The study of complexity in chronic care is an emergent discipline that has not yet developed a consistent theoretical framework. Thinking in the field of complexity encompasses complexity science and complexity theories, which represent a convergence of different types of ideas and theories that focus on the interactions of individual parts that make up a complex system. In this context, an important distinction is to be made between "complex" and "complicated." If a system—despite the fact that it may consist of (...) a huge number of components— can be given a complete description in terms of its individual constituents, such a system is merely complicated. An example could be computers. In a complex system, on the .. (shrink)

Rationale In Belgium, several policies regulating reimbursement of acid suppressant drugs and evidence-based recommendations for clinical practice were issued in a short period of time, creating a unique opportunity to observe their effect on prescribing. Aims and objectives To describe the evolution of prescriptions for acid suppressants and explore the interaction of policies and practice recommendations with prescribing patterns. Method Monthly claims-based data for proton pump inhibitors (PPIs) and H-2-antihistamines by general practitioners, internists and "astroenterologists were obtained from the Belgian (...) national health insurance database (1997-2005). The evolution of reimbursed defined daily doses and expenses after introduction of reimbursement regulations and dissemination of practice recommendations was explored. Results Recommendations had no impact on prescribing. All changes can be related to concomitant policies. Lifting reimbursement restrictions for cheaper products did not control growth or save costs in the Iona term. Only restricting reimbursement of all PPIs managed to curb the growth. We observed an unintended increase of non-omeprazole PPIs by gastroenterologists. Conclusions Reimbursement policies influence prescribing, but their effect can be unintended. A dialogue between policymakers and guideline developers, and evidence-based policies that are linked to clinical guidelines, could be an effective way to pursue both cost-containment and quality of care. (shrink)

Seattle, Prague, Quebec, Nice, Gothenburg, Genoa, Brussels, Barcelona, ≡ All these cities formed the setting of mass globalization protests. In most mass media reports, the presence of thousands of peaceful demonstrators has been outshone by the pictures of radical activists smashing McDonald's and Niketown. In the search for an adequate theological response to today's context of globalization, this article takes precisely this radical activism as a starting–point. In line with those postmodern iconoclasts’ own legitimation, a theological approach to this case (...) leads to the Marxist theory of fetishism and idolatry as it has already been investigated by liberation theologians two decades ago. Surprisingly, a renewed version of this critique of the theologization of economics can be found in No Logo , the trend–setting globalization critique written by the Canadian journalist Naomi Klein. A theological close reading of this best–selling book brings to the light a recurrent use of religious metaphor to characterize the corporate logo as a major aesthetic figure in the context of globalization. In order to understand the aesthetic and theological processes involved, a confrontation with the theological aesthetics of Hans Urs von Balthasar delivers a striking formal parallel between the Church's cross and today's corporate logo. Beyond an at first sight similar theo–aesthetic programme, Balthasar's theological aesthetics however opens up a position which enables us to expose the contemporary global socio–economic system as a subtly inverted Christianity. (shrink)

Through an exploration of the interpretation history of Matt. 25:33-46, this article develops an apocalyptic ethics based on Christ’s encountering us in the least of his brothers and sisters. Proposing the newly coined expression ‘ visitatio Christi’, the article offers a counterpoint to the common theological-ethical theme of imitatio Christi. First, it recalls how Jesus’ eschatological parable has time and again inspired love of the neighbour in need and challenged the scope of the required option for the poor. Next, the (...) article shows how an apocalyptic ethics based in Matthew 25, which imagines our moral life as a response to the visitatio Christi, implies a transformation of attitude/perception, a reversal of roles, and finds its source in the sacramental presence of Christ in the poor. Finally, the different aspects of the argument are recapitulated drawing upon Pope Francis’s use of Matthew 25. (shrink)

BackgroundRespect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately (...) operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics.MethodsUsing PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced.ResultsFifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations.ConclusionsThree main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations. (shrink)

BackgroundRespect for autonomy is a paramount principle in end-of-life ethics. Nevertheless, empirical studies show that decision-making, exclusively focused on the individual exercise of autonomy fails to align well with patients’ preferences at the end of life. The need for a more contextualized approach that meets real-life complexities experienced in end-of-life practices has been repeatedly advocated. In this regard, the notion of ‘relational autonomy’ may be a suitable alternative approach. Relational autonomy has even been advanced as a foundational notion of palliative (...) care, shared decision-making, and advance-care planning. However, relational autonomy in end-of-life care is far from being clearly conceptualized or practically operationalized.Main bodyHere, we develop a relational account of autonomy in end-of-life care, one based on a dialogue between lived reality and conceptual thinking. We first show that the complexities of autonomy as experienced by patients and caregivers in end-of-life practices are inadequately acknowledged. Second, we critically reflect on how engaging a notion of relational autonomy can be an adequate answer to addressing these complexities. Our proposal brings into dialogue different ethical perspectives and incorporates multidimensional, socially embedded, scalar, and temporal aspects of relational theories of autonomy. We start our reflection with a case in end-of-life care, which we use as an illustration throughout our analysis.ConclusionThis article develops a relational account of autonomy, which responds to major shortcomings uncovered in the mainstream interpretation of this principle and which can be applied to end-of-life care practices. (shrink)

This short article provides an introduction to a special section, consisting of six papers on human evolution and the imago Dei. These papers are the result of dialogue between theologians and philosophers of religion at the University of Oxford and the Catholic University of Leuven. All contributors focus on the imago Dei, and consider how this theological notion can be understood from an evolutionary perspective, looking at a variety of disciplines, including the psychology of reasoning, cognitive science of religion, paleoanthropology, (...) evolutionary psychology, and evolutionary ethics. (shrink)

Love lies at the very heart of the Christian faith and its conception of both God and the human being. Nevertheless, the growing field of theological anthropology has yet to fully avail itself of philosophy’s and theology’s renewed attention to the theme of love. The Introduction to this special issue proposes the phrase ‘in the image of Love’ as an invitation to examine the relation between theological anthropology and love throughout the history of Christian thought. Guided by this motif, the (...) issue’s contributors consider ten historical thinkers on love and the human in relation to their philosophical conversation partners at the time. The volume thus has a genealogical dimension, delving into often forgotten layers beneath our current, late modern view of the human/love. It thereby assists future theological anthropological discussions in the much-needed task of both integrating the crucial theme of love and formulating more historically grounded perspectives. This special issue also reveals the ways in which theologians have attempted to respond to the challenge posed by the modern subject while retaining the idea that the human creature is called by Love and called to Love, and provides an alternative to Nygren’s opposition of agape and eros. (shrink)

Evaluative conditioning refers to the changes in liking of an evaluatively neutral stimulus (the conditional stimulus or CS) as a result of merely pairing it with another, already liked or disliked stimulus (the unconditional stimulus or US). We examined whether other, non‐evaluative stimulus properties of a US can also be associatively transferred to a CS. In a series of experiments, we tried to transfer perceptions of the gender of children and the gender of first names. We found evidence for the (...) associative transfer of these properties but only when participants were aware of the contingencies. (shrink)

In this volume we present the proceedings from the fourth international Leuven Encounters in Systematic Theology (LEST IV, November 5-8, 2003), which focussed ...

This paper describes the common techniques used in the constitution of candidates-lists for parliamentary elections. A common feature of these techniques is the consultation of party members. But the way in which this is done differs among the parties. AGALEV, the ecologist party, offers every member the possibility to have his say about every candidate. The socialist party uses this system in two constituencies ; in the other constituencies a special congress decides. The christiandemocrats, the liberals and the Flemish nationalists (...) constitute their lists by indirect vote : the leadership performs a first selection and the members then either approve or disapprove of this choice.Our research indicates that there are no essential differences between these two techniques from the point of view of membership participation.In both the ecologist and the socialist party the majority of members does not participate in the candidates-elections. Therefore, as with the indirect vote, candidates-lists are constituted by an active, militant and elitist group of members. Whatever the technique used the infl,uence of the rank-and-file-member is small. (shrink)

Pig farmers and scientists appear to have different perspectives and underlying framing on animal welfare issues as tail biting and natural behaviour of pigs. Literature proposes a joint learning process in which a shared vision is developed. Using two different settings, a symposium and one-to-one dialogues, we aimed to investigate what elements affected joint learning between scientists and pig farmers. Although both groups agreed that more interaction was important, the process of joint learning appeared to be rather potentially dangerous for (...) the farmer–scientist relationship. During the symposium, farmers were only moderately open for scientific knowledge and the issue of tail biting had the tendency to run into a deadlock. The setting was an influencing element for the degree of success, because the dialogues did lead to improved mutual trust and understanding of each other’s framing and context. Another element was the degree of usability and absoluteness of scientific facts. They were frequently not concrete enough, too uncertain or not relating to the context of the farmers. In addition, some scientific facts were not recognized by the farmers. Both groups appeared to react and argue from their praxis, including their local environment, way of living, handling and understanding their environment. These praxises appeared to function as a filter, influencing the way of observing the environment, inducing ‘blind spots’ and misunderstandings. Stepping in each other’s praxis might provide concrete and fusing insights, required to realize joint learning processes. (shrink)

With reference to the unsuccessful attempt of the Labour Government to make sex education a statutory part of the National Curriculum, this paper argues in favour of making liberal sex education compulsory at all state schools. First, the main characteristics of a liberal sex education are briefly explained. Promoting the virtue of respect for every adults right of sexual self-determination is presented as one of its central aims. Then the paper shows that state enforcement of liberal sex education is justifiable (...) to reasonable citizens in several ways and therefore meets the liberal criterion of political legitimacy. Finally, the relevant clauses of the Bill of the Labour Government are briefly evaluated. (shrink)

Trade unions have been the object of sustained critique coming from across the political spectrum for several decades now. Based on a discourse theoretical analysis of articles in three Dutch-speaking Belgian newspapers, published in two periods of social protest in 2014 and 2016, this article identifies six strands of critique: (1) critiques that label unions as conservative anachronisms that are out of sync with the realities of our times; (2) critiques that psychologize unions as egoistic, irresponsible and child-like actors; (3) (...) critiques that criminalize unions as vandals, hostage takers or terrorists; (4) critiques that oppose unions to a homogenized general interest; (5) metadiscursive critiques of unions’ discursive practices; and (6) metapolitical critiques that problematize unions as polarizing and ‘political’ actors. These six strands of critique get articulated through discursive logics that operate within and across texts, newspapers and voices. Together they constitute a heterogenous but relatively consonant polyphonic discourse that challenges trade unions and their right to strike. This discourse has metapolitical implications for the debate on the mode(s) of politics that can legitimately be practiced by civil society actors. (shrink)

This volume includes the critical edition of five apologias (1522-1529) in which Erasmus defended his New Testament translation and commentary (1516)against Diego López de Zúñiga and Sancho Carranza. The edition is partly based on manuscript sources never used before.

ABSTRACT The number of people suffering from dementia will rise considerably in the years to come. This will have important implications for society. People suffering from dementia have to rely on relatives and professional caregivers when their disorder progresses. Some people want to determine for themselves their moment of death, if they should become demented. They think that the decline in personality caused by severe dementia is shocking and unacceptable. In this context, some people consider euthanasia as a way to (...) avoid total deterioration. In this article, we discuss some practical and ethical dilemmas regarding euthanasia in persons with severe dementia based on an advance euthanasia directive. We are using a personalist approach in dealing with these ethical dilemmas. (shrink)

While self?evaluation leads to valuable results in some schools, it appears that in other schools this is true only to a lesser extent or not at all. This raises the question of how differences in the results of self?evaluations can be explained. This study looks at to what extent the results of self?evaluation are determined by the way in which self?evaluation is conducted, by characteristics relating to the general functioning of the school and by the support which schools enjoy. One (...) thousand seven hundred and eighty?six school principals and team members from 96 schools (primary and secondary) were surveyed by means of a written questionnaire. The data collected were then analysed using multi?level structural equation modelling. The results provide strong empirical evidence that ?attitude with regard to self?evaluation?, ?self?evaluation as a policy action? and ?self?evaluation as an act of research? are powerful predictors of the quality of self?evaluations. (shrink)

The present book is the result of the conference 'Renovatio, inventio, absentia imperii. From the Roman Empire to Contemporary Imperialism', held in Brussels at the occasion of the 75th anniversary of the Academia Belgica in Rome (September 11-13, 2014). At the heart of the conference was the 'reception', 'Nachleben' or 'permanence' of the Roman Empire, of an idea and a historical paradigm which since classical Antiquity has supported the most widespread claims to obtain and consolidate power. The volume's focus is (...) on culture in a broad sense, i.e. including besides the arts, philosophy, religion and, most importantly, discourse. As such, a wide array of themes are subjected to academic scrutiny. Whereas the main focus is on Europe and North America, some contributors also reach out towards non-Western contexts, whether or not directly related to the Roman example. A theoretical and sociological dimension is also added thanks to the discussion on methodological issues. More specifically, the following question(s) receive particular attention: what is our position as researchers, embedded in a contemporary, often Western, democratic and capitalist context; what about the notion of empire itself, its constituent elements and the kind of ideological prerogatives to which it is generally subjected; in other words, apart from the many historical variants and instances of reception of empire, through which filters can, and inevitably do, we approach this topic? A question that has become ever more pregnant since the beginning of the twenty-first century, after the dissolution of the Soviet Union, the events of September 11, which have revivified what could be called American 'imperialism', and at a time when an essentially economic variant, driven by 'emerging' powers such as China, has increasingly contested existing power structures."--Page [4] of cover. (shrink)

Many public information documents attempt to persuade the recipients that they should engage in or refrain from specific behaviour. This is based on the assumption that the recipient will decide about his or her behaviour on the basis of the information given and a rational evaluation of the pros and cons. An analysis of 20 public information brochures shows that the argumentation in persuasive brochures is often not marked as such. Argumentation is presented as factual information, and in many instances (...) the task of making argumentational links and drawing conclusions is left to the reader. However, since the information offered does follow familiar argumentational schemes, readers can, in principle, reconstruct the argument. All the brochures make use of pragmatic argumentation (argumentation from consequences),i. e.,they formulate at least certain benefits of the desirable behaviour or disadvantages of the undesirable behaviour. In addition, they make regular use of argumentation from cause to effect and argumentation from example. Argumentation from rules and argumentation from authority are less frequently used. This empirical analysis of the use of argumentation schemes is a solid base for interesting and rich hypotheses about the cognitive processing of persuasive brochures. Central processing requires the reader to be able to reconstruct argumentation from informational texts and to identify and evaluate various types of argumentation. (shrink)

This volume includes the critical edition of five apologias in which Erasmus defended his New Testament translation and commentary against Diego López de Zúñiga and Sancho Carranza. The edition is partly based on manuscript sources never used before.

BackgroundA patient who fulfils the due diligence requirements for euthanasia, and is medically suitable, is able to donate his organs after euthanasia in Belgium, the Netherlands and Canada. Since 2012, more than 70 patients have undergone this combined procedure in the Netherlands. Even though all patients who undergo euthanasia are suffering hopelessly and unbearably, some of these patients are nevertheless willing to help others in need of an organ. Organ donation after euthanasia is a so-called donation after circulatory death (DCD), (...) Maastricht category III procedure, which takes place following cardiac arrest, comparable to donation after withdrawal of life sustaining therapy in critically ill patients. To minimize the period of organ ischemia, the patient is transported to the operating room immediately after the legally mandated no-touch period of 5 min following circulatory arrest. This means that the organ donation procedure following euthanasia must take place in the hospital, which appears to be insurmountable to many patients who are willing to donate, since they already spent a lot of time in the hospital. Case presentationThis article describes the procedure of organ donation after euthanasia starting at home (ODAEH) following anesthesia in a former health care professional suffering from multiple system atrophy. This case is unique for at least two reasons. He spent his last conscious hours surrounded by his family at home, after which he underwent general anaesthesia and was intubated, before being transported to the hospital for euthanasia and organ donation. In addition, the patient explicitly requested the euthanasia to be performed in the preparation room, next to the operating room, in order to limit the period of organ ischemia due to transport time from the intensive care unit to the operating room. The medical, legal and ethical considerations related to this illustrative case are subsequently discussed.ConclusionsOrgan donation after euthanasia is a pure act of altruism. This combined procedure can also be performed after the patient has been anesthetized at home and during transportation to the hospital. (shrink)

This paper presents a single case-study of a longitudinal shared reading programme that took place in Dutch kindergartens with first language speakers of 4 to 6 years old. As will be shown, children participate both in a traditional instructional structure and in a participation framework characterised by a more or less free discussion. These structures establish an optimal learning environment both together and in relationship to each other. Our case study demonstrates how the teacher and the pupils participate in these (...) successive frameworks and how this supports the construction of conceptual knowledge. It will be shown that participation during shared reading of picture books at kindergarten is directly linked to interactional learning opportunities. (shrink)

This volume includes the critical edition of five apologias in which Erasmus defended his New Testament translation and commentary against Diego López de Zúñiga and Sancho Carranza. The edition is partly based on manuscript sources never used before.

This second volume of the Amsterdam edition of the apologias contains the critical edition of the Latin text of one of the apologias against the Spanish theologian Jacobus Lopis Stunica.

Evaluative conditioning (EC) is one of the terms that is used to refer to associatively induced changes in liking. Many controversies have arisen in the literature on EC. Do associatively induced changes in liking actually exist? Does EC depend on awareness of the fact that stimuli are associated? Is EC resistant to extinction? Does attention help or hinder EC? As an introduction to this special issue, we will discuss the extent to which the papers that are published in this issue (...) help to resolve some of the controversies that surround EC. We also speculate about possible boundary conditions of EC and attempt to reconcile conflicting results on the functional properties of EC. (shrink)

Logical frameworks for analysing the dynamics of information processing abound [4, 5, 8, 10, 12, 14, 20, 22]. Some of these frameworks focus on the dynamics of the interpretation process, some on the dynamics of the process of drawing inferences, and some do both of these. Formalisms galore, so it is felt that some conceptual streamlining would pay off.This paper is part of a larger scale enterprise to pursue the obvious parallel between information processing and imperative programming. We demonstrate that (...) logical tools from theoretical computer science are relevant for the logic of information flow. More specifically, we show that the perspective of Hoare logic [13, 18] can fruitfully be applied to the conceptual simplification of information flow logics. (shrink)

This short article provides an introduction to a special section, consisting of six papers on human evolution and the imago Dei. These papers are the result of dialogue between theologians and philosophers of religion at the University of Oxford and the Catholic University of Leuven. All contributors focus on the imago Dei, and consider how this theological notion can be understood from an evolutionary perspective, looking at a variety of disciplines, including the psychology of reasoning, cognitive science of religion, paleoanthropology, (...) evolutionary psychology, and evolutionary ethics. (shrink)

Influential theories on affect and emotion propose a fundamental differentiation between emotion and cognition, and research paradigms designed to test them focus on differences rather than similarities between affective and cognitive processes. This research orientation is increasingly challenged by the widespread and successful use of cognitive research paradigms in the study of affect and emotion—a challenge with far-reaching implications. Where and on what basis should theorists draw the line between cognition and emotion, and when is it useful to do so? (...) Should researchers build more global, integrative models of cognition and emotion, or should they rely on local, content-specific models that draw attention to a differentiation between affective and cognitive processes? This special issue compiles different viewpoints on fundamental issues in the relationship between affect and cognition. (shrink)