Related Dilemmas Research Articles

Enacting Civic‐Minded Early Childhood Pedagogy in the Context of Chauvinistic Education Legislation

AbstractAmid efforts to limit “divisive concepts” in educational settings, this article investigates the obstruction of a civic‐focused early childhood curriculum. Joy Dangora Erickson and Winston Thompson analyze the challenges faced by a resourceful kindergarten teacher striving to uphold curriculum goals despite constraints imposed by the state legislature. Through an empirically informed exploration of political and pedagogical factors, this conceptual analysis elucidates the moral complexities of risks, costs, and outcomes as educators navigate non‐ideal political conditions. By doing so, the authors provide valuable insights to scholars and practitioners, suggesting productive avenues for future research on these and related dilemmas of practice.

Coloring Outside the Lines: Teaching Graphic Medicine as Disability Studies

The article argues for the importance of teaching undergraduate graphic medicine courses informed by disability studies. Using her experiences teaching graphic medicine classes over the last eight years, the author argues for the importance of graphic medicine courses beyond medical school curricula. This creates an opportunity not just to introduce disability studies concepts to undergraduates, but also for disability studies and graphic medicine to meaningfully illuminate each other. The article argues that framing comics through disability aesthetics and disability activism (including precepts such as access intimacy and disability justice) reveals how powerfully and consistently graphic medicine centers each. In turn, graphic medicine provides powerful opportunities to reimagine disability representation and access as aesthetics and accommodation. The article shares experiences of teaching graphic medicine, reflects on related dilemmas, and offers fruitful strategies for anyone wishing to teach graphic medicine courses informed by a disability studies approach.

Trilemma versus dilemma: Monetary autonomy and long‐term interest rate independence

AbstractThis study investigates the issue of trilemma versus dilemma in relation to monetary autonomy. We construct a long‐term interest rate independence index (LRI) apart from the conventional monetary policy independence evaluated on the basis of the short‐term interest rate independence index (SRI). LRI intends to capture the independence of domestic financial conditions and the monetary policy in a broad sense. Empirical results are as follows. On the basis of SRI, trilemma holds well, in which trade‐offs between SRI and international capital mobility and between SRI and exchange rate stability are found. This outcome is consistent with the findings of many past studies that support trilemma. However, on the basis of LRI, dilemma holds after the global financial crisis because only the trade‐off between LRI and international capital mobility exists. This result is consistent with the conclusion of Rey (2013), which emphasized the huge effects of the global financial cycle on the domestic financial condition owing to the integration of international financial markets. Empirical results settle the issue between trilemma and dilemma.

A Study on Perceptions of Undetectable = Untransmittable Among Gay Men with Human Immunodeficiency Virus in the HIV Community on Twitter in Japan: An Exploratory Qualitative Study Using a Modified Grounded Theory Approach.

This study explores the perceptions of the Undetectable = Untransmittable (U = U) campaign among gay men with HIV in Japan who are part of the HIV community on Twitter. We conducted detailed semistructured interviews with 12 participants using a modified grounded theory approach. The analysis resulted in 31 concepts, 5 subcategories, 9 categories, and 2 core categories. The relationship between categories and core categories was examined in conjunction with the transcriptions, yielding a comprehensive category map depicting the process of understanding U = U. The three main processes emerged: participants expressed "expectations for improvement," underwent stages of "understanding U = U," and encountered "dilemmas" in forming their opinions. There are two routes to "understanding U = U": Route 1 involved a frictionless understanding of U = U, and Route 2 involved difficulty in understanding the slogan. In both routes, participants experienced the dilemma of "but I still have HIV" and regarding its ease of use. These dilemmas and difficulties in understanding U = U affected their "expectations for improvement." Efforts to promote U = U in Japan must address challenges in public understanding and related dilemmas. This entails reformulating the U = U message in simpler terms, leveraging professional explanations, disseminating it to a broader audience, and incorporating ideas from individuals living with HIV to enhance the message.

NATO's new front: deterrence moves eastward

Abstract Why has NATO taken so long in adapting its deterrence strategy to Russian revisionism and extending its military presence to the eastern allies? The setting up of NATO's Enhanced Forward Presence (eFP) in Poland and the Baltic states offers a critical case for examining the changing understandings of allied deterrence in the post-post-Cold War era. eFP is a story of negotiating the political acceptability and military credibility of NATO's modern extended deterrence strategy in the exposed eastern flank, and the navigation of the alliance security dilemma in relation to Russia while buttressing the eastern allies' physical and NATO's ontological security. This article traces NATO's extended conventional deterrence posture in the eastern flank from the adoption of the tripwire model shortly after Russia's annexation of Crimea to the commitment to defend ‘every inch of Allied territory’ via embracing the forward defence stance in 2022. Mapping the evolutionary curve of NATO's post-enlargement politics of deterrence through documentary analysis and interviews with diplomats and military representatives in NATO headquarters and national capitals, the article makes two contributions. Conceptually, it dissects the political rationalities and historical analogies underpinning contemporary allied deterrence strategy and posture in NATO's eastern frontline. Empirically, the study illustrates how allied deterrence is made to matter on the ground, and why this matters for deterrence credibility.

The Agency Problem: Examining the Dilemma Between Shareholder and CEO Bonus Structures

The principal-agent problem is a well-known issue that arises when one party hires another party to act on their behalf, but the interests of the two parties are not perfectly aligned. When there is information imbalance between the principal and the agent, or when one party has more or better information than the other, this frequently occurs. The principal-agent dilemma in relation to information asymmetry is the main topic of this essay, which is a pervasive issue in various industries and has significant impacts on firm performance and dividend policies. By analyzing and synthesizing previous literature, the paper identifies that agency problems can lead to moral hazard and agency-costs-related issues, which in turn can negatively affect the financial outcomes of the firm. To tackle these problems, the paper proposes three potential solutions, equity incentives and debts, external auditors and consultants, and ownership and board structure. These solutions are effective in reducing agency problems. Moreover, the paper discusses how these solutions can be tailored to different contexts and industries. The proposed solutions can effectively alleviate agency problems, but they need to be implemented appropriately and tailored to specific contexts. To investigate the viability and efficacy of these solutions in various contexts, more study is required.

Cooperative Dilemmas with Binary Actions and Multiple Players

The prisoner’s dilemma, the snowdrift game, and the stag hunt are two-player symmetric games that are often considered as prototypical examples of cooperative dilemmas across disciplines. However, surprisingly little consensus exists about the precise mathematical meaning of the words “cooperation” and “cooperative dilemma” for these and other binary-action symmetric games, in particular when considering interactions among more than two players. Here, we propose definitions of these terms and explore their evolutionary consequences on the equilibrium structure of cooperative dilemmas in relation to social optimality. We show that our definition of cooperative dilemma encompasses a large class of collective action games often discussed in the literature, including congestion games, games with participation synergies, and public goods games. One of our main results is that regardless of the number of players, all cooperative dilemmas—including multi-player generalizations of the prisoner’s dilemma, the snowdrift game, and the stag hunt—feature inefficient equilibria where cooperation is underprovided, but cannot have equilibria in which cooperation is overprovided. We also find simple conditions for full cooperation to be socially optimal in a cooperative dilemma. Our framework and results unify, simplify, and extend previous work on the structure and properties of cooperative dilemmas with binary actions and two or more players.

How to Develop Organizational Forms for a Successful Digital Transformation? Findings from Two Case Studies

AbstractPrevious research has increased our understanding of individual digital transformation (DT) activities, roles, responsibilities, and related dilemmas, yet a comprehensive insight is missing with respect to the organizational forms that are most appropriate for developing the capabilities needed for successful DT. The purpose of this paper is to identify the main organizational characteristics and organizational forms for a successful DT and to identify influential factors that impact decisions about suitable organizational forms. Drawing on two case studies, we look at how companies can develop digital capabilities through different configurations of organizational forms. Findings show that decisions on organizational forms have to be influenced by digital culture, IT department’s role, and the goals of DT. Moreover, top management leadership is more important than a formal digital strategy, and DT projects must be executed by coordinated interdisciplinary teams. The presented research offers a comprehensive insight on how companies can develop digital capabilities that enable a successful DT by developing their organizational forms, i.e., by combining the different DT actions, actors, their roles and responsibilities, their interplay, implementing DT strategies, and combining the design of digital software solutions with the design of organizational routines and practices.

Why Should Health Researchers Use Policy Theories? Comment on "Modelling the Health Policy Process: One Size Fits All or Horses for Courses?"

Powell and Mannion suggest that 'health policy process' research should draw more lessons from 'the wider policy process literature.' While health research could continue with sector specific models, the wider literature is 'conceptually stronger.' In that context, I clarify how and why health researchers should use policy theories. I describe a review of the use of policy theories in public health research to show that many researchers use them to not only understand policy-making but also influence policy and policy-making. Most policy theories are not designed for that purpose, but it is still possible to produce practical lessons. I outline the issues that arise when repurposing theory-informed insights, such as that policy change takes a long time, and the scale of policy-making is potentially overwhelming. I then highlight the valuable role of theories in raising dilemmas in relation to modes of governance and evidence production.

Václav Havel’s Search for Emancipatory Governmentality

ABSTRACT This paper deals with the political philosophy of Václav Havel, mainly its relation to ethics and what Michel Foucault called governmentality. Besides using his analytical framework, Foucault’s politics are engaged with to highlight similar trajectories of two intellectuals dealing with related dilemmas of ethics and politics. As a dissident of communist Czechoslovakia Havel, developed a profound critique of modernity, but also discovered technologies of the self, exclusive to dissidents, which empowered them in their moral struggle against the regime. The Velvet Revolution in 1989 ascended Havel to the presidency of the republic, a position from which he quickly embraced and disseminated neoliberal governmentality. The final section deals with Havel’s use of human rights in the later years of his presidency, being a justification for military interventions and comparing them to Foucault’s conceptualisation of rights. Human rights discourse is the culmination of Havel’s lifelong quest for the ethical foundation of politics and it is the source of most difficulties and potentialities associated with this project.

Enlisted in struggle

Abstract In this article, I analyze Marxist activists’ narratives of becoming Marxist and their practices in activist spaces. Drawing on Jeffrey Juris and Alex Khansnabish's notion of “militant ethnography” and on Jodi Dean's recuperation of the political party form of organizing, I ethnographically describe activists’ motivations to become Marxist and examine two events—a pro-Bernie political meeting and an anti-Trump rally—in which activists intervened with the Marxist idea of “uniting working-class struggles” in democratic spaces. I argue that the socialist party form of organization addresses two related dilemmas that anti-capitalist activists face in the context of systemic economic and political crises in the United States: how to develop class consciousness and how to engage in the seemingly impossible, personally risky endeavor of radically challenging capitalism.

The dilemma of France's relations with Africa in the 21st century: the relationship between discourse and practice

The object of the study is the foreign policy of the French Republic. The subject of the study is the African vector of France's foreign policy in the 21st century during the presidencies of N. Sarkozy, F. Hollande and the current head of state E. Macron. The purpose of the study is to identify the reasons why France faced difficulties in the African direction of its foreign policy in the 21st century. The author analyses in detail the declarative and practical components of French policy towards Africa in the period under study. Particular attention is paid to the evolution of French military intervention in Africa between 2007 and 2023. The novelty of the study lies in the fact that the study makes a comparative analysis of the discursive and practical dimensions of French policy towards Africa between 2007 and 2023 in order to identify possible reasons for the failure of France's policy course towards Africa in the 21st century. The study concludes that France, which has a long history of colonisation of Africa, still does not consider Africa as an equal partner, while the African dimension of French foreign policy is characterised by a contradiction between its declarative and practical components, as the declared principle of equality as the basis of Franco-African relations actually gives way to the traditional policy of spheres of influence and France's desire to maintain its position on the African continent.

Neke pravne nedoumice u vezi sa zabranom zapošljavanja

In 2013, the National Assembly of the Republic of Serbia passed amendments to the Budget System Law prescribing the measure of the moratorium on employment in public services. The implementation of this measure was directed towards controlling (i.e. cutting) expenses and reducing the number of employees in the organizations financed from the government budget. Despite the analysis of the measure under scrutiny pointing out a lack of systematic, argumented and reliable reports and objective analyses of both positive and negative consequences of this decision, it appears that its application was associated with more negative consequences than positive ones whilst the largest and most significant effects were suffered by the sectors of healthcare, social protection and education. In addition, the negative consequences of the measure had a direct impact on women and young members of the workforce. The extension of this measure, in several iterations, has manifested itself through significant obstacles in the provision of services as well as a reduction in the quality of these services. Therefore, it is worthwhile to examine the content and the consequences of the application of the measure of the moratorium on public employment, certain legal dilemmas in relation to it, as well as whether the autonomy of public services has been restored following its repeal.

Contested Narratives of the Pandemic Crisis

This paper seeks to open a discussion about the role played by the extreme right within the contemporary ‘anti-vaxxer’ movement as it has developed during the recent Covid-19 pandemic. While supporters of this movement are politically diverse, we see the far right as having used the Covid crisis as a significant opportunity to place their conspiratorial narrative before a wider audience, where a rhetoric of victimisation around pandemic related restrictions masks their deep authoritarianism and profound racism and misogyny. We discuss ‘white replacement’ theory as the key idea animating the contemporary far right, in both its secular and religious manifestations, and we argue that this theory has offered the framework for the far right’s opposition to vaccinations and public health related restrictions. Throughout the pandemic, the far right’s use of conspiracy theory and calculated disinformation – particularly online – has thrown up considerable dilemmas in relation to issues of freedom of speech for progressives. We conclude by discussing how the feminist anti-racist left must continue to defend freedom of speech in the face of this, but this understanding needs to be informed by a conception of the ‘common good’.

ACADEMIC EXPATRIATION INTO EUROPEAN UNIVERSITIES: APPLICATION OF PERSON IN ENVIRONMENT THEORY

Academic staffs migrate from one institution to another, some within the same country while some academics migrate to foreign institutions. Academic migration to foreign institutions entails greater challenges due to various factors including different national policies, language and cultural adaptations. Based on the theoretical concept of "person-in-environment", this research focused on three factors that would appeal to foreign academics who seek engagement with universities in the European Union countries, i.e. 1) accessibility to rules of conducts at EU universities, 2) understandable languages for foreign academics, and 3) organizational units assisting with the integration of foreign academics. Thirty-one universities from countries within the EU were randomly selected for the purpose of data collection. A formal analysis was carried out on the selected university websites to assess both the presence and the extend of the three factors of this research. The findings show the existence of ethical principles in the universities’ internal rules and practical manuals available to help solve situations associated with foreign academics adaptation into the work and social environment. However the availability of such support is not adequately available in all institutions and are limited in many institutions. Comprehensive support is found in the four universities - the University of Limerick in Ireland, the University of Heidelberg in Germany, the University of Malta, and the University of Utrecht in the Netherlands. The Swedish University of Linköping also has rules in place for whistleblowing, paving the way for other EU universities to emulate. The ethics of the 21st century will have to address new situations, and dilemmas in relation to migration, and different values among social, cultural, and religious backgrounds. This article provides guidelines for better integration in the working environment abroad by introducing the three factors for integration, and points out the need to shift basic standards into practice to cater for better assimilation of expats into host country environment.

P32 Therapeutic dilemma due to gut complications with spondyloarthritis

Introduction/BackgroundTumor necrosis factor (TNF) inhibitor therapy is one of the primary modalities of treating spondyloarthritis. However, infections secondary to biologic use is a common complication. Clostridium difficile is a gut colonizer which may become pathogenic in the presence of dysbiosis and antibiotic use. Symptomatic clostridium difficile infection(CDI) due to adalimumab(ADA) use causing lymphocytic colitis(LC) is rarely reported. We present a case of axial plus peripheral spondyloarthritis on adalimumab who developed CDI and presented a therapy related dilemma.Description/MethodWe present a case of a 52-year-old lady who was diagnosed as HLAB27 positive axial spondyloarthritis with bilateral sacroiliitis on MRI bilateral sacroiliac joint in 2016. She failed two non-steroidal antinflammatory drugs (NSAID) with high disease activity scores(BASDAI 8.6, BASFI 6.2, Spinal VAS 9). She was eventually initiated on injection adalimumab in 2017. There was clinical improvement after 6 months of initiating ADA. Repeat MRI spine and SI joint showed resolution of inflammatory changes with adalimumab. Sulfasalazine was added in the treatment protocol due to peripheral arthralgia, however she developed a drug rash to it and it was stopped. In September 2021, she developed recurrent non-bloody watery diarrhoeal episodes. Adalimumab was stopped and she tested positive for Clostridium difficile on three occasions. She received multiple courses of vancomycin, fidoxamycin and metronidazole with partial resolution of diarrhoea. Adalimumab was rechallended in January 2022 since her disease activity was worsening in the absence of NSAID and biologic use. However, it was paused again due to worsening of diarrhoea. Gastroenterology conducted a Colonoscopy and biopsy of colonic polyps which showed increased number of intraepithelial lymphocytes with no thickening of subepithelial collagen plate suggestive of lymphocytic colitis (LC). It was postulated that CDI may have been the trigger for her LC. She has been started on local corticosteroid therapy(budesonide) for her LC. At this junction, we were faced with the decision of restarting adalimumab for her which may have been the original cause of her CDI.Discussion/ResultsWe present this case in view of a dilemma regarding which problem occurred first Did immunosuppression due to adalimumab lead to CDI? Literature is not suggestive of increased risk of CDI with adalimumab, especially in a non-inflammatory bowel disease (IBD) background. Was the lymphocytic colitis triggered by the CDI or was clostridium difficile just incidentally detected on a background of LC? There is a well documented associated of LC with autoimmune conditions and use of NSAIDs along with proton pump inhibitor is another trigger for it. TNF alpha inhibitor is one of the treatment modalities of refractory LC. Would it be appropriate to restart ADA for her since she responded well despite there being a risk of recurrence of a CDI? Finally, what is the role of gut dysbiosis in the role of CDI and LC in this situation. Presently, she is planned to be treated with local steroid therapy for her LC. ADA will be rechallenged once her gut has responded to the steroid course. In the event of her gut worsening on a rechallenge, she will be given a trial of Infliximab.Key learning points/ConclusionThe case highlights the crucial point of thinking of causes of diarrhea apart from well documented conditions of ulcerative colitis/Crohn’s disease in an immunosuppressed spondyloarthritis patient. A detailed stool examination including bacterial and parasitic examination is crucial in recurrent diarrhea. The threshold for colonoscopy should be low when episodes are refractory to treatment. The case-based conference gives us an opportunity to receive feedback regarding further management approaches in this case.

The Goldilocks of Social Justice Education: Balint Groups as a Curricular Intervention to Support Equitable Health Care.

While there is consensus within the medical profession on the importance of ensuring future physicians are well versed in issues of social justice, there is little consensus on how to best achieve this. Traditional methods of didactic lectures or case-based learning, with an emphasis on the transmission of knowledge, run the risk of reinforcing the very inequities they are aiming to disrupt. The classroom experiences do not call on trainees to act on issues of social justice beyond discussing imagined actions in a carefully constructed case. Balint Groups offer an alternate pedagogy that align with a more interpretative style of teaching and offer an opportunity for meaningful engagement with issues of social justice. In Balint Groups, students are engaged in cases where the presenter has participated directly in the clinical encounter. While these cases tend to focus on relational dilemmas between the doctor and patient, the dilemma can also highlight an internal dilemma between competing professional identities - such as the biomedical expert and the socially conscious professional. Imagined agency is removed and the group is tasked with reflecting on the dissonance created by these two competing identities. While the use of Balint Groups as a curricular intervention offers exciting opportunities to promote social justice, there are cautions. First, Balint Groups operate within the dominant discourse of medical education and facilitators must be sensitive to how this may position the presenter; second, it cannot be forced - it must arise from the case presented.

Civilization dilema of quality of life

The results of human biological and cultural evolution are currently at odds. A prosperous consumer lifestyle as a result of cultural evolution does not provide enough of the adaptive stimuli that man claims as a result of natural biological evolution. The aim of this article is to define civilization dilemmas in relation to the quality of life of modern man. The chosen methods were the methods of analysis, synthesis, induction and deduction applied to the method of anchored theory in the sense of studying the concept as the main category, as well as causal and operational thinking. A synthesis of evidence and a critical and reproducible summary of the results of available publications on the subject were performed as well. The results of the study provide knowledge that quality longevity (delaying senescence) requires a certain degree of hormetic stress, especially in the area of ​​caloric restriction, physical and mental exertion and hardening (salutogenetic quadrivium). The first dilemma analyzed is the autodeterministic discomfort self-limitation of the ascetic type. Within the framework of cognitive dissonance and causal attribution, it leads to the question of whether the advanced discomfort will be balanced by a subsequent comfortable life. The second dilemma analyzed is the use of technological possibilities of biotracking (BZV, biomonitoring), which will be increasingly, in accordance with the progress of knowledge, offered in deciding on the nature of necessary human activities, which can be interpreted as a restriction on freedom of decision. Conclusions: The analyzed dilemmas will increasingly affect a person's quality of life in their self-limiting form.

CIVILIZATION DILEMMA OF QUALITY OF LIFE

The results of human biological and cultural evolution are currently at odds. A prosperous consumer lifestyle as a result of cultural evolution does not provide enough of the adaptive stimuli that man claims as a result of natural biological evolution. The aim of this article is to define civilization dilemmas in relation to the quality of life of modern man. The chosen methods were the methods of analysis, synthesis, induction and deduction applied to the method of anchored theory in the sense of studying the concept as the main category, as well as causal and operational thinking. A synthesis of evidence and a critical and reproducible summary of the results of available publications on the subject were performed as well. The results of the study provide knowledge that quality longevity (delaying senescence) requires a certain degree of hormetic stress, especially in the area of ​​caloric restriction, physical and mental exertion and hardening (salutogenetic quadrivium). The first dilemma analyzed is the autodeterministic discomfort self-limitation of the ascetic type. Within the framework of cognitive dissonance and causal attribution, it leads to the question of whether the advanced discomfort will be balanced by a subsequent comfortable life. The second dilemma analyzed is the use of technological possibilities of biotracking (BZV, biomonitoring), which will be increasingly, in accordance with the progress of knowledge, offered in deciding on the nature of necessary human activities, which can be interpreted as a restriction on freedom of decision. Conclusions: The analyzed dilemmas will increasingly affect a person's quality of life in their self-limiting form.

Ethical dilemmas and care actions in nurses providing palliative sedation.

Recently, palliative care is increasingly important, with an emphasis on the process of dying with dignity. However, nurses who care for such patients experience the associated ethical dilemmas. To explore the meaning of nurses' experiences in dealing with ethical dilemmas in relation to palliative sedation. A qualitative research design was employed with a thematic analysis approach. Using purposive sampling, 15 nurses, working at palliative care units for at least 1year, were recruited as participants. Data were collected using unstructured in-depth interviews, and data collection and analysis was performed simultaneously. Ethical approval was obtained from the authors' institutional review board. All participants provided informed consent. For the face-to-face interview, the South Korean standard COVID-19 quarantine guidelines, such as mandatory masking and social distancing, were followed. Dilemmas raised by patients, were related to concerns about appropriate drug dose; dilemmas raised by nurses, were related to passive care, sense of guilt for failure to predict death, and colleague's disrespectful attitudes toward patients; dilemmas from patients' families were related to demands for palliative sedation and reversal of those demands. Care actions to deal with ethical dilemmas comprised evidence-based care, person-centered thinking, reflecting on the death situation, compassion, providing explanation and help to family members. Nurses' ethical dilemmas were pre-dominantly influenced by themselves, rather than by the patients or their families, especially if they felt they could not do their best for patients. The core concept of care actions to deal with the ethical dilemmas, was person-centered care and compassion. Then, how patients and their family members perceive person-centered care and compassion, should be further explored to improve palliative sedation.