After 40 years of attributing high rates of physician career dissatisfaction, attrition, alcoholism, divorce and suicide to ‘burnout’, there is growing recognition that these outcomes may instead be caused by moral injury. This has led to a debate about the relative diagnostic merits of these two terms, a recognition that interventions designed to treat burnout may be ineffective, and much perplexity about how—if at all—this changes anything. The current research seeks to develop the construct of moral injury outside military contexts, (...) generate more robust validity tests and more fully describe and measure the experiences of persons exposed to moral harms. Absent from the literature is a mechanism through which to move from the collective moral injury experience of physicians to a systematic change in the structure of medical practice. To address this, after providing a brief history, definitions and contrasts between burnout, moral distress and moral injury, we review the interplay of moral and ethical codes in the context of moral injury. We conclude by suggesting that professional associations can potentially prevent moral injury by providing protections for physicians within their codes of ethics. There are no data in this work. (shrink)

Corporate social responsibility (CSR) is a comprehensive concept that aims at the promotion of responsible business practices closely linked to the strategy of enterprises. Although there is no single accepted definition of CSR, it remains an inspiring, challenging and strategic development that is becoming an increasingly important priority for companies of all sizes and types, particularly in Europe. Promotion of well-being at work is an essential component of CSR; however, the link between CSR, working conditions and work organisation is still (...) found to be unfamiliar to stakeholders. As CSR is strategic and is regarded by many companies and corporate leaders as an important development, it offers opportunities for psychosocial risk management, an area that is currently among the top priorities in working environment and well-being at work debates. However, the link between CSR and psychosocial risk management has not been addressed clearly before. This paper aims to explore the potential role of CSR in promoting well-being at work through the development of a framework for the management of psychosocial risks. As part of the research, key stakeholders [including the World Health Organization (WHO), the International Labour Organization (ILO), the European Agency for Safety and Health at Work (EU-OSHA), the European Commission (EC), employers’ associations, trade unions and other policy experts] across Europe participated in a survey, interviews and focus groups to assess and clarify the link between CSR and psychosocial risk management. On the basis of the findings, a CSR-inspired approach to the management of psychosocial issues at work is proposed. Such an approach can be a useful tool in contexts where, up until now, expertise and tradition in dealing with psychosocial issues have been lacking. (shrink)

This essay is conceived as a contribution to the academic debate on the ethical status of mystical traditions with regard to Jain asceticism in particular and—through comparison of Jain with Advaita Vedanta asceticism—to ideologies of radical quietism more generally. For both Jain and Advaita Vedantic ascetic traditions, the material world, and particularly the body, are the primary obstacles to spiritual development. We deal with the social, physical, and environmental implications of such a worldview, rather than with the practice or the (...) phenomenology or the doctrine of mysticism, which we grant to be an accurate reflection of a particular kind of cosmic experience. We address ethical issues, not metaphysical ones. In our discussion of Jain asceticism, we demonstrate that the basic problem (and promise) of quietism, in almost any cultural form, is the shocking realization it can occasion that the Real has absolutely nothing to do with the social or with any sort of ethical action. We argue that Jain asceticism cannot function as an adequate resource for contemporary ethics. Our normative concerns lie exclusively with the adequacy of Jain quietism in supporting a stable global community and a sustainable natural environment. One can be mystical without being ethical, and ethical without being a mystic. We conclude that the truths of quietism are both very profound and profoundly nonethical. (shrink)

This paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on (...) Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal. (shrink)

Humans' voice offers the widest variety of motor phenomena of any human activity. However, its clinical evaluation in people with movement disorders such as Parkinson's disease lags behind current knowledge on advanced analytical automatic speech processing methodology. Here, we use deep learning-based speech processing to differentially analyze voice recordings in 14 people with PD before and after dopaminergic medication using personalized Convolutional Recurrent Neural Networks and Phone Attribute Codebooks. p-CRNN yields an accuracy of 82.35% in the binary classification of ON (...) and OFF motor states at a sensitivity/specificity of 0.86/0.78. The PAC-based approach's accuracy was slightly lower with 73.08% at a sensitivity/specificity of 0.69/0.77, but this method offers easier interpretation and understanding of the computational biomarkers. Both p-CRNN and PAC provide a differentiated view and novel insights into the distinctive components of the speech of persons with PD. Both methods detect voice qualities that are amenable to dopaminergic treatment, including active phonetic and prosodic features. Our findings may pave the way for quantitative measurements of speech in persons with PD. (shrink)

Purpose This research aims to study the coping experience of visually impaired bankers in India after they have received reasonable accommodation from their employers, that is, the work process or environment has been suitably modified to ensure a barrier-free environment for them. Design/methodology/approach Data were collected through semi-structured interviews with 12 VI bankers working with public sector banks in India. A phenomenological approach was adopted during data analysis. Findings Despite the provision of reasonable accommodations, VI employees often find it difficult (...) to fulfill their job responsibilities. This is on account of extensive paperwork required for completion of their jobs and the partially accessible information systems available to them. As a result, these VI employees are found resorting to workarounds to carry out their jobs, with the nature of workarounds adopted varying with the type and extent of visual impairment. Furthermore, it is observed that VI employees require social support not only from their superiors and peers but also from their subordinates and customers to carry out their tasks. Research limitations/implications Data collection was done through snowball sampling which could have resulted in sampling bias. Due to confidentiality issues, observation of workarounds in practice by VI employees could not be carried out as part of the study. Originality/value The study contributes to the literature on integration of persons with disabilities by examining their coping experience after provision of reasonable accommodations. It emphasizes the role of workarounds, an under-studied area in PwD integration, as well as support of other stakeholders in the experience. (shrink)

This essay introduces the second installment of a symposium in Common Knowledge called “Apology for Quietism.” This introductory piece concerns the sociology of quietism and why, given the supposed quietude of quietists, there is such a thing at all. Dealing first with the “activist” Susan Sontag's attraction to the “quietist” Simone Weil, it then concentrates on the “activist” William Empson's attraction to the Buddha and to Buddhist quietism, with special reference to Empson's lost manuscript Asymmetry in Buddha Faces. The author, (...) who is also editor of the journal, argues against the effort of some contributors to substitute new terms for quietism and emphasizes instead what he calls “the need for repose.”. (shrink)

This essay introduces the second installment of a symposium in Common Knowledge called “Apology for Quietism.” This introductory piece concerns the sociology of quietism and why, given the supposed quietude of quietists, there is such a thing at all. Dealing first with the “activist” Susan Sontag's attraction to the “quietist” Simone Weil, it then concentrates on the “activist” William Empson's attraction to the Buddha and to Buddhist quietism, with special reference to Empson's lost manuscript Asymmetry in Buddha Faces (and to (...) Sharon Cameron's work on the topic in her book Impersonality). The author, who is also editor of the journal, argues against the effort of some contributors to substitute new terms for quietism and emphasizes instead what he calls (quoting Sontag) “the need for repose.”. (shrink)

We compute the model-theoretic Grothendieck ring, \\), of a dense linear order with or without end points, \\), as a structure of the signature \, and show that it is a quotient of the polynomial ring over \ generated by \\) by an ideal that encodes multiplicative relations of pairs of generators. This ring can be embedded in the polynomial ring over \ generated by \. As a corollary we obtain that a DLO satisfies the pigeon hole principle for definable (...) subsets and definable bijections between them—a property that is too strong for many structures. (shrink)

The paper investigates the structure and functioning of the science and technology (S&T) system in India as it has evolved in the post-independence period (1947 onwards). The networks of entities involved in S&T actions, the paper argues, can be categorised, in terms of adopted approaches to agenda and priority setting and accounting for actions, into two streams. The origins and expansion of the two streams are traced. One, the ‘Elite’ stream (high profile and visibility linked to big industry), adopting what (...) the paper has generically termed the ‘Nehruvian’ model of development, is shown to have emerged as a dominant network. The other socially powerful ‘Subaltern’ stream (less visible, closer to ground realities and linked to village and cottage industry), adopting the ‘Gandhian’ model of development, still remains dispersed and outside the consideration of high-level decision-making bodies. The paper stresses the importance of moving the support and attention from the dominant stream to efforts that attempt a synthesis between the dominant and the subaltern. (shrink)