This intervention study examined the effects of a career crafting training on physicians' perceptions of their job crafting behaviors, career self-management, and employability. A total of 154 physicians working in two hospitals in a large Dutch city were randomly assigned to a waitlist control group or an intervention group. Physicians in the intervention group received an accredited training on career crafting, including a mix of theory, self-reflection, and exercises. Participants developed four career crafting goals during the training, to work on (...) in the subsequent weeks, after which a coaching conversation took place over the phone. Physicians in the control group received no intervention. A pre- and post-test 8 weeks later measured changes in job crafting and career self-management and employability of 103 physicians that completed the pre- and post-test. RM ANOVAs showed that the intervention enhanced perceptions of career self-management and job crafting behavior to decrease hindering job demands. No support was found for the effect of the intervention on other types of job crafting and employability. This study offers novel insights into how career crafting can be enhanced through training, as this is the first empirical study to examine a career crafting intervention. HR managers can use the outcomes to develop tailored career policies and career development practices. (shrink)

Recent analysis of genome sequences has identified individuals that are healthy despite carrying severe disease‐associated mutations. A possible explanation is that these individuals carry a second genomic perturbation that can compensate for the detrimental effects of the disease allele, a phenomenon referred to as suppression. In model organisms, suppression interactions are generally divided into two classes: genomic suppressors which are secondary mutations in the genome that bypass a mutant phenotype, and dosage suppression interactions in which overexpression of a suppressor gene (...) rescues a mutant phenotype. Here, we describe the general properties of genomic and dosage suppression, with an emphasis on the budding yeast. We propose that suppression interactions between genetic variants are likely relevant for determining the penetrance of human traits. Consequently, an understanding of suppression mechanisms may guide the discovery of protective variants in healthy individuals that carry disease alleles, which could direct the rational design of new therapeutics. (shrink)

There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with.

Patients with a life-threatening illness can be confronted with various types of loneliness, one of which is existential loneliness (EL). Since the experience of EL is extremely disruptive, the issue of EL is relevant for the practice of end-of-life care. Still, the literature on EL has generated little discussion and empirical substantiation and has never been systematically reviewed. In order to systematically review the literature, we (1) identified the existential loneliness literature; (2) established an organising framework for the review; (3) (...) conducted a conceptual analysis of existential loneliness; and (4) discussed its relevance for end-of-life care. We found that the EL concept is profoundly unclear. Distinguishing between three dimensions of EL—as a condition, as an experience, and as a process of inner growth—leads to some conceptual clarification. Analysis of these dimensions on the basis of their respective key notions—everpresent, feeling, defence; death, awareness, difficult communication; and inner growth, giving meaning, authenticity—further clarifies the concept. Although none of the key notions are unambiguous, they may function as a starting point for the development of care strategies on EL at the end of life. (shrink)

Patients with a life-threatening illness can be confronted with various types of loneliness, one of which is existential loneliness (EL). Since the experience of EL is extremely disruptive, the issue of EL is relevant for the practice of end-of-life care. Still, the literature on EL has generated little discussion and empirical substantiation and has never been systematically reviewed. In order to systematically review the literature, we (1) identified the existential loneliness literature; (2) established an organising framework for the review; (3) (...) conducted a conceptual analysis of existential loneliness; and (4) discussed its relevance for end-of-life care. We found that the EL concept is profoundly unclear. Distinguishing between three dimensions of EL—as a condition, as an experience, and as a process of inner growth—leads to some conceptual clarification. Analysis of these dimensions on the basis of their respective key notions—everpresent, feeling, defence; death, awareness, difficult communication; and inner growth, giving meaning, authenticity—further clarifies the concept. Although none of the key notions are unambiguous, they may function as a starting point for the development of care strategies on EL at the end of life. (shrink)

This chapter focuses on the dialectic of desire in She Came to Stay. What it seeks to show is that this dialectic is not strictly a Hegelian or Kojèvean one but in fact introduces a similar transformation of this dialectic similar to the one we find in Lacan. As such, She Came to Stay is not an incomplete or insufficient restaging of the dialectical constitution of the subject of consciousness; instead it presents the dialectic of desire as constitutive of a (...) split subject – what Lacan will describe as the subject of the unconscious. This chapter interprets Beauvoir's account of the dialectic of desire in She Came to Stay in Lacanian terms, and to take up The Second Sex in light of this thesis. (shrink)

Although sexual difference is widely regarded as the concept that lies at the center of Luce Irigaray's thought, its meaning and significance is highly contested. This dissensus, however, attests to more than merely the existence of a recalcitrant conceptual ambiguity. That is, Irigaray's discussion of sexual difference remains fraught not because she leaves this concept undefined but because the centrality of sexual difference in fact marks a complex and unstable nexus of phenomena that shift throughout her work. Consequently, if Irigaray (...) is indeed the preeminent thinker of sexual difference, this is not in virtue of her recurrent appeal to a monolithic, readily digestible concept but rather somehow despite the absence of precisely this gesture. In this paper, I will attempt to elucidate the peculiar preeminence of sexual difference in Irigaray's work by identifying her persistent, though largely unexamined, commitment to transcendental phenomenology. Indeed, I attempt to show that the complex of phenomena of sexual difference emerges in L'oubli de l'air and The Way of Love as a modulation of Heidegger's own revision of transcendental phenomenology. In this sense, the peculiar preeminence of sexual difference does not mark the centrality of a concept but Irigaray's amplification of this Heideggerian gesture. (shrink)

Animating Luce Irigaray’s oeuvre are two indissociable projects: the disruption of Western metaphysics and the thinking of sexual difference. The intersection of these two projects implies that any attempt to think through the meaning and significance of Irigaray’s notoriously fraught invocation of sexual difference must take seriously the way in which this invocation is itself always already inflected by her disruptive gesture. In this paper, I will attempt to elucidate one moment of this intersection by focusing on her critical engagement (...) with Heidegger. In L’oubli de l’air, Irigaray criticizes Heidegger’s interpretation of the principle of identity as instantiating the same neglect of sexual difference that has been inscribed throughout the history of Western metaphysics. Moreover, Irigaray identifies the vestigial traces of this metaphysical legacy in Heidegger’s commitments to phenomenology. My claim, however, is that if we turn to Derrida’s second Geschlecht essay in order to mediate between Irigaray and Heidegger, the coimplicative nature of their projects comes into focus: on one hand, Derrida identifies within Heidegger’s work an incipient articulation of the very notion of sexuate difference that, on Irigaray’s reading, Heidegger’s work requires but nonetheless elides; on the other hand, Derrida’s rereading of Heidegger’s phenomenological commitments corroborates the philosophical significance of Irigaray’s intervention by recontextualizing the parameters that delimit her invocation of sexuate difference. (shrink)

Although sexual difference is widely regarded as the concept that lies at the center of Luce Irigaray's thought, its meaning and significance is highly contested. This dissensus, however, attests to more than merely the existence of a recalcitrant conceptual ambiguity. That is, Irigaray's discussion of sexual difference remains fraught not because she leaves this concept undefined but because the centrality of sexual difference in fact marks a complex and unstable nexus of phenomena that shift throughout her work. Consequently, if Irigaray (...) is indeed the preeminent thinker of sexual difference, this is not in virtue of her recurrent appeal to a monolithic, readily digestible concept but rather somehow despite the absence of precisely this gesture. In this paper, I will attempt to elucidate the peculiar preeminence of sexual difference in Irigaray's work by identifying her persistent, though largely unexamined, commitment to transcendental phenomenology. Indeed, I attempt to show that the complex of phenomena of sexual difference emerges in L'oubli de l'air and The Way of Love as a modulation of Heidegger's own revision of transcendental phenomenology. In this sense, the peculiar preeminence of sexual difference does not mark the centrality of a concept but Irigaray's amplification of this Heideggerian gesture. (shrink)

In Wrong Medicine, Lawrence J. Schneiderman, M.D., and Nancy S. Jecker, Ph.D., address issues that have occupied the media and the courts since the time of Karen Ann Quinlan. The authors examine the ethics of cases in which medical treatment is offered--or mandated--even if a patient lacks the capacity to appreciate its benefit or if the treatment will still leave a patient totally dependent on intensive medical care. In exploring these timely issues Schneiderman and Jecker reexamine the doctor-patient relationship and (...) call for a restoration of common sense and reality to what we expect from medicine. They discuss economic, historical, and demographic factors that affect medical care and offer clear definitions of what constitutes futile medical treatment. And they address such topics as the limits on unwanted treatment, the shift from the "Age of Physician Paternalism" to the "Age of Patient Autonomy," health care rationing, and the adoption of new ethical standards. (shrink)

Recent policy developments in the area of livestock husbandry have suggested that, from the perspective of optimizing animal welfare, new animal husbandry systems should be developed that provide opportunities for livestock animals to be raised in environments where they are permitted to engage in “natural behavior.” It is not known whether consumers regard animal husbandry issues as important, and whether they differentiate between animal husbandry and other animal welfare issues. The responsibility for the development of such systems is allocated jointly (...) between farmers, regulators, different actors in the food chain, and consumers. This research focuses on understanding consumer attitudes and preferences regarding the development and introduction of such systems, to ensure that they are acceptable to consumers as well as producers, regulators, and scientists. Consumer perceptions of animal welfare and animal husbandry practices were evaluated using quantitative consumer survey, which focused on two animal husbandry issues – farmed pigs and farmed fish. Following pilot work, 1000 representative Dutch consumers were sampled about their attitudes to either pig or fish husbandry. The results indicated that consumers think about animal welfare in terms of two broad categories related to their health and living environment, but do not think about welfare issues at a more detailed level. Greater concern was expressed about the welfare of pigs compared to fish. Consumer trust in labeling also emerged as an important issue, since consumers need to trust different food chain actors with responsibility for promoting animal welfare, and are reluctant to consider the details of animal husbandry systems. As a consequence, a transparent, enforceable, and traceable monitoring system for animal welfare friendly products is likely to be important for consumers. (shrink)

Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the (...) informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)