The aim of this study is to understand how governance mechanisms in cross-sector collaborations (CSCs) for sustainability affect value creation and capture and subsequently the survival of this organizational form. Drawing on a longitudinal, participatory, single-case study of collaborative action in the textile industry, we identify three governance mechanisms—safeguarding, bundling and connecting—that coevolve with the rising and waning of collaborative tensions and the shifting levels of action in the CSC we studied. These mechanisms aided value creation and helped facilitate private (...) value capture. We integrate these insights into a process model that visualizes the interplay between governance mechanisms of tensions and systems of value creation and capture in CSCs for sustainability. Our study contributes to the cross-sector collaboration literature by providing a dynamic and nuanced understanding of how governance mechanisms influence outcomes in CSCs for sustainability. We also add to the business model for sustainability literature by theorizing the value creation and capture system of collaborative rather than individual organizations. Our findings have important implications for policymakers who fund collaborative organizations and practitioners who manage or participate in them. (shrink)

We endorse Amy Caruso Brown’s position that clinicians and ethicists should consider the voices of people marginalized by hierarchical family or community structures. In this open peer comme...

Feigning symptoms distorts diagnostic evaluations. Therefore, dedicated tools known as symptom validity tests have been developed to help clinicians differentiate feigned from genuine symptom presentations. While a deviant SVT score is an indicator of a feigned symptom presentation, a non-deviant score provides support for the hypothesis that the symptom presentation is valid. Ideally, non-deviant SVT scores should temper suspicion of feigning even in cases where the patient fits the DSM’s stereotypical yet faulty profile of the “antisocial” feigner. Across three studies, (...) we tested whether non-deviant SVT scores, indeed, have this corrective effect. We gave psychology students and clinical experts a case alluding to the DSM profile of feigning. In successive steps, they received information about the case, among which non-deviant SVT outcomes. After each step, participants rated how strongly they suspected feigning and how confident they were about their judgment. Both students and experts showed suspicion rates around the midpoint of the scale and did not respond to non-deviant SVT outcomes with lowered suspicion rates. In Study 4, we educated participants about the shortcomings of the DSM’s antisocial typology of feigning and the importance of the negative predictive power of SVTs, after which they processed the case information. Judgments remained roughly similar to those in Studies 1–3. Taken together, our findings suggest that students and experts alike have difficulties understanding that non-deviant scores on SVTs reduce the probability of feigning as a correct differential diagnosis. (shrink)

PurposeThe aim of this study was to investigate the effect of possible late effects of cancer treatment and of two job resources on future burnout complaints, among employees living 2–10 years beyond breast cancer diagnosis.MethodsData at T1 and at T2 were collected in 2018 and 2019. These data were part of a longitudinal study among Dutch speaking workers with a cancer diagnosis 2–10 years ago. All complaints and job resources were self-reported. Longitudinal multivariate regression analyses were executed, controlling for years (...) since diagnosis, living with cancer, and other chronic or severe diseases. Mediation by baseline burnout complaints was considered.ResultsA higher level of fatigue and cognitive complaints at baseline resulted in higher future burnout complaints, with partial mediation by baseline burnout complaints. No effect of physical complaints at T1 was observed. Higher levels of autonomy or a supportive leadership style resulted in lower burnout complaints, with full mediation by baseline burnout complaints. Buffering was observed by autonomy in the relationship of cognitive complaints with future burnout complaints. No moderation was observed by supportive leadership.ConclusionThe level of burnout complaints among employees 2–10 years beyond breast cancer diagnosis may be an effect of fatigue or cognitive complaints, and awareness of this effect is necessary. Interventions to stimulate supportive leadership and autonomy are advisable, the latter especially in the case of cognitive complaints. (shrink)

The impact of COVID-19 on chronic pain in non-infected vulnerable South American subjects is unknown. Healthcare workers are at increased risk for CP. During the pandemic, many HCWs with CP kept working. Knowing how cognition is affected by CP in these subjects is an important subject for work safety. The attention domain has a pivotal role in cognition. Previously, the Continuous Visual Attention Test was applied to detect specific attention deficits in fibromyalgia patients. The present investigation described CP prevalence in (...) non-infected Brazilian HCWs during the pandemic and assessed HCWs’ attentional performance with the aid of the CVAT. This study was carried out at a reference University Hospital in Rio de Janeiro, Brazil. HCWs of both sexes, aged 20 or older, were interviewed from August to December 2020. A 90-second version of the CVAT was performed. The average reaction time to correct responses and the respective intraindividual reaction time variability for correct responses to target was determined. Omission and commission errors were also calculated. Then, for each participant we calculated the Z-scores of the CVAT variables based on the distribution of CVAT performance of 211 healthy subjects. HCWs with Z-scores > 1.64 were classified as significantly impaired. From the 154 selected HCWs, 72 reported CP during the pandemic. Post hoc ANCOVAs showed that the average correct VRT was significantly higher in the CP group than in the non-CP group. The percentage of participants with impaired VRT performance was 30% in the CP group and 16% in the non-CP group. The difference between these two propositions reached significance. As VRT is associated with the sustained-attention subdomain, our data suggest that this subdomain is disrupted in the CP group. (shrink)

This document presents the Bonn PRINTEGER Consensus Statement: Working with Research Integrity—Guidance for research performing organisations. The aim of the statement is to complement existing instruments by focusing specifically on institutional responsibilities for strengthening integrity. It takes into account the daily challenges and organisational contexts of most researchers. The statement intends to make research integrity challenges recognisable from the work-floor perspective, providing concrete advice on organisational measures to strengthen integrity. The statement, which was concluded February 7th 2018, provides guidance on (...) the following key issues: § 1.Providing information about research integrity § 2.Providing education, training and mentoring § 3.Strengthening a research integrity culture § 4.Facilitating open dialogue § 5.Wise incentive management § 6.Implementing quality assurance procedures § 7.Improving the work environment and work satisfaction § 8.Increasing transparency of misconduct cases § 9.Opening up research § 10.Implementing safe and effective whistle-blowing channels § 11.Protecting the alleged perpetrators § 12.Establishing a research integrity committee and appointing an ombudsperson § 13.Making explicit the applicable standards for research integrity. (shrink)

This paper examines the role of clinical practitioners and clinical researchers internationally in establishing the utility of harm-reduction approaches to substance use. It thus illustrates the potential for clinicians to play a pivotal role in health promoting structural interventions based on harm-reduction goals and public health models. Popular media images of drug use as uniformly damaging, and abstinence as the only acceptable goal of treatment, threaten to distort clinical care away from a basis in evidence, which shows that some ways (...) of using drugs are far more harmful than others and that punitive approaches and insistence on total abstinence as the only goal of treatment often increases the harms of drug use rather than reducing drug use. Therefore the leadership and scientific authority of clinicians who understand the health impact of harm-reduction strategies is needed. Through a review of harm-reduction interventions in Canada, the United Kingdom, the United States, Australia, Switzerland, and the Netherlands, we identify three ways that clinicians have helped to achieve a paradigm shift from punitive approaches to harm-reduction principles in clinical care and in drug policy: through clinical research to provide data establishing the effectiveness and feasibility of harm-reduction approaches, by developing innovative clinical programmes that employ harm reduction, and thereby changing the standard of care to include routine use of these evidence-based approaches in their practices. We argue that through promotion of harm-reduction goals and methods, clinicians have unique opportunities to improve the health outcomes of vulnerable populations. (shrink)

There is a relationship between the different means of action of pressure groups - aimed at exerting pressure on the national government - and its effectiviness on policy level. Because a theoretical analysis is indispensable for further emperical research, the study first focuses on a general survey of possible means of action. This theoretical scheme is applied to four pressure groups. The analysis ofJour quite different pressure groups: 'Vrouwen Overleg Komitee', 'Bond Beter Leefmilieu', 'Vlaams Artsensyndicaat' and 'Belgische Boerenbond' shows that (...) the use of indirect means of action produces a greater effectiviness on policy level. But the choice of the means of action by an organisation depends on several determining factors. Following hypothesis can be sustained by this emperical study: stronger pressure groups, like Vlaams Artsensyndicaat and Belgische Boerenbond, mostly use indirect means of action and are characterised by a greater effectiviness than the two other organisations. (shrink)

This article addresses the question whether a basic income will be a just social policy for women. The implementation of a basic income will have different effects for different groups of women, some of them clearly positive, some of them negative. The real issues that concern feminist critics of a basic income are the gender-related constraints on choices and the current gender division of labour, which are arguably both playing at the disadvantage of women. It is argued that those issues (...) are not adequately addressed by a basic income proposal alone, and therefore basic income has to be part of a larger packet of social policy measures if it wants to maximise real freedom for all. (shrink)

This study investigated Belgian and Dutch parental opinions on confidentiality and consent regarding medical decisions about adolescents. Through an online survey, we presented six cases (three on confidentiality, and three on consent) to 1,382 Belgian and Dutch parents. We studied patterns in parental confidentiality and consent preferences across and between cases through binomial logistic regressions and latent class analysis. Participants often grant the right to consent for a treatment to the adolescent, but the majority diverges from the adolescent’s preferences regarding (...) confidentiality. More educated participants would rather not be informed about cases regarding a sexually transmitted disease or depression than lower educated participants. Further analysis shows that participants’ preferences correspond to authoritative (47%), permissive (30%) and authoritarian (17%) parenting styles. Belgian and Dutch parents are willing to grant some degree of autonomy, but they want to be informed about specific health issues. Parental views on confidentiality and granting consent appear to mirror existing parenting styles. (shrink)

Amsterdam University Press is a leading publisher of academic books, journals and textbooks in the Humanities and Social Sciences. Our aim is to make current research available to scholars, students, innovators, and the general public. AUP stands for scholarly excellence, global presence, and engagement with the international academic community.

Het Leids-Haags Allegorieënlexicon toont nieuwe perspectieven op de maatschappelijke werkelijkheid met een actuele duiding van vijftig kernthema’s uit de wetenschap. De auteurs zijn de duale promovendi en hun promotores van Leiden University Dual PhD Centre The Hague. Ze worden daarbij geïnspireerd door de metafoor van de grot van Plato: Waar ben ik? Waar sta ik? Welk beeld zie ik? Hoe kan ik dat begrijpen? Er ontstaan beeldende voorstellingen van begrippen waarin op zoek wordt gegaan naar de centrale gedachten die ten (...) grondslag liggen aan die begrippen. Zo wordt de veranderende wereld waargenomen met het besef dat we nooit kunnen weten of we de gehele werkelijkheid kunnen zien of begrijpen. De waarneming is afhankelijk van de zichtpositie die de waarnemer inneemt. Zo ontstaan verbeeldingen van waarnemingen van ons menselijk bestaan. Zoals: assimilatie, creativiteit, gender, kunstenaarschap, magistraat, participatie, regels, tragedie en verzorgingsstaat. Eerst wordt actuele literatuur besproken. Daarna volgt discussie. Tenslotte neemt de auteur positie in. Met bijdragen van promotores Wilfried Admiraal, Ingrid van Biezen, Hans Borgman, Paul Cliteur, Jaap van den Herik, Rikki Holtmaat, Willem Otterspeer, Jos Raadschelders, Robert Tijssen, Wim Willems en promovendi. (shrink)

Background:The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction.Aim:Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway.Research design:A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020.Ethical considerations:Ethical approval granted by the Regional Research Ethics Committee in (...) Western Norway (131421).Findings:Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful.Discussion:By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority.Conclusion:Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

Ancient philosophers had always been fascinated by religion. From the first century BC onwards the traditionally hostile attitude of Greek and Roman philosophy was abandoned in favour of the view that religion was a source of philosophical knowledge. This book studies that change, not from the usual perspective of the history of religion, but as part of the wider tendency of Post-Hellenistic philosophy to open up to external, non-philosophical sources of knowledge and authority. It situates two key themes, ancient wisdom (...) and cosmic hierarchy, in the context of Post-Hellenistic philosophy and traces their reconfigurations in contemporary literature and in the polemic between Jews, Christians and pagans. Overall, Post-Hellenistic philosophy displayed a relatively high degree of unity in its ideas on religion, which should not be reduced to a preparation for Neoplatonism. (shrink)

The idea that the state ought to be neutral towards different conceptions of the good life has been an influential principle in liberal theory since the 1970s. It has, however, been subject to criticism by communitarians, multiculturalists and liberal perfectionists. Recently, Peter Balint has attempted to defend state neutrality against its liberal critics as the adequate interpretation of the liberal project by redefining it as a range concept. By arguing that neutrality always occurs within a specific range of permissible conceptions (...) of the good life, Balint provides a convincing rebuttal of neutrality’s critics. In this paper I argue that while neutrality as a range concept provides an adequate account of state neutrality, it also makes it vulnerable to a new line of critique. Since the range of neutrality cannot be deduced from the principle of neutrality itself, neutrality is subject to political developments beyond its own control. I will start by clarifying the notion of neutrality as a range concept. Secondly, I will demonstrate that Balint’s notion of the range concept finds ample support in the wider literature on neutrality. Thirdly, I will argue that, as a range concept, neutrality ultimately depends on politically constituted value judgments. (shrink)

Continuing medico-technical progress has led toan increasing medicalisation of pregnancy andchildbirth. One of the most common technologiesin this context is ultrasound. Based on someidentified `pro-technology feminist theories',notably the postmodernist feminist discourse,the technology of ultrasound is analysedfocusing mainly on social and political ratherthan clinical issues. As empirical researchsuggests, ultrasound is welcomed by themajority of women. The analysis, however, showsthat attitudes and decisions of women areinfluenced by broader social aspects. Furthermore, it demonstrates how the visualtechnology of ultrasound, in addition to otherreproductive technology (...) in maternity care, islinked to the `personification' of the foetusand has therefore contributed to a new image ofthe foetus. The exploration of these issueschallenges some arguments of feministdiscourse. It draws attention to possibleadverse implications of the technology forwomen's reproductive freedom and indicates theimportance of the topic for politicaldiscussions. (shrink)

Abstract.Klaus Günther's (1988) book developed the distinction between two kinds of discourse, the foundation discourse and the application discourse. In an article (Günther 1989a) following the publication of the book, he used this basic distinction as the starting point for a criticism of the special case‐thesis as defended by Robert Alexy (1978, 32ff., 263ff.; Alexy 1989, 16ff., 213ff.). The aim of this article is to criticize this criticism in its turn and to show that the special case‐thesis does not need (...) the reformulation which Günther proposes. It should be clear from the outset that this concerns an internal discussion in the field of discourse theory; certain discourse‐theoretical premises are taken for granted. In order to understand Giinther's criticism I will first give a brief account of the distinction he has made. (shrink)

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the (...) responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)

Abstract‘Social inclusion’ is the leading ideal in services and care for people with intellectual disabilities in most countries in the Global North. ‘Social inclusion’ can refer simply to full equal rights, but more often it is taken to mean something like ‘community participation’. This narrow version of social inclusion has become so ingrained that it virtually goes unchallenged. The presumption appears to be that there is a clear moral consensus that this narrow understanding of social inclusion is good. However, that (...) moral consensus is not clear in the case of people with profound intellectual and/or multiple disabilities (PIMD), who are not able to express their needs and preferences verbally. Moreover, social inclusion has proven to be difficult to conceptualize and implement for people with PIMD. Therefore, it becomes imperative to ask about the ethical rationale of the narrow understanding of social inclusion. For what reasons do we think social inclusion is good? And do those reasons also apply for people with PIMD? This article addresses these questions by providing an ethical analysis of the ideal of social inclusion for people with PIMD. It discusses four ethical arguments for social inclusion and probes their relevance for people with PIMD. The article argues that none of these arguments fully convince of the value of the narrow understanding of social inclusion for people with PIMD. It ends with advocating for an ethical space for imagining a good life for people with PIMD otherwise. (shrink)

During the past decade, screening tests using computed tomography have disseminated into practice and been marketed to patients despite neither conclusive evidence nor professional agreement about their efficacy and cost-effectiveness at the population level. This phenomenon raises questions about physicians' professional roles and responsibilities within the setting of medical innovation, as well as the appropriate scope of patient autonomy and access to unproven screening technology. This article explores how physicians ought to respond when new screening examinations that lack conclusive evidence (...) of overall population benefit emerge in the marketplace and are requested by individual patients. To this end, the article considers the nature of evidence and how it influences decision-making for screening at both the public policy and individual patient levels. We distinguish medical and ethical differences between screening recommended for a population and screening considered on an individual patient basis. Finally, we discuss specific cases to explore how evidence, patient risk factors and preferences, and physician judgment ought to balance when making individual patient screening decisions. (shrink)

This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being in (...) the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection. (shrink)

Human embryos produced in labs since the 1970s have generated layers of uncertainty for law and policy: ontological, moral, and administrative. Ontologically, these lab-made entities fall into a gray zone between life and not-yet-life. Should in vitro embryos be treated as inanimate matter, like abandoned postsurgical tissue, or as private property? Morally, should they exist largely outside of state control in the zone of free reproductive choice or should they be regarded as autonomous human lives and thus entitled to constitutional (...) protection like full-fledged citizens? Administratively, if they deserve protection, what institutional and policy mechanisms are best suited to carrying out the necessary oversight? Using a method termed comparative problematization, this article traces divergent answers to these questions produced in three countries—the United States, United Kingdom, and Germany—across the last twenty-five years. Comparison reveals distinct bioconstitutional foundations that give rise to systematically different understandings of each state’s responsibilities toward human life and hence its particular treatment of claims on behalf of embryonic lives. (shrink)

In 1730, the Dutch cartographer and meteorological observer Nicolaas Samuel Cruquius constructed a spectacular map of the river Merwede. Cruquius’s map is celebrated as one of the earliest to use lines of equal depth—or indeed any type of contour lines. So far, however, the secondary literature has paid no attention to why Cruquius created these lines or to the knowledge involved in his innovation. This essay makes three related points. First, Cruquius intentionally used lines representing equal depth in an entirely (...) new way: whereas earlier maps had used similar lines to represent a river’s navigability, for Cruquius they visualized river flow. Second, different technical and epistemic practices grounded the making of the map: Cruquius built on his expertise in surveying but also on practices from both natural history and mathematical physics, with which he was familiar through contacts at Leiden University and the Royal Society of London. Third, Cruquius’s case does not fit with the way work cutting across different fields of expertise is usually conceptualized. Cruquius did not just straddle different fields. Instead, he gave new meaning to lines of equal depth by integrating specific practices from different fields of expertise and omitting others; through this integration, Cruquius created a way to visualize water flows and gave shape to possible new ways of acting on the river and its environment. (shrink)

This study investigated attitudes toward the use of deception in negotiation, with particular attention to the distinction between deception regarding the informational elements of the interaction (e.g., lying about or misrepresenting needs or preferences) and deception about emotional elements (e.g., misrepresenting one's emotional state). We examined how individuals judge the relative ethical appropriateness of these alternative forms of deception, and how these judgments relate to negotiator performance and long-run reputation. Individuals viewed emotionally misleading tactics as more ethically appropriate to use (...) in negotiation than informational deception. Approval of deception predicted negotiator performance in a negotiation simulation and also general reputation as a negotiator, but the nature of these relationships depended on the kind of deception involved. (shrink)

In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and (...) nurses’ ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses’ everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care. (shrink)

This article is based on an empirical study regarding ethical challenges in intercultural nursing. The focus is on autonomy and disclosure. Autonomy is a human capacity that has become an important ethical principle in nursing. Although the relationship between autonomy and patients’ possibly harmful choices is discussed, the focus is on ‘forced’ autonomy. Nurses seem to equate respect with autonomy; it seems to be hard to cope with the fact that there are patients who voluntarily undergo treatment but who actively (...) participate neither in the treatment offered nor in making choices regarding that treatment. Nurses’ demand for patients to be autonomous may in some cases jeopardize the respect, integrity and human worth that the ethical principle of autonomy is meant to ensure. Even though respect for a person’s autonomy is also respect for the person, one’s respect for the person in question should not depend on his or her capacity or aptitude to act autonomously. Is autonomy necessarily a universal ethical principle? This article negates this question and, through the issues of culture, individualism versus collectivism, first- and second- order autonomy, communication and the use of family interpreters, and respect, an attempt is made to explain why. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Right HeartIngrid GouldI remarked to a friend, “We haven’t spoken since my arrest!” Alarm and confusion clouded his face, given my half-century of squeaky-clean living. “Cardiac arrest,” I clarified. “The fire department rebooted me.”An electrophysiologist diagnosed Arrhythmogenic Right Ventricular Dysplasia, prescribed medication, and implanted a defibrillator. For the next three-and-a-half years, he helped me live with a disease I didn’t know existed until he told me I had (...) it.The disease progressed—an ironic, disease-centric term since its advancement was to my detriment— prompting my cardiologist to recommend seeing someone who specialized in heart failure. I resisted the very idea of heart failure, a terrible term for a struggling organ, but took her advice and scheduled an appointment.The new cardiologist urged transplant testing, a lengthy process. I agreed, figuring that by the time I needed a new heart in 15–20 years, they’d be rolling off 3D printers.To record occasional transplant musings and inchoate fears and perhaps, over time, untangle them, I began journaling. I chronicled my passage through the echocardiogram, heart catheterization, 31 tubes of bloodwork, interviews with different clinical specialties, a pulmonary function test in a machine reminiscent of Star Trek’s Transporter, and more. Testing had barely begun when my medication stopped working—a Halloween shock.I began a harsher medication, underwent an ablation, and spent six weeks in a wearable defibrillator, a vest with abundant wires, and a purse-sized battery pack that made me resemble a character in [End Page 123] the Jetsons. This attire did not bring holiday comfort or joy to the TSA1 when I flew to visit my sister. As my R-waves faded to a whisper, I swapped the vest for a second implanted defibrillator, substantially more sensitive than the first.In early 2018, we learned I had qualified for transplant listing, though I wished to get as much mileage as possible from the original engine. My cardiologist warned, “There is no Plan B—no machine, device, or medication for the long-term. You will need a transplant.” He explained that since most cardiac patients have left-heart problems, companies develop products for the left side of the heart. My problem was on the right—a tiny market. He also cautioned that a patient needs to be sick enough to warrant transplant and well enough to remain a candidate, survive the surgery, and recover.Although clinically I was ready, I was not personally ready. I felt too good to trade an excellent quality of life for the promised miserable post-transplant year. The cardiologist wisely asked if I wanted to speak with another patient. When I requested someone beyond the dreaded first year, he put me in touch with two women who had received new hearts a few years earlier and befriended each other. They soon became my invaluable mentors and cherished friends. I will never forget seeing them stride into our first meeting and thinking, “They are beautiful! They look totally normal!”By May, climbing four flights of stairs took as much effort as five used to take. Tests confirmed further deterioration and suggested I had 7–13 months of declining health before my heart would give out completely. We chose a date for hospital admission, and I started telling people outside my immediate family. Most were flabbergasted, believing heart transplants were the last hope of the desperately ill. I did not look moribund, though, apparently, I was.The eight months after my first transplant appointment let me prepare psychologically to bid farewell to my heart—the metaphor for kindness, love, and bravery in our culture—and to welcome a new organ from a generous person less medically fortunate than I.In the hospital, I met others awaiting their hearts. A sudden intimacy arises when mortal choices catapult people into a medical realm suggestive of science fiction. Add the emotional intensity that accompanies knowing your extended life comes courtesy of a person who breathes no more on this earth and you wonder how an organ recipient integrates sorrow and gratitude.Two weeks after I was hospitalized, my cardiologist informed me the wait was over... (shrink)

La universidad adecuó la formación profesional hacia la virtualidad, adaptando con ello la teoría y la practica de las distintas materias, en ese nuevo contexto el objetivo de este estudio fue desarrollar un juego de simulación de selección de talento humano y describir la experiencia de juego en pandemia. Con un enfoque metodológico cuantitativo, diseño descriptivo no experimental transeccional, aplicado a estudiantes del VIII ciclo del curso de Gestión de Recursos Humanos. Se concluye que el juego simulado es una herramienta (...) que facilita el aprendizaje de forma virtual, asimismo contribuye con el aprendizaje del tema propuesto, de una forma organizada, dinámica y divertida. (shrink)

Este trabalho tem por objetivo examinar possíveis contribuições de Lyotard e Jameson para pensar um dos obstáculos ao ensino de filosofia que, por falta de melhor denominação chamaremos "regime de atenção dos adolescentes contemporâneos".