRB procedures within Europe. Results From 18 countries, 66 centers provided the requested documents. The primary IRB review was conducted centrally or locally and primary IRB approval was obtained after one, two or three review rounds with a median duration of respectively 50 and 98 days until primary IRB approval. Additional IRB approval was required in 55% of countries and could increase duration to 535 days. Total duration from submission until required IRB approval was obtained was 114 days and appeared to be shorter after submission to local IRBs compared to central IRBs. Conclusion We found variation in IRB procedures between and within European countries. There were differences in submission and approval requirements, number of review rounds and total duration. Research collaborations could benefit from the implementation of more uniform legislation and regulation while acknowledging local cultural habits and moral values between countries. (shrink)

BackgroundBayesian estimation with informative priors permits updating previous findings with new data, thus generating cumulative knowledge. To reduce subjectivity in the process, the present study emphasizes how to systematically weigh and specify informative priors and highlights the use of different aggregation methods using an empirical example that examined whether observed mother-adolescent positive and negative interaction behavior mediate the associations between maternal and adolescent internalizing symptoms across early to mid-adolescence in a 3-year longitudinal multi-method design.MethodsThe sample consisted of 102 mother-adolescent dyads. (...) Mothers and adolescents reported on their internalizing symptoms and their interaction behaviors were observed during a conflict task. We systematically searched for previous studies and used an expert-informed weighting system to account for their relevance. Subsequently, we aggregated the priors using three methods: linear pooling, logarithmic pooling, and fitting a normal distribution to the linear pool by means of maximum likelihood estimation. We compared the impact of the three differently specified informative priors and default priors on the prior predictive distribution, shrinkage, and the posterior estimates.ResultsThe prior predictive distributions for the three informative priors were quite similar and centered around the observed data mean. The shrinkage results showed that the logarithmic pooled priors were least affected by the data. Most posterior estimates were similar across the different priors. Some previous studies contained extremely specific information, resulting in bimodal posterior distributions for the analyses with linear pooled prior distributions. The posteriors following the fitted normal priors and default priors were very similar. Overall, we found that maternal, but not adolescent, internalizing symptoms predicted subsequent mother-adolescent interaction behavior, whereas negative interaction behavior seemed to predict subsequent internalizing symptoms. Evidence regarding mediation effects remained limited.ConclusionA systematic search for previous information and an expert-built weighting system contribute to a clear specification of power priors. How information from multiple previous studies should be included in the prior depends on theoretical considerations, and may also be affected by pragmatic considerations regarding the impact of the previous results at hand. (shrink)

Previous research has demonstrated that trait self-control is related to a range of positive romantic relationship processes, suggesting that trait self-control should be positively and robustly linked to relationship satisfaction in both partners in a romantic relationship. However, the existing empirical evidence is limited and mixed, especially regarding partner effects. With three datasets of heterosexual couples, the present pre-registered studies examined: the dyadic associations between trait self-control and relationship satisfaction both cross-sectionally and longitudinally, and whether these effects hold when controlling (...) for both partners’ relationship commitment. The results indicated a cross-sectional positive actor effect, some support for a positive cross-sectional partner effect, and only little support for a longitudinal actor effect. After controlling for relationship commitment, all effects of trait self-control on satisfaction diminished except for a longitudinal actor effect among women in Study 2. Potential explanations for the current results, and implications for theory and practice, are discussed. (shrink)

PurposeThe purpose of this study is to describe the implementation and outcomes of an Eye Movement and Desensitization Reprocessing treatment-program for women with posttraumatic stress disorder after childbirth.MethodsA prospective cohort-study with pre- and post-measurements was carried out in the setting of an academic hospital in the Netherland. Included were women who gave birth to a living child at least 4 weeks ago, with a diagnosis of PTSD, or severe symptoms of PTSD combined with another psychiatric diagnosis. All received up to (...) 8 sessions of EMDR-therapy. The posttraumatic stress disorder Checklist for DSM-5 was administered before and after treatment. Trauma history was assessed before treatment with the Life Events Checklist for the DSM-5, the Childhood Trauma Questionnaire and the Childbirth Perception Scale. Descriptive statistics were used.ResultsForty-four women were referred, 26 met the inclusion criteria. After treatment, none of the women met the criteria for diagnosis of PTSD after on average 5 weekly sessions of EMDR- therapy. These outcomes are promising, as they were achieved in women with relatively high levels of psychiatric comorbidity and high rates of previous mental health treatment.ConclusionImplementing an EMDR-treatment program for women with PTSD after childbirth in the setting of an academic hospital is feasible and effective. Key factors for success include a close collaboration between the relevant hospital departments and a thorough case conceptualization addressing the etiology of the PTSD. (shrink)

Drug Safety Communications are used by the Food and Drug Administration to inform health care providers, patients, caregivers, and the general public about safety issues related to FDA-approved drugs. To assess patient knowledge of the messaging contained in DSCs related to the sleep aids zolpidem and eszopiclone, we conducted a large, cross-sectional patient survey of 1,982 commercially insured patients selected by stratified random sampling from the Optum Research Database who had filled at least two prescriptions for either zolpidem or eszopiclone (...) between July 1, 2012 and June 30, 2013. Among the 594 respondents, two-thirds reported hearing generally about drug safety information prior to starting a new drug, with the remaining one-third “rarely” or “never” hearing such information. Providers and pharmacists were primary sources of drug safety information. Two-thirds of zolpidem users and half of eszopiclone users reported having heard about the related DSC messages, ability to accurately identify the major factual messages was limited. Respondents reacted to new drug safety information about their sleep aids by reporting that they would want to learn about alternative ways to help them sleep and seek out more information about the safety of their specific sleeping pill. Opportunities may exist for the FDA to work with providers and pharmacies to help ensure the DSC information is more widely received and is more fully understood by those taking the affected medications. (shrink)

A orientação filosófica de João Mendes Júnior, por E. de Figueiredo Ferraz.--Pressupostos filosófico-jurídicos da revisão constitucional, por T. Cavalcanti Filho.--A justiça como história, por R. Cirell Czerna.--As regras de trato social em confronto com o direito, por D. de Santis Garcia.--Estado e direito, por C. Ashcar.--Doutrinas interpretativas do fenômeno jurídico, por J. Cretella Júnior.