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

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

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

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

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

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

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

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

A quick mental survey of one's friends or acquaintances reveals an important difference between them. On the one hand, there are seemingly stoic people for whom emotional events (e.g., having a pap...

It is always possible to construct a real function f, given random quantities X and Y with continuous distribution functions F and G, respectively, in such a way that f(X) and f(Y), also random quantities, have both the same distribution function, say H. This result of De Finetti introduces an alternative way to somehow describe the `opinion' of a group of experts about a continuous random quantity by the construction of Fields of coincidence of opinions (FCO). A Field of coincidence (...) of opinions is a finite union of intervals where the opinions of the experts coincide with respect to that quantity of interest. We speculate on (dis)advantages of Fields of Opinion compared to usual `probability' measures of a group and on their relation with a continuous version of the well-known Allais' paradox. (shrink)

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

A particle of molecular dimensions which can exist in two states is associated with a membrane pore through which molecules of a gas can pass. The gas molecules from two identical phases on either side of the membrane may pass only when the particle is in one particular state. If certain restrictions are imposed on the system, then the particle appears to act like a Maxwell's Demon(1) which “handles” the gas molecules during their passage through the pore.

The discussion among philosophers and experimental scientists on the pages of Problems of Philosophy [Voprosy filosofii] about the substance of and relations between the fundamental and applied sciences [1] persuades me that this remains a topical issue despite the very deep crisis that followed the breakup of the USSR in all spheres of society, including science, throughout the post-Soviet region. Most likely, it is precisely the crisis phenomena in society that impel its thinking part to answer the questions: What has (...) happened to us? Where are we now? Where do we go from here and by which paths? What is the role of science in changing the situation? And inasmuch as science and philosophy are the supreme creations of the human mind, called upon to reflect by specific means what is taking place in society, these questions have been at the center of philosophers' and scientists' attention. (shrink)

The new thinking is making itself known in the posing and resolution of problems of man as an extremely important philosophical problem. The old philosophical question of the relationship between freedom and necessity in their dialectical interconnection once again occupies center stage.

An attempt to reveal the linguistic and cultural potential of education in the process of learning Russian as a means of communication, of cognition of the linguistic picture of the world and the phenomenon of culture is made in the article. The stages of development of linguocultural concept of teaching Russian language in the Republic of Bashkortostan are presented. New approaches to teaching Russian language are considered. The author shows that in the process of education, elementary literacy of students should (...) be achieved while they are dealing with communicative and socially important tasks contributing to the development and formation of students as linguistic personalities. The author concludes that the actual task of the modern school, which is a successful preparation for the unified state examination, should also be achieved not by increased training before the exam, but provided by the total system of education aimed at the formation of personality with a wide range of language capabilities: a cultural person, well-speaking, correct writing, able to understand and interpret the text, to express their thoughts and feelings in their own texts. Such training involves the ascent of a language personality from basic literacy to formed linguistic, communicative and cultural competences. Theoretical basis and methodological support of the concept are presented in the list of publications. (shrink)

The ethical pre-condition of randomised controlled trials is, at present, the presence of equipoise. This refers to an opinion of the investigator that there is uncertainty as to the merits of the treatments being compared. It is argued that since the decision to enrol is the potential subject’s, the investigator’s opinion is not ethically relevant. It is proposed instead that equipoise be patient-centred, and that a trial is in equipoise for a patient when enrolling gives them the same chance of (...) a good outcome as not enrolling. It is shown that trial enrolment is normally easily the best strategy for achieving a good outcome, and that trials currently thought to be unethical may be in patient-centred equipoise. This is so for three reasons: (1) patients in trials receive superior care, (2) trial enrolment minimises the risk of being a victim of a therapeutic disaster and (3) health professionals make mistakes, and a 50% chance of receiving the worse treatment until a trial reports is always better than any chance of receiving the worse treatment indefinitely. It is concluded that so long as the standard of professional conduct is the furtherance of patients’ objective interests randomised controlled trials are ethical. (shrink)

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

An interdisciplinary course was designed as an introduction to the applications of, and the socio-economic issues associated with, biotechnology. College students enrolled in the course were surveyed prior to the first formal lecture, and again upon completion of the course. Assessment was made of the impact of the educational materials on the attitudes and perceptions of the students toward the applications of biotechnology to agriculture. Data were collected for the first three semesters in which the course was offered. Answers to (...) survey questions were analyzed on a before and after basis. It was found that students were very accepting of biotechnology prior to taking the course, despite a generally low level of exposure to this type of technology. The course was effective in increasing the knowledge base of the students, but not as effective in allaying their perceptions of risks associated with biotechnology. (shrink)