IntroductionThe objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals.MethodsParticipants from within Baylor Health Care System completed an online seven-point Likert scale (range, 0 to 6) moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant’s discipline. Higher scores reflected greater intensity and/or frequency of moral distress.ResultsMore than 2,700 healthcare professionals responded to the survey (response rate 18.14 (...) percent); survey respondents represented multiple healthcare disciplines across a variety of settings in a single healthcare system. Intensity of moral distress was high in all disciplines, although the causes of highest intensity varied by discipline. Mean moral distress intensity for the nine core scenarios was higher among physicians than nurses, but the mean moral distress frequency was higher among nurses. Taking into account both intensity and frequency, the difference in mean moral distress score was statistically significant among the various disciplines. Using post hoc analysis, differences were greatest between nurses and therapists.ConclusionsMoral distress has previously been described as a phenomenon predominantly among nursing professionals. This first-of-its-kind multidisciplinary study of moral distress suggests the phenomenon is significant across multiple professional healthcare disciplines. Healthcare professionals should be sensitive to situations that create moral distress for colleagues from other disciplines. Policy makers and administrators should explore options to lessen moral distress and professional burnout that frequently accompanies it. (shrink)

We study the groups Gal L and Gal KP, and the associated equivalence relations EL and EKP, attached to a first order theory T. An example is given where EL≠ EKP. It is proved that EKP is the composition of EL and the closure of EL. Other examples are given showing this is best possible.

La evaluación constituye un elemento curricular decisivo para mejorar el aprendizaje del alumnado, siempre que se utilice de modo continuo y con carácter formativo. La evaluación formativa evalúa procesos, ofreciendo datos permanentes acerca de cómo se produce paso a paso ese aprendizaje, permitiendo así detectar las dificultades que se presentan y los talentos del alumnado y adoptar las medidas adecuadas de modo inmediato. Este planteamiento favorece la personalización de la evaluación y, con ello, la atención a cada estudiante en función (...) de sus peculiaridades, garantizando la inclusión educativa de calidad para todos. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

A model $M$ of countable similarity type and cardinality $\kappa$ is expandable if every consistent extension $T_{1}$ of its complete theory with $|T_{1}|\leq \kappa$ is satisfiable in $M$ and it is compactly expandable if every such extension which additionally is finitely satisfiable in $M$ is satisfiable in $M$ . In the countable case and in the case of a model of cardinality $\geq 2^{\omega}$ of a superstable theory without the finite cover property the notions of saturation, expandability and compactness for (...) expandability agree. The question of the existence of compactly expandable models which are not expandable is open. Here we present a test which serves to prove that a compactly expandable model of cardinality $\geq 2^{\omega}$ of a superstable theory is expandable. It is stated in terms of the existence of a certain elementary submodel whose corresponding theory of pairs of models satisfies a weak elimination of Ramsey quantifiers. (shrink)

In this paper, we describe the use of legal ontologies as a basis to improve IT support for professional judges. As opposed to most legal ontologies designed so far, which are mostly based on dogmatic and normative knowledge, we emphasize the importance of professional knowledge and experience as an important pillar for constructing the ontology. We describe an intelligent FAQ system for junior judges that intensively use the ontology.

A Steiner triple system (STS) is a set S together with a collection B of subsets of S of size 3 such that any two elements of S belong to exactly one element of B. It is well known that the class of finite STS has a Fraïssé limit M_F. Here, we show that the theory T of M_F is the model completion of the theory of STSs. We also prove that T is not small and it has quantifier elimination, (...) TP2, NSOP1, elimination of hyperimaginaries and weak elimination of imaginaries. (shrink)

There has been considerable research on confusion and frustration that has treated them as two unitary constructs, distinct from each other. In this article, we argue that there is instead a constellation of different types of confusion and frustration, with different antecedents, manifestations, and impacts, and that the commonalities between many types of confusion and frustration justify thinking of them as part of the same constellation of affect, distinct from other prominent affective categories. We discuss how these types of affect (...) have been considered historically and in key models. We then discuss unusual manifestations of each form of affect that have been documented in the literature, and what light they shed on the broader constructs. We conclude with a discussion of a new theoretical framing that treats confusion and frustration as a confrustion constellation, and the opportunities and open questions that this perspective presents. (shrink)

A simplified definition of point local clocks and the relationship between an inertial reference frame and a class of such clocks, at rest with respect to each other, are used for an algebraic determination of the geometry of Minkowski's space-time on the set of point events. The group of all automorphisms that preserve the time ordering induced by the set of all equivalent local clocks is shown to be generated by the inhomogeneous orthochronous Lorentz group and dilatations, consistently with a (...) well-known result of E. C. Zeeman. The existence of a universal limit velocity and of an invariant clock cone through any event is among the implications of our proof, thus effectively exploiting a suggestion due to F. Severi. (shrink)

بالحرف نفهم الوجود، ونكتشفُ مُعَمَّيَاتِه وملابساته.فالوجود حرف، والحرف وجود، فهما معا يتماهيان، وهما معا يتبادلان الأدوار في مرآة الحياة والذاكرة والدين والأسطورة و المخيال، وفي فضاء الترميز بالقوة القَوَوِيَّةِ والتجريد المتعالي. وإذا كانت حبة الرمل تختزن الصحراء وتؤشر عليها، وقطرةُ الماء تختزل البحرَ وتومئ إليه، ونبضةُ العِطر تحوز الأزهارَ وتدل عليها، فإن الحرف هو كذلك يمثِّل كثافة الوجود في أعالي أعاليها، فهو الشجرة الرامزة إليه أونطولوجيا. إذْ من هذه الشجرة خرج الأمر الإلهي، فصار كونا ووجودا هو عبارة عن شجرة الكون (...) التي يُجَسِّد كل جزء من أجزائها حرَكِيَّةَ الوجود، وتوهجَ اختلافاته، وتناغمَ إيقاعاته، وتشابكَ دلالاته. إن الوجود حرف لا تكون الكتابة إلا به، والخلْق كتابة، والكتابة غرْسٌ، والغرس نفْسٌ، والنفْس وجود.وهكذا تبتدئ دائرة الوجود بالحرف وتنتهي به وإليه، فخلْقُ آدم وتركيبُه له دلالة على هذا المَنْحَى، فهو وسلالته يشبهان رمزيا في حياتهما حروفَ الأبجدية في بدايتها ونهايتها، فهما يدخلان إلى هذه الحياة على شكل ألِفٍ، ويخرجان منها على شكل ياءٍ.فالعِلم بالأسماء موضوع في قلب آدم، وتصْويرُها في صدره، وتعبيرها فيما بين حلْقه إلى شفتيه، فالقلبُ طَرَفٌ للعلْم، والصدر طَرَفٌ للتصاوير، والفم طَرَفٌ للتعبير. فالعالمُ في أول ظهورٍ له كان على صورة الإنسان، وصورة الإنسان هي صورة الحق. فصورتُه التي على صورة الحق تُؤَهِّلُه لمعرفة الحق من خلال معرفته لذاته الإنسانية. (shrink)

Introduction: Uncertainty is omnipresent in cancer care, including the ambiguity of diagnostic tests, efficacy and side effects of treatments, and/or patients' long-term prognosis. During second opinion consultations, uncertainty may be particularly tangible: doubts and uncertainty may drive patients to seek more information and request a second opinion, whereas the second opinion in turn may also affect patients' level of uncertainty. Providers are tasked to clearly discuss all of these uncertainties with patients who may feel overwhelmed by it. The aim of (...) this study was to explore how oncologists communicate about uncertainty during second opinion consultations in medical oncology.Methods: We performed a secondary qualitative analysis of audio-recorded consultations collected in a prospective study among cancer patients who sought a second opinion in medical oncology. We purposively selected 12 audio-recorded second opinion consultations. Any communication about uncertainty by the oncologist was double coded by two researchers and an inductive analytic approach was chosen to allow for novel insights to arise.Results: Seven approaches in which oncologists conveyed or addressed uncertainty were identified: specifying the degree of uncertainty, explaining reasons of uncertainty, providing personalized estimates of uncertainty to patients, downplaying or magnifying uncertainty, reducing or counterbalancing uncertainty, and providing support to facilitate patients in coping with uncertainty. Moreover, oncologists varied in their choice of words/language to convey uncertainty.Discussion: This study identified various approaches of how oncologists communicated uncertain issues during second opinion consultations. These different approaches could affect patients' perception of uncertainty, emotions provoked by it, and possibly even patients' behavior. For example, by minimizing uncertainty, oncologists may consciously steer patients toward specific medical decisions). Future research is needed to examine how these different ways of communicating about uncertainty affect patients. This could also facilitate a discussion about the desirability of certain communication strategies. Eventually, practical and evidence-based guidance needs to be developed for clinicians to optimally inform patients about uncertain issues and support patients in dealing with these. (shrink)

Firms’ real estate choices significantly affect their sustainability, due to real estate’s impact on the natural environment. This paper investigates the ecological responsiveness of firms in specific industries by analyzing the decisions these firms make in occupying office space. We analyze the decisions of more than 11,000 tenants to choose office space in green buildings or in, otherwise comparable, conventional buildings nearby. Controlling for building quality and location, we find that corporations in the oil and banking industries, as well as (...) non-profit organizations, are among the most prominent green tenants. Furthermore, measures of an industry’s human capital intensity are positively related to the propensity to lease green office space. These empirical findings confirm the theoretical framework on economic advantage and institutional pressure as important determinants for the ecological responsiveness of firms. (shrink)

It is the intention in this article to explain the electoral stagnation of the Republican People’s Party (Cumhuriyet Halk Partisi, CHP) in the light of the 2015 parliamentary elections in Turkey. Drawing on theories of voting behavior, the article uncovers the organizational shortcomings within the party and the problem of credibility that have emerged as significant impediments to the party in addressing long-term historical-structural issues, mainly the division of Turkish society between the religious periphery and the secular center. Furthermore, the (...) strong identification between the ruling Justice and Development Party (Adalet ve Kalkınma Partisi, AKP) and its partisans have made party-switching difficult, having been achieved, above all, through the provision of economic benefits and public services and the consolidation of party identification through growing polarization and division in Turkish politics. Last but not least, the changes to the political environment between the June 7 and November 1, 2015 elections, pushed stability and security to the top of the agenda, as well as AKP’s electoral adjustments in the run-up to the November 1 elections inhibited any possible flow of votes to the CHP. (shrink)