Patient-centeredness can be considered a popular, and at the same time “fuzzy”, concept. Scientists have proposed different definitions and models. The present article studies scientific publications that discuss the meaning of patient-centeredness to identify different “discourses” of patient-centeredness. Three discourses are presented; the first is labelled as “caring for patients”, the second as “empowering patients” and the third as “being responsive”. Each of these discourses has different things to say about the why of patient-centeredness; the patient’s identity; the role of (...) the healthcare professional; responsibilities for medical decision-making, and the role of health information. This article compares and contrasts the discourses in ways that allow us to see differences that matter for practitioners in healthcare. On the basis of a relational constructionist philosophy, it is argued that discursive diversity is both an inevitable and a potentially valuable aspect of conversations in healthcare. We are therefore invited to center the challenge of dealing with diversity in productive ways. This article ends with a discussion of the practical implications of the discourse analysis for projects that aim to make healthcare more patient-centered. Debates on patient-centered “Health Information Exchange” are used to explain the need for a recognition of different discourses of patient-centeredness and a reflexive stance towards them. (shrink)

Während der größte Teil der Bevölkerung die kieferorthopädische Therapie, also die Veränderung der Zahn- bzw. Kieferstellung, als eine Behandlung betrachtet, die vor allem auf eine Verbesserung des Erscheinungsbildes zielt, sehen der kieferorthopädische und zahnärztliche Berufsstand sowie auch private und öffentliche Kostenträger in bestimmten Abweichungen von Zahn- oder Kieferstellungen eine Gefährdung der oralen Gesundheit und der Funktionsfähigkeit des Gebisses. Letztere Auffassung bestimmt das ärztliche Handeln in der Kieferorthopädie und begründet auch die Übernahme zumindest bestimmter Leistungen durch die gesetzlichen Krankenkassen. Anhand aktueller (...) wissenschaftlicher Erkenntnisse lassen sich jedoch in vielen Fällen keine (akuten oder potentiellen) gesundheitlichen oder essentiellen funktionellen Beeinträchtigungen und Risiken abweichender Zahnstellungen nachweisen. Ziel dieses Aufsatzes ist es, diesem Widerspruch nachzugehen. Im Folgenden werden wir aufzeigen, welche Faktoren die Anbieter kieferorthopädischer Leistungen beeinflussen, welches die entscheidenden Gründe und Grundlagen für die Behandlung sind und an welchen Kriterien sich die Leistungsübernahme durch die Krankenkassen orientiert. Dabei wird deutlich werden, dass die formalen Kriterien von Behandlung und Kostenübernahme, die tatsächliche Behandlungs- und Kostenerstattungspraxis, die Erwartungen derjenigen, die Behandlungsleistungen in Anspruch nehmen und der aktuelle Stand der Forschung zu erwartbaren Funktionsbeeinträchtigungen durch Zahnstellungsvariationen nicht zwanglos zu vereinbaren sind. Erforderlich erscheint ein interdisziplinärer normativer Diskurs über die Frage, wie die diagnostizierten Spannungen aufzulösen wären. Als Anregung für einen solchen Diskurs werden wir im Ausblick alternative Lösungsstrategien vorstellen. (shrink)

In this article I discuss the history of Italian Jews from the Emancipation to the racial laws of 1938 and their present-day attitudes to Judaism and the State of Israel. My aim is to suggest how the policy of social integration enabled Italian Jews to construct a new identity without losing their ancestral heritage. The example of Italian Jewry is relevant to understanding the growing need in today‘s European Union—now comprising 27 countries with different languages, cultures, and values—of revising the (...) concept of national identity and of exploring ways of constructing a new European identity. (shrink)

The history of Italian Jews from 1861 to 1938 is often viewed as the period in which they totally assimilated into the Italian nation. This article, however, argues that rather than their assimilation it was a period of their integration into Italian society. Various approaches to this question are presented, including a review of the literature, with a view to reconsidering the relationship between Jewish culture and Italian culture, or rather non-Jewish culture. Italian Jewish history is shown not to be (...) separated from, but to be “internal” to Italian social, cultural, and political history—part of the dynamic process of change that occurred during this period not only in Italy but throughout Europe. (shrink)

Jean Paul's novel The Life of Fibel, Author of the Bienrodische Fibel places itself in a specifi c relation to literacy by identifying the alphabet and the spelling-book as a matrix of its own production. Thus, the text refers itself and its sense-effects back to the arbitrariness of its elements and their combinatorics. Moreover, at the margins of the book, it feigns to be abandoned to the contingency of its preliteral physis which is suppressed by sense, authority, authorship and control (...) of the work. (shrink)

Jean Paul's novel The Life of Fibel, Author of the Bienrodische Fibel places itself in a specifi c relation to literacy by identifying the alphabet and the spelling-book as a matrix of its own production. Thus, the text refers itself and its sense-effects back to the arbitrariness of its elements and their combinatorics. Moreover, at the margins of the book, it feigns to be abandoned to the contingency of its preliteral physis which is suppressed by sense, authority, authorship and control (...) of the work. (shrink)

"Erscheinen und Verschwinden sind als Auf und Abtreten physische und symbolische Operationen, die sich auf die den Schauplatz abscheidend konstituierenden Grenze zwischen on-stage und backstage beziehen, aus dem das Geschehen auf der Bühne sich speist. Auftreten ist derart als ein riskanter und instabiler Vorgang zwischen Erscheinen und Verschwinden zu kennzeichnen. Am Beispiel zeitgenössischer Auseinandersetzungen mit den Bedingungen des Theaters, die die Bühne als Gefüge diverser Darstellungs-Flächen und -Räume nutzen, bekommt die Verwiesenheit der theatralen Präsentation auf das Anderswo einen spezifischen Witz (...) für das Verschwinden: was hier ›verschwindet‹ ist irgendwo anders. As entrances and exits, appearance and disappearance are physical and symbolic operations, which refer to the border between onstage and backstage that constitutes the scene and with it the action on stage. To make an entrance is thus a risky and unstable operation between appearance and disappearance. Using the example of contemporary explorations of the conditions of theater that use the stage as a structure of various presentation areas and -spaces, the dependence of the theatrical presentation on an Elsewhere produces a specific pun on disappearance: that which ›disappears‹ here is somewhere else.". (shrink)

?Starting from the literary translations and reflections on the theory of translation of Christoph Martin Wieland, this book deals with different modalities and methods of translating and transmitting? not only from language to language, but also between literary genres, epochs, knowledge formations and nations. Wieland is portrayed as an author and editor who devoted himself? with experimental openness? to a project of mediating and resolving dichotomies such as cosmopolitism and nation.".

Artikelen vanuit verschillende invalshoeken over het wezen en de oorsprong van het kwaad en de omgang ermee in verschillende culturen.

This is a welcome reprint of a book that continues to grow in importance.

Metabolic dysfunction is a ubiquitous underlying feature of many neurological conditions including acute traumatic brain injuries and chronic neurodegenerative conditions. A central problem in neurological patients, in particular those with traumatic brain injuries, is an impairment in the utilization of glucose, which is the predominant metabolic substrate in a normally functioning brain. In such patients, alternative substrates including ketone bodies and lactate become important metabolic candidates for maintaining brain function. While the potential neuroprotective benefits of ketosis have been recognized for (...) up to almost a century, the majority of work has focused on the use of ketogenic diets to induce such a state, which is inappropriate in cases of acute disease due to the prolonged periods of time (i.e., weeks to months) required for the effects of a ketogenic diet to be seen. The following review seeks to explore the neuroprotective effects of exogenous ketone and lactate preparations, which have more recently become commercially available and are able to induce a deep ketogenic response in a fraction of the time. The rapid response of exogenous preparations makes their use as a therapeutic adjunct more feasible from a clinical perspective in both acute and chronic neurological conditions. Potentially, their ability to globally moderate long-term, occult brain dysfunction may also be relevant in reducing lifetime risks of certain neurodegenerative conditions. In particular, this review explores the association between traumatic brain injury and contusion-related dementia, assessing metabolic parallels and highlighting the potential role of exogenous ketone and lactate therapies. (shrink)