Numerous studies have revealed that health care transitions for chronically ill older adults are frequently poorly managed, often with devastating human and economic consequences. And poorly managed transitions and their consequences also occur among younger, relatively healthy individuals who have adequate resources and are prepared to advocate on their own behalf. Despite the rich base of research confirming that evidence‐based transitional care enhances patients’ experiences, improves health and quality of life, and reduces costs, organizational, regulatory, financial, and (...) cultural barriers have, until recently, prevented widespread adoption of these proven approaches. Provisions of the Affordable Care Act, such as reductions in Medicare payments to hospitals with very high thirty‐day rehospitalization rates, have reduced barriers, but uptake of evidence‐based transitional care beyond demonstration projects continues to be sporadic and far too slow. With a rich understanding about how to better anticipate and respond to the compelling problems experienced by patients, family caregivers, and health care professionals throughout episodes of acute illness, the time has come to frame transitional care as a system's ethical responsibility in an aging society. Embedding transitional care within the ethical obligations of a health care system requires the perspectives and involvement of nurses and nursing because of this profession's integral role in every aspect of care transitions. (shrink)

Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services. Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective (...) of this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area. (shrink)

Background:Moving into the last phase of life comprises a developmental transition with specific needs and risks. Facilitating transitions is an important component of the work of nurses. When curative interventions are no longer helpful, nurses enact key roles in caring for patients and families.Aim:The aim of this study was to examine the experiences of registered nurses in acute care settings as they worked with patients and families to facilitate transition to comfort-focused care.Research design:Sampling, data collection, and data analysis (...) were guided by constructivist grounded theory, chosen because of its strength in identifying and explicating social processes.Participants and context:A purposeful sample of 26 registered nurses working in acute care hospitals in one community in the northeastern United States participated in this study through semi-structured interviews.Ethical considerations:The study received approval from the university’s Institutional Review Board for the Protection of Human Subjects. Participants provided informed consent.Findings:Nurses facilitated transition to comfort-focused care by enacting their moral commitments to patients and families. They focused on building relationships, honoring patient self-determination, and maintaining respect for personhood. In this context, they discerned a need for transition, opened a discussion, and used diverse strategies to facilitate achieving consensus on the part of patients, family members, and care providers. Regardless of how the process unfolded, nurses offered support throughout.Discussion:Achievement of consensus by all stakeholders is critical in the transition to comfort-focused care. This study deepens our understanding of how nurses as moral agents utilize specific strategies to assist progress toward consensus. It also offers an example of recognizing the moral agency of nurses through listening to their voices.Conclusion:Increased understanding of effective nursing strategies for facilitating transition to comfort-focused care is essential for developing needed evidence for excellent care and strengthening end-of-life nursing education. (shrink)

Whether practiced by ethics committees or clinical ethicists, medical ethics enjoys a solid foundation in acute care hospitals. However, medical ethics fails to have a strong presence in the primary care setting. Recently, some ethicists have argued that the reason for this disparity between ethics in the acute and primary care setting is that primary care ethics is distinct from acute care ethics: the failure to translate ethics to the primary care setting stems from (...) the incorrect belief that acute care ethics can be applied to the primary care setting. In this paper, I argue that primary care ethics and acute care ethics are species of the same ethical genus, and that the ethical differences are not ones of kind but of circumstance. I do this by appealing to the role obligations that underlie acute care and primary care clinicians’ medical ethical obligations and the shared institutions that ground those obligations. (shrink)

In this article I discuss 'the transition' of Lithuanian health care. In order to illustrate the size of the difficulties the people of Lithuania presently face, I focus in particular on the problem of resource allocation. I believe my observations (both general and particular) reflect the experiences of other post-socialist countries, especially those nations which were directly incorporated within the former USSR. Certainly, the two other Baltic states -- Latvia and Estonia -- have a great deal in common with (...) Lithuania, both politically and culturally. I have identified four questions to act as a framework for my discussion: -/- • What were the main causes of the Soviet health care crisis? -/- • What was the basis for resource allocation in the former socialist health care system? -/- • What are the major obstacles set against the implementation of alternative principles of resource allocation in Lithuania? -/- • What ideas might underlie and inform the design of a new Lithuanian health care system? (shrink)

This paper represents one of the first critical social science interrogations of an agrifood just-in-case transition. The just-in-case transition speaks to a philosophy that values building buffers and flexibility into longer value chains to make them more resilient to shocks, which stands in contrast to the just-in-time philosophy with its emphasis on long, specialized, and often inflexible networks. Influenced by COVID-related disruptions and climate change induced uncertainties, the just-in-case transition examined here centers on the heightened interest in vertical farm-anchored supply (...) chains. Interviewing actors responsible for promoting vertical farm-anchored local supply chains in the US and Canada, I attempt to sketch out how these spaces, infrastructures, and practices care. Put differently, as understood through a feminist ethics of care, _whom_ and _what_ are cared for and _how_ is care practiced in these just-in-case transitions and _why_? Enumerative politics was observed in the data—the idea that we can make care count. Practices and discourses linked to infrastructural/supply chain transitions are highlighted that result in care being narrowly conceived as a technical or transactional matter. The paper concludes reflecting on what it means to afford just-in-case agrifood transitions animated by matters of care that hold greater emancipatory potentials. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Managing the Transition from Patient-Centered Care to ProtocolDavid SlakterI learned that I would need a kidney transplant in the summer of 2015. This was not a complete surprise to me, as I had been subjected to a number of tests and invasive procedures to investigate nephritis since I was a child. I had heard similar stories of clinicians performing repeated tests on my father for similar reasons without (...) any conclusions. Following my recommendation for transplant and consultation with genomics specialists, the cause of my kidney failure was determined to be Alport syndrome. What made Alport syndrome so difficult to diagnose in my case was that the associated mutation is a rare, autosomal-dominant one that has only recently been associated with the condition.After reviewing the data on survival rates for transitioning to dialysis versus a transplant, my family and I then considered the success rates for living versus cadaver donors, and the success rates at various transplant centers. The current data favor the long-term outcomes of transplant over dialysis and living over cadaver donors. Since we had decided to focus on searching for a live donor, my nephrologist recommended contacting Renewal, an organization that specializes in connecting those in need of a kidney transplant with live donors and providing support for donors to make the donation process less burdensome.On Renewal’s recommendation, my family and friends reached out across their social networks to search for potential donors. Many of those tested for compatibility were eliminated on basic matching criteria, others due to previously undiagnosed medical problems. Finally, the wife of a childhood friend came forward as an eligible donor and was also an incredibly close match on the antigens tested for kidney transplants.Having a living donor who was also a friend made the transplant experience somewhat less intimidating than it might have been. It meant the transformation of an existing relationship with someone already close to me, with fewer open questions about what may have motivated them to be so generous than if the donor had been someone I did not know. It also meant our families could be together in the waiting room, and that we shared in each other’s recoveries.Life post-transplant has been a significant improvement from what it was like immediately beforehand. Before my transplant, I regularly weighed food and consulted nutrition charts to gauge how much potassium I was consuming. To prevent too much potassium from building up in my bloodstream, I had to take sodium polystyrene [End Page 111] regularly. As one might guess from the name, it tastes much like burnt Styrofoam, and I could only ingest it with copious amounts of fruit-flavored syrup (strawberry covered up the awful flavor the best). There are other potassium binders on the market now, so fewer people with kidney failure will likely need to engage in such gustatory experimentation.I was also able to engage in more activities than what was possible even years before my transplant. I had long experienced difficulty with aerobic exercises, but assumed the reason was merely being out of shape. Though I have always walked regularly, even the one-mile walk from my office to my apartment had become a chore by the end. Within a few months after my transplant, I was riding a bicycle all over NYC, from Harlem to Brooklyn and back regularly, and hiking trails in nearby state parks. I began sessions with a personal trainer and attained a level of fitness I had not reached since I played soccer as a child.The transition from personalized care to one more driven by protocol has been a surprising and challenging aspect of the transplant process. While my previous experience with medical treatment has been individual meetings with physicians, my post-transplant care is managed by a team of nephrologists and other specialists in transplant care. My initial transplant nephrologist was automatically assigned to me. Because the standard of care for transplant patients is often driven by protocol, my assigned nephrologist recommended a biopsy on my transplanted kidney due to results in my recent lab tests. When pressed on the necessity of a biopsy in my case versus... (shrink)

This article addresses two components of the new governing architecture that help to reform the delivery of health care and to control costs of the health care system: the Center for Medicare and Medicaid Innovation and the Independent Payment Advisory Board. The republican controlled federal government has partially disassembled these two components, threatening the effectiveness of federal delivery system reform and cost control initiatives.

The authors of the two main articles in this supplement recognize the enormous potential of learning health care systems. Their first article argues that the development of these systems calls into question existing guidelines and practices that treat clinical care and clinical research as distinct activities. Their second article proposes to replace this traditional approach with a new framework, one intended to promote two important goals: support the transformation to a learning health care system and help to (...) ensure the ethical appropriateness of the activities carried out within such a system. To promote these goals, the authors propose a framework consisting of seven obligations. The authors are aware that their framework does not provide much guidance for promoting their second goal. At first glance, the seven obligations also might appear to offer little in the way of promoting the first goal. In what way, then, is the proposed framework novel and transformative, as the authors claim? The answer appears to lie largely in how the authors interpret the sixth obligation in the framework—the obligation to conduct learning activities. (shrink)

This article focuses on rationing of expensive medical care in the Czech Republic. It distinguishes between political and clinical decision levels and reviews the debate in the Western literature on explicit and implicit rules. The contemporary situation of the Czech health care system is considered from this perspective. Rationing reoccurred in the mid 90s after the shift in health care financing from fee-for-service to prospective budgets. The lack of explicit rules is obvious. Implicit forms of rationing, done (...) by physicians at the clinical level prevail, implying uncontrolled power of the medical profession and lacking transparency for ethical considerations of equity to access. It seems to be acceptable for physicians to play the role of allocators, probably because of their experience with rationing during the socialist period. Traditional rationing stereotypes from the previous regime seem to persist despite the health care system transformation during the 90s. (shrink)

Background: To place a dependent with severe dementia in a nursing home is a painful and difficult decision to make. In collectivistic oriented societies or families, children tend to be socialised to care for ageing parents and to experience guilt and shame if they violate this principle. Leaving the care to professional caregivers does not conform with the cultural expectations of many ethnic groups and becomes a sign of the family’s moral failure. Research design: Qualitative design with individual (...) in-depth interviews with nurses, family members and dementia care coordinators in Norway, Montenegro, Serbia and South Africa. Braun and Clarke’s six analytic phases were used. Ethical considerations: The project was approved by the Regional Committee for Research, South-Eastern Norway; the Norwegian Centre for Research Data; the Ethics Committee; University of Limpopo, MEDUNSA Campus, South Africa; and by the local heads of the respective nursing homes or home care services. Interviewees were informed orally and in writing and signed an informed consent form. Findings: Healthcare professionals tend to be contacted only when the situation becomes unmanageable. Interviewees talked about feelings of obligation, shame and stigma in their societies regarding dementia, particularly in connection with institutionalisation of family members. Many lacked support during the decision-making process and were in a squeeze between their own needs and the patients’ need of professional care, and the feeling of duty and worry about being stigmatised by their surroundings. This conflict may be a source of pre-decision regret. Conclusion: Family caregivers need help to understand the behaviours of persons with dementia and how to access the formal and informal services available. Thus, they may provide effective support to patients and family carers alike. Supportive interventions for caregivers need to be tailored to meet the individual needs of both the caregiver and the persons with dementia. (shrink)

Despite recent efforts to improve on counterfactual theories of causation, failures to explain how effects depend on their causes are still manifest in a variety of cases. In particular, theories that do a decent job explaining cases of causal preemption have problems accounting for cases of causal intransitivity. Moreover, the increasing complexity of the counterfactual accounts makes it difficult to see why the concept of causation would be such a central part of our cognition. In this paper, I propose an (...) account of our causal thinking that not only explains the hitherto puzzling variety of causal judgments, but also makes it intelligible why we would employ such an elusive concept. (shrink)

Nearly a million Indian women lack access to safe and dignified abortion services from public healthcare facilities and instead opt to induce abortions by themselves or with the help from unskilled and unauthorized practitioners. Unsafe abortions account for an estimated 9% of all maternal deaths in India despite the legalization of abortion on all grounds since 1971 via the MTP Act. However, the Act technically does not make any provision for abortion based on a woman’s request alone, subjecting her decision (...) to the approval of her healthcare provider, limiting reproductive autonomy. Moreover, the problem of female feticide through sex‐selective abortions has also contributed to a conflicting public agenda that prioritizes preventing the former over allowing women access to abortion services for other reasons. Women who are socio‐economically, culturally, and educationally vulnerable and minors may experience further abortion related stigmatization. These ethico‐legal considerations highlight the need for transition from a provider‐centered to a woman‐centered abortion service model. (shrink)

This qualitative study examined hospital nurses’ methods in handling meal and nutrition care during inpatient time, with an underlying focus on undernourished older adult. Observations and interviews were used to document nurses’ methods through the span of a transition (defined by an entry, passage, and exit). The study finds inconsistencies in care methods due to institutional processes restricting both mealtime care and nutritional logging of information throughout hospitalization. It is concluded that the consequences of these inconsistencies must (...) be recognized and that new approaches to meals and nutritional care should be introduced in order to provide greater flexibility. Based on the assumption that mobilizing patient resources is pivotal for meal and nutritional care, it is argued that it may be important to mobilize patient resources during mealtime and in nutritional logging of information in order to increase the visibility of meal and nutritional care in patient transitions within the institution and across settings. Both nurses’ methods and institutions developmental initiatives regarding meal and nutritional care need to accommodate the differences between what in this paper is defined as social‐bodily care and text‐based care. This could be met through care methods that take place with, more than for the patient. (shrink)

The healthcare system—the assemblage of hospitals, insurers, professional associations, policymakers, patients, caregivers, and other entities oriented toward health in the United States—does more than cure illness. It is, and in some cases ought to be but falls short, attentive to endpoints other than cure, such as comfort, participation in desired activities, and the creation of families—things that may broadly be understood as promoting well-being. In the United States, health care utilization is prohibitively expensive. As a result, most people can (...) only access care through insurance. While the care available within the broad U.S. healthcare system may be oriented toward a wide variety of endpoints, insurance... (shrink)

Background:In Ontario, Canada, patients who lack decision-making capacity and have no family or friends to act as substitute decision-makers currently rely on the Office of the Public Guardian and Trustee to consent to long-term care (nursing home) placement, but they have no legal representative for other placement decisions.Objectives:We highlight the current gap in legislation for difficult transition cases involving unrepresented patients and provide a novel framework for who ought to assist with making these decisions and how these decisions ought (...) to be made.Research design:This paper considers models advanced by Volpe and Steinman with regard to who ought to make placement decisions for unrepresented patients, as well as current ethical models for analyzing how these decisions should be made.Participants and research context:We describe an anonymized healthcare transition case to illustrate the fact that there is no legally recognized decision-maker for placement destinations other than long-term care facilities and to show how this impacts all stakeholders.Ethical considerations:The case provided is an anonymized vignette representing a typical transition case involving an unrepresented patient.Findings:As a result of a gap in provincial legislation, healthcare providers usually determine the appropriate placement destination without a clear framework to guide the process and this can cause significant moral distress.Discussion:We argue for a team decision-making approach in the short term, and a legislative change in the long-term, to respect the patient voice, evaluate benefit and risk, enhance collaboration between healthcare providers and patients, and promote social justice. We believe that our approach, which draws upon the strengths of interprofessional teams, will be of interest to all who are concerned with the welfare and ethical treatment of the patients for whom they care.Conclusions:One of the main strengths of our recommendation is that it provides all members of the healthcare team (including nurses, social workers, therapists, and others) an increased opportunity to advocate on behalf of unrepresented patients. (shrink)

Although telepsychiatry consultations have been tried and tested for several years, at least in relatively limited numbers and settings, the current COVID-19 pandemic has caused an exponential increase in their application. Even as lockdown restrictions were lifted and a return to face-to-face consultations was possible, many practitioners and patients decided to uphold teleconsultations for some or a large part of their interactions. This was mostly driven by the exceptional circumstances of the pandemic, as ongoing safety concerns, the need for PPE (...) use and uncertainty around whether face-to-face meetings could go ahead continued to form barriers to usual care practices. Frittgen and Haltaufderheide aptly hypothesise that extensive changes in online communication behaviour will also impact ethical aspects of the therapeutic relationship.1 After considering how the use of technology may affect the therapeutic relationship in video-based consultations, they provide an ethical analysis of this impact along four dimensions: respect for autonomy, lucidity, fidelity and humanity.1 In this commentary I will have a look at the difference between crisis standards of care and usual care, the need to consider specific patient needs in teleconsultation use, the importance of justice understood as equity and access to technology, and a major challenge ahead. Throughout history, crisis situations have often been major catalysts of technological and other progress. Under challenging …. (shrink)

This paper presents the Norwegian national health care system and the manner in which the problems of rationing and pluralism of values create new ethical and political challenges. The paper concludes with some doubts about the feasibility of the transformation taking place within this kind of health care system, with special reference to governmental control and consumer preference. Keywords: national health care, pluralism, rationing, two-tier system CiteULike Connotea Del.icio.us What's this?

At the heart of China's remarkable economic growth is a new economic system, which has emerged out of radical reforms in virtually all areas of economic activity. Understanding this system is the key to understanding the Chinese economy. This book, the culmination of many years of research in Hong Kong and China, is a comprehensive account of these systemic reforms, as well as of their transferability to other economies in transition. The starting-point of Dr Chai's analysis is a careful examination (...) of the structural elements of China's new economic system, focusing particularly on the decentralization of property rights in both the agricultural and industrial sectors. There follows a detailed analysis of changes in the functional elements of the system: its price and financial mechanisms. An assessment of the open-door policy also considers the twin impact of the liberalization of China's foreign trade and foreign investment regimes. Finally, China: Transition to a Market Economy highlights the increasingly important role of the non-state sector in facilitating economic growth and structural transformation. It will be essential reading for any student or researcher concerned with the Chinese economy, or with transition economies in general. (shrink)

Background: The transition to child care is a challenging time in a child’s life and leads to elevated levels of cortisol. These elevations may be influenced by the quality of the mother-child-relationship. However, remarkably little is known about cortisol production in response to the beginning of child care among children-at-risk such as children with an immigrant background. However, attending kindergarten or any other child day-care institution can for example have a compensating effect on potential language deficits thus (...) improving the educational opportunities of these children. Method: Data of a subsample of N = 24 “hard-to-reach” mother-child dyads was collected in the context of the psychoanalytic early prevention project “First Steps”. The project focuses on the earliest integration of children with an immigrant background by supporting parenting capacities in the critical phase of migration and early parenthood. Children’s hair cortisol concentration (HCC) was assessed one week before (mean age = 38.77 months) and three months after kindergarten entry (mean age = 42.26 months). Hair analysis was conducted for both times of measurement, reflecting the first 3 months after kindergarten entry and 3 months prior. Furthermore, the emotional quality of the mother-child-relationship was assessed with the help of the Emotional Availability Scales (EAS) shortly before kindergarten entry when the children were about three years old (mean age = 37.2). Results and Conclusion: Children’s mean cumulated HCC was higher after kindergarten entry than before. The increase correlated negatively with several dimensions of the EAS. Repeated measures ANCOVA revealed that particularly responsive children and children who had experienced less intrusive mother-child-relationships demonstrated lower elevations in HCC after kindergarten entry. Furthermore, a decreased EA score was found in all EA dimensions, besides the dimension “mother’s non-hostility”, indicating problematic EA within the mother-child-relationships of the sample. The results suggest that children with an immigrant background who experience more emotional available mother-child-relationships seem to regulate stress induced by kindergarten entry more effectively, indicated by lower cortisol elevations after entry. This implicates that supporting early mother-child-relationships by intervention may have a positive effect on the children’s ability to regulate stress induced by kindergarten entry thus promoting child development. (shrink)

This article is about the concept of professional transition that is a specific moment in the careers that are no longer linear. We characterize professional transitions from the explanation of the activity in mobilizing a dual theoretical framework: the one of professional didactics and the other of communicative action (Habermas). Respondents subjects are nurses who become health health framework in care unit. The main results presented show that this transition has value for each test subject so that they dominate (...) unusual work situations, potential source of professional development. These professional situations demand new skills and the development of professional identity. (shrink)

Collaborative cross-sector business models for sustainability innovation (CCSBMSI) in response to grand challenges are rich foci for tensions. This is the case of CCSBMSI targeting independent living through Information and Communication Technology–enabled care. This research aims at identifying the relevant tensions, understanding their interactions, and assessing how they can be effectively managed so that CCSBMSI become more valuable for partners and transformative for society. A conceptual framework that understands the management of interrelated institutional and interorganizational tensions as a dynamic (...) capability is substantiated through in-depth, qualitative analysis of the long-term dynamics of a four-sector CCSBMSI in telecare—including government, businesses, nonprofits, and informal actors. Its effects on the transition of business models in terms of value creation, delivery, and capture; on relevant stakeholders—particularly nonprofits and beneficiaries; and on the development of the sustainability innovation are discussed. The conceptualization, tension categories, and management capabilities of CCSBMSI are amplified. (shrink)

In “The Virtual and the Real,” David Chalmers argues that there is an epistemic and ontological parity between VR and ordinary reality. My argument here is that, whatever the plausibility of these claims, they provide no basis for supposing that there is a similar parity of value. Careful reflection upon certain aspects of the transition that individuals make from interacting with real-world, physical environments to interacting with VR provides a basis for thinking that, to the extent that there are good (...) reasons to deny the reality of virtual objects, there are also reasons to place a correspondingly higher value upon the experience of interacting with a VR environment. Chalmers’ assumption to the contrary arises from a subtle misrepresentation of how the phenomenon of cognitive penetration works in the perception of virtual objects, and from an unwillingness to acknowledge how our attitudes toward virtual environments are conditioned by the values we adopt when engaged in gameplay. (shrink)

Summary Although by the mid-eighteenth century colonial American makers of mathematical instruments were producing many of the scientific instruments required in the British Colonies of North America for surveying and navigation, it was not until after the first quarter of the nineteenth century that American makers had the capability to produce sophisticated precision optical instruments for astronomy and microscopy. Until then, these had to be imported from overseas, chiefly England, at considerable cost and after long delays. Included among them were (...) historically important instruments required for establishing provincial and territorial boundaries, and for making astronomical observations. Although generally treated with the utmost care while in use, eventually one after another was misplaced, lost, destroyed by fire, or, in one instance, carefully hidden away then forgotten until it was discovered more than a century later. (shrink)

The European Union faced high risks from personal data proliferation to individuals’ privacy. Legislation has emerged that seeks to articulate all interests at stake, balancing the need for data flow from EU countries with protecting personal data: the General Data Protection Regulation. One of the mechanisms established by this new law to strengthen the individual’s control over their data is the so-called “right to be forgotten”, the right to obtain from the controller the erasure of records. In gender transition, this (...) right represents a powerful form of control over personal data, especially health data that may reveal a gender with which they do not identify and reject. Therefore, it is pertinent to discern whether the right to have personal data deleted—in particular, health data—is ethically acceptable in gender transition. Towards addressing the ethical dimensions of the right to be forgotten in this case, this study presents relevant concepts, briefly outlines history, ethics and law of records considering the evolution from paper to electronic format, the main aspects of identity construction and gender identity, and explores the relationship between privacy, data protection/information control and identity projection. Also, it discusses in gender transition the relation between “the right to self-determination”, “the right to delete”, and “the right to identity and individuality”. Conclusions on the ethical admissibility of the ‘right to be forgotten’ to control gender-affirming information are presented. (shrink)

The authors draw on their extensive early years experience to provide a comprehensive and up-to-date review of the key issues in the field of early childhood care and education. In this fully updated and revised new edition, rewritten to include the new Early Years Foundation Stage, students will find that this text now meets the needs of students on Foundation degrees, Early Childhood Degrees and the new Early Years Professional qualification. Topics covered in this essential textbook include: an overview (...) of the principles of effective practice discussions on equal opportunities and children's rights an update of the latest development theories relating to brain development and how children learn and the difficulties children may face in their learning investigations into what working with parents really means consideration of the different early years systems in operation summaries of key management issues and useful information on how to address them comparison with European perspectives on early years care and education the importance of play in children's early learning. Readers of this second edition will also find the expansion of existing chapters in order to include topics such as inclusion, transitions, child protection in relation to the internet and partnerships with parents. The book covers the whole age range from birth to eight years with a special section on the birth to three years age group. Each chapter is fully referenced and has case studies or reflective practice boxes within the text. Informative and engaging, the book challenges the reader to think about how underlying theory may be reflected in practice. It will be essential reading for all students who are studying for early childhood qualifications at levels four, five and six. (shrink)

Cancer care has transitioned from clinical-based to home-based care to support longterm care in a more familiar and comfortable environment. This care transition has put family caregivers (FCGs) in a strategic position as care providers. Cancer care at home involves psychological and emotional treatment at some point, making FCGs deal with the stress of cancer patients frequently. Due to their limited care competencies, they need supportive care from healthcare professionals in cancer stress (...) management. This study aims to examine how types of demanded healthcare information affect the FCG’s role in reducing the stress of female cancer patients. The mindsponge theory was used in conceptual development and interpretation. Bayesian Mindsponge Framework (BMF) analytics were used for statistical analysis on a dataset of 48 spouses (husbands) and 12 other family members in five congested communities of Surabaya, Indonesia. Results showed that among the six types of healthcare information, FCGs with higher demand for cancer-specific information were more likely to need support in reducing the stress of female cancer patients. Meanwhile, FCGs with a higher demand for information about support services were less likely to need support to reduce cancer patients’ stress. Other types of healthcare information have ambiguous effects on the need for support in reducing cancer-induced stress. This study reveals that the demanded cancer-specific information, e.g., cancer prognosis or likely outcome, must be prioritized to assist FCG’s role in managing cancer stress. (shrink)

In this paper, the nonsmooth compound transmission control protocol with the gentle random early detection system with the state-dependent round-trip delay is investigated in detail. Uniqueness of the positive equilibrium is proved firstly. Then, the closed approximate periodic solutions in this state-dependent delayed nonsmooth compound TCP with the GRED model are obtained by employing the harmonic balance and alternating frequency/time domain method. Then, we compare the results generated by numerical simulations with those of the closed approximate expressions obtained by HB-AFT. (...) It indicates that HB-AFT is simple, correct, and powerful for state-dependent delayed nonsmooth dynamical systems. Finally, we find the complicated dynamic: chaos. It is a grazing chaos with a hybrid property, i.e., where usually w oscillates at a very low frequency and q oscillates at a very high frequency. And, the route to chaos is a very rare route, i.e., the instantaneous and local transition of stable equilibrium to chaos. So, to the end of stability and good performance, we should adjust the parameters carefully to avoid the periodic and chaotic oscillations. (shrink)

The book is an accurate and accessible introduction to the complex and dynamic field of transitional and post-conflict justice, providing an overview of its recurring concepts and debated issues. Particular attention is reserved to how these concepts and issues have been addressed, both theoretically and literally, by lawyers, policy-makers, international bodies, and other actors informing the practice. By presenting significant, if undeniably disputable, alternatives to mainstream theories and past methods of addressing past injustice and (re)building a democratic state, the (...) work aims to illustrate some foundational themes of transitional justice that have emerged from a diverse set of discussions. The author's position thus arrives from a careful analysis of the advantages and disadvantages of answers to the question: how, after a traumatic social experience, is justice restored? (shrink)

The Danish health care sector currently undergoes changes that imply a gradual transition from an evidence‐based activity model to a value‐based quality model centered on patient involvement and value‐based governance. The patient naturally occupies a central position in health care, and the transition therefore raises important questions about health care quality and how successive national health quality strategies value quality and ascribe roles and agency to patients. To explore the complexity of these quality strategies, we analyze and (...) discuss how political discourse moments influence the contents of the national health quality strategies and how variation in the construal of patient roles and agency indicates discursive struggle in Danish national health care policy. Underlying theoretical concepts are informed by New Public Management, the welfare state, health communication, and discourse theory. Our analytical approach is inspired by Critical Discourse Analysis and combines content analysis with linguistic analysis. (shrink)

There is a mystery at the heart of Plato's Parmenides. In the first part, Parmenides criticizes what is widely regarded as Plato's mature theory of Forms, and in the second, he promises to explain how the Forms can be saved from these criticisms. Ever since the dialogue was written, scholars have struggled to determine how the two parts of the work fit together. Did Plato mean us to abandon, keep or modify the theory of Forms, on the strength of Parmenides' (...) criticisms? Samuel Rickless offers something that has never been done before: a careful reconstruction of every argument in the dialogue. He concludes that Plato's main aim was to argue that the theory of Forms should be modified by allowing that forms can have contrary properties. To grasp this is to solve the mystery of the Parmenides and understand its crucial role in Plato's philosophical development. (shrink)

Emphasizing the importance of language is a key characteristic of philosophical reflection in general and of bioethics in particular. Rather than trying to eliminate the historicity and ambiguity of language, a continental approach to bioethics will make conscious use of it, for instance by closely studying the history of the key terms we employ in bioethical debates. Continental bioethics entails a focus on the historical vicissitudes of the key signifiers of the bioethical vocabulary, urging us to study the history of (...) terms such as “bioethics,” “autonomy,” “privacy,” and “consensus.” Instead of trying to define such terms as clearly and unequivocally as possible, a continental approach rather requires us to take a step backwards, tracing the historical backdrop of the words currently in vogue. By comparing the original meanings of terms with their current meanings, and by considering important moments of transition in their history, obfuscated dimensions of meaning can be retrieved. Thus, notwithstanding a number of methodological challenges involved in etymological exercises, they may foster moral articulacy and enhance our ability to come to terms with moral dilemmas we are facing. (shrink)

This positional paper explores the role of personal networks (family and friends) in caring for people with mental health problems. Since the eighties, major changes have been made in the organization and focus of professional mental healthcare. Correspondingly, new expectations and changes in the division of care responsibilities between people with mental health problems, their personal networks and their professional care providers were created. In this paper, I investigate how the transition in mental healthcare changed the allocation of (...) care responsibilities between personal networks, people with mental health problems and professional caregivers. I will consider why care responsibilities of personal networks have been taken for granted in these processes, and discuss whether personal networks should have a more prominent voice in the assignment of care responsibilities, and how this can be done. A theoretical framework of feminist care ethics inspired by scholars such as Margaret Urban Walker, Joan Tronto and Hilde Lindemann is used to reflect on the need for social inclusion. (shrink)

The power of care: the Women’s Hospital 1884–1914The effectiveness of late‐nineteenth‐century nursing care should not be underestimated. The archive of patient records at Melbourne’s Women’s Hospital reveals a commitment to patient care that more often than not made the difference between life and death in the recovery from major surgery or post‐partum infection. These records suggest the need to reassess the role of medical care in the mortality transition after 1850.

Career transitions in psychiatry have rarely been discussed openly. Yet, in the light of health care reform and other forces affecting clinical practice, it is more important than ever that psychiatrists have information about the career options within their specialty. _Career Pathways in Psychiatry: Transition in Changing Times_ serves that purpose. It explores the professional development and career choices of prominent American psychiatrists, each of whom is identified with a particular career track and many of whom have themselves experienced (...) one or more career transitions. The autobiographical accounts of the contributors survey a wide range of career pathways in psychiatry, including clinical practice, HMO practice, research, administration, entrepreneurism, psychoanalysis, organized medicine, the pharmaceutical industry, public psychiatry, occupational psychiatry, forensic psychiatry, and military psychiatry. These accounts are as engaging as they are informative; their anecdotal nature and conversational tone make for pleasurable reading. References at the end of each chapter serve as recommended reading for those who wish to learn more about specific career options. Intended for psychiatric residents and psychiatrists early in their careers, _Career Pathways in Psychiatry_ will also appeal to their more experienced colleagues, including seasoned clinicians who have contemplated career changes. With a preface summarizing research on career transitions in medicine and numerous chapters shedding light on factors contributing to resistance to change, this book will also be of interest to social scientists, mental health administrators, and professional recruiters. (shrink)

Career transitions in psychiatry have rarely been discussed openly. Yet, in the light of health care reform and other forces affecting clinical practice, it is more important than ever that psychiatrists have information about the career options within their specialty. _Career Pathways in Psychiatry: Transition in Changing Times_ serves that purpose. It explores the professional development and career choices of prominent American psychiatrists, each of whom is identified with a particular career track and many of whom have themselves experienced (...) one or more career transitions. The autobiographical accounts of the contributors survey a wide range of career pathways in psychiatry, including clinical practice, HMO practice, research, administration, entrepreneurism, psychoanalysis, organized medicine, the pharmaceutical industry, public psychiatry, occupational psychiatry, forensic psychiatry, and military psychiatry. These accounts are as engaging as they are informative; their anecdotal nature and conversational tone make for pleasurable reading. References at the end of each chapter serve as recommended reading for those who wish to learn more about specific career options. Intended for psychiatric residents and psychiatrists early in their careers, _Career Pathways in Psychiatry_ will also appeal to their more experienced colleagues, including seasoned clinicians who have contemplated career changes. With a preface summarizing research on career transitions in medicine and numerous chapters shedding light on factors contributing to resistance to change, this book will also be of interest to social scientists, mental health administrators, and professional recruiters. (shrink)

Suppose you are presented with three red objects. You are then asked to take a careful look at each possible pair of objects, and to decide whether or not their members look chromatically the same. You carry out the instructions thoroughly, and the following propositions sum up the results of your empirical investigation: <blockquote> i. red object #1 looks the same in colour as red object #2. </blockquote> ii. red object #2 looks the same in colour as red object #3.

In this careful study, Woolf traces the international effort to make accurate observations of the transits of Venus across the face of the sun in 1761 and 1769. Precise measurement of these infrequent transits permitted the calculation of the distance from the earth to the sun, and enabled the eighteenth century to give fixed scalar dimensions to the Newtonian account of the solar system.--L. S. F.

Socialism from a feminist perspective is not an all or nothing blueprint, but rather a vision of degrees of power/freedom that people in a particular society have in economic, political, social and personal relations. Examples are discussed of societies which are more or less socialist in their class, racial/ethnic, and gender equality, power and freedom. Historical changes in affective economic relations of care, love and affection inform such class, race/ethnic, gender and sexual differences. Three types of transitional strategies (...) are relevant for social movements working toward socialism. (shrink)

What are the ethical concerns among the growing populations of business people in Central & Eastern Europe, and how might they be dealt with practically in the course of business life? David Murray has been a management consultant since 1979 working primarily with the Hay Group in the area of strategic organisational change. Since founding Maine Consulting Services in 1991 he spends most of his time in the field of business and professional ethics, also holding a Visiting Fellowship at the (...) University of Central Lancashire. He is chairman of the Professional & Technical Board at the (British) Institute of Quality Assurance and a coordinating editor of the quarterly Organisations & People. Marek Kucia is a social researcher operating his own research agency (which organised the Polish part of this exercise) and an academic teaching sociology, and conducting and co‐ordinating Central European Studies at the Jagiellonian University, Krakow. He studied political science, sociology and philosophy at Krakow and studied for his PhD at Oxford. He has also worked for Gallup, London, in opinion and market research. This survey report is based on presentations made in April 1994 to the EBEN Research Centres Conference in Prague, and in June 1994 to the conference on “Ethics in Transition” organised in Gödöllö, Hungary, by the Democracy after Communism Foundation, Budapest. The authors wish to acknowledge the major contribution to this work of Mr Juraj Kusnierik of the Central European Foundation, SEN, Bratislava, who co‐ordinated the survey exercise. The project was sponsored by The Ethics Development Initiative, CARE, London; the Central European Foundation, SEN, Bratislava, Slovakia; SIS Ltd., Bratislava, Slovakia; and Maine Consulting Services, 16 Acrefield, Blackburn, Lancashire, England BB2 7BJ, to which all correspondence connected with this report should be addressed. (shrink)