Expression Of Autonomy Research Articles

Hauora Māori – Māori health: a right to equal outcomes in primary care

BackgroundFor more than a century, Māori have experienced poorer health than non-Māori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by “failing to design and administer the current primary health care system to actively address persistent Māori health inequities”. Many Māori (44%) have unmet needs for primary care. Seven models of primary care were identified by the funders and the research team, including Māori-owned practices. We hypothesised patient health outcomes for Māori would differ between models of care.MethodsCross-sectional primary care data were analysed at 30 September 2018. National datasets were linked to general practices at patient level, to measure associations between practice characteristics and patient health outcomes. Primary outcomes: polypharmacy (≥ 55 years), HbA1c testing, child immunisations, ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Regressions include only Māori patients, across all models of care.ResultsA total of 660,752 Māori patients were enrolled in 924 practices with 124,854 in 65 Māori-owned practices.Māori practices had: no significant association with HbA1c testing, ambulatory sensitive hospitalisations or ED attendances, and a significant association with lower polypharmacy (3.7% points) and lower childhood immunisations (13.4% points).Māori practices had higher rates of cervical smear and cardiovascular risk assessment, lower rates of HbA1c tests, and more nurse (46%) and doctor (8%) time (FTE) with patients.The average Māori practice had 52% Māori patients compared to 12% across all practices. Māori practices enrolled a higher percentage of children and young people, five times more patients in high deprivation areas, and patients with more multimorbidity.More Māori patients lived rurally (21.5% vs 15%), with a greater distance to the nearest ED. Māori patients were more likely to be dispensed antibiotics or tramadol.ConclusionsMāori practices are an expression of autonomy in the face of enduring health system failure. Apart from lower immunisation rates, health outcomes were not different from other models of care, despite patients having higher health risk profiles. Across all models, primary care need was unmet for many Māori, despite increased clinical input. Funding must support under-resourced Māori practices and ensure accountability for the health outcomes of Māori patients in all models of general practice.

Understanding the Decision-Making Process of Women to Engage in Cohabiting Relationships

Despite the extensive literature on cohabitation, there is scant literature that explores women’s decisions to engage in cohabitation. Drawing on the theory of planned behaviour and a qualitative research approach, this article explores the decision-making processes among women to engage in cohabitation. For some women, cohabitation was preceded by a clear conversation about the intention to marry. The second group of women described cohabitation as an expression of autonomy and independence by rejecting traditionally prescribed conventions such as marriage. When the promise of marriage fails to materialise, some women become increasingly disillusioned and opt to terminate their co-residence relationships in order to negotiate marriage as an option with their partners. This article utilised purposively and snowball sampling to gather data and this was through semi-structured interviews. This data was analysed thematically, and the results show a preponderance of a desire for autonomy that is checked by the harsh persistence of disempowering narratives. Further research is needed to establish patterns of autonomy in cohabiting partners.

Social representations of physical education teachers concerning the game: a qualitative study in Chile

Background and Study Aim. The objective of this research was to determine the social representations of the game in physical education teachers belonging to the Chilean educational system, searching for the sense and meaning given by the educators to the game aspect.
 Material and Methods. The study sample consisted of 14 physical education teachers, who were chosen by the convenience sampling method. Semi-structured interviews were used to collect data from the participants, maintaining gender equity. The analysis of the data obtained was by means of content analysis and the NVivo 11 program was used to process the data.
 Results. Our research indicates that of the categories analyzed, the highest was the role of the game (22.29%), demonstrating the relevance given by teachers to the game in the development of meaningful learning. On the contrary, the category characteristics of the game (17.42%), describe how teachers visualize the contributions of play at the educational level, in this sense, the role of the game goes beyond motor contributions, but also provides tools for social and cognitive development.
 Conclusions. For the teachers, the game promotes autonomous and proactive actions of the students, which will be beneficial to understand that playfulness in education implies not to put in contradiction the rational and emotional faculties. This comprehensive view is called full attitude, and it is a relevant step toward the understanding of the game from a complex perspective. In this area, it is evident that, in the social representations of the participating teachers, the game constitutes a natural environment in which children develop, where the physical education teacher should create an environment that facilitates the game, facilitating the expression of autonomy, freedom, creativity, and playfulness.

Implementing Personalized Genetic Medicine

Implementing Personalized Genetic Medicine

Consent in medical practice

Consent is an expression of autonomy and represents the right of a patient to make a decision in a medical matter concerning him. Consent is not just a procedural formality but also a legal requirement. The process of informed consent occurs when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention. In India, the number of suits against doctors is increasing because of failure to take informed consent or inadequate consent from patients for various procedures. Any examination of a patient by the doctor without his consent amounts to assault (351IPC). Ignorance of laws is not a defense in negligence cases, so every practicing doctor should be aware of their responsibilities about consent in medical practice. Consent is not an option but a necessity in medical practice. Keywords: Consent; informed consent; autonomy

Rising to the Challenge: The Effect of Individual and Social Metacognitive Scaffolds on Students’ Expressions of Autonomy and Competence Throughout an Inquiry Process

Engaging students in inquiry is a key component in order to fulfill essential goals in science education. To achieve successful engagement in inquiry process, students need to feel competent and autonomous in spite of the cognitive and mental challenges the process entails. The study focuses on the problematizing mechanisms of scaffolds and highlights the centrality of metacognition in the inquiry process. The study’s primary goal was to examine how providing students involved in inquiry with individual, social, or a combination of both metacognitive scaffoldings affected their expressions of competence and autonomy. Using both qualitative and quantitative methods, we examined middle-school students’ expressions of competence and autonomy in an online asynchronous forum that accompanied a year-long socio-scientific inquiry process. The process included four research conditions which differed by the metacognitive scaffolding students received: only individual, only social, both individual and social, and no metacognitive scaffolds. Although no significance difference was observed in students’ expressions of competence in the initial phases of the inquiry among the research groups, students who received individual or social metacognitive scaffolding increased these expressions as they progressed through the process. Expressions of competence by students who received a combination of both types of support remained constant. In contrast, a significant decrease in students’ expressions of competence was observed in the control group. Regarding autonomy, students’ expressions of autonomy from all scaffolded conditions remained constant throughout the inquiry process, except for a significant decrease, experienced by students in the control group. The results are discussed through the lens of problematizing mechanism by which metacognitive scaffolding operate.

DIMENSIONAL VALIDITY OF THE INVENTORY OF ETHICAL PROBLEMS IN PRIMARY HEALTH CARE IN THE CONTEXT OF CHILDREN'S HEALTH

ABSTRACT Objective: to assess the dimensional validity and reliability of the Inventory of Ethical Problems in Primary Health Care adapted to the children's health context. Method: a cross-sectional study with 101 nurses from the Family Health Strategy Units in a city of the Brazilian Northeast region. Data collection was carried out between May 2016 and June 2017. Construct validity was assessed by means of exploratory factor analysis and reliability by verifying internal consistency using Cronbach's alpha coefficient. Results: the factor analysis revealed the multidimensionality of the Inventory of Ethical Problems in Primary Health Care-Children's Health. It consisted of 19 items, distributed into 4 factors: Factor 1 - Organization of the health system; Factor 2 - Professional Ethics; Factor 3 - Teamwork; and Factor 4 - Parents (or guardians) autonomy expression. Overall internal consistency by Cronbach's alpha and for the factors was moderate to satisfactory. Conclusion: factor analysis revealed that the inventory has a multidimensional structure with 4 factors. The study showed evidence of validity and reliability that recommends the application of the IPE-APS to the context of children's health.

Perfil e vozes dos participantes de pesquisas clínicas no Brasil

Resumo Este estudo de caso buscou traçar o perfil socioeconômico de participantes de ensaios clínicos em centro de pesquisa brasileiro, analisando suas decisões, motivações e experiências, seu conhecimento sobre riscos, benefícios e cuidados dispensados e o processo de consentimento. Dados de 327 participantes foram coletados, realizando-se entrevistas semiestruturadas com 19 deles. Nas pesquisas executadas no centro estudado houve maior participação de homens, de pessoas com poucos anos de estudo formal e de baixa renda. A maioria é aposentada, não tem assistência privada à saúde e tende a não perceber os efeitos da investigação ou superestimar os benefícios médicos diretos. A busca pelo tratamento médico foi o principal fator que influenciou suas decisões/participação, e a assinatura do termo de consentimento livre e esclarecido não garantiu a expressão da autonomia. Conclui-se que o perfil e o conteúdo dos discursos dos participantes são sensíveis indicadores de vulnerabilidade e desigualdade social.

Creative Agency in The Scarlet Letter

This article provides a critical analysis of Nathaniel Hawthorne’s employment of artistic defiance in The Scarlet Letter. In reading Hester Prynne’s artistic ability and theological dissent as tools of creative resistance, the article claims that Hawthorne uses self-expression to critique Puritan values. When Hester redesigns the symbol of the scarlet letter A that she is forced to wear as a punishment for the sin of committing adultery, the act of sewing becomes a transgressive form of resistance. By examining the way in which she transforms her symbol of shame into an expression of autonomy, I trace the spiritual significance of Hester’s resistance and Hawthorne’s statement of individualism as reflecting the Transcendentalist rhetoric of early nineteenth-century New England. Hester’s ability to transcend institutional authority to create an independent identity, in turn, cultivates an independent relationship with God. Finally, I read Hawthorne’s own parallel creative struggle as author as a metaphor for national independent identity that can be contextualised within the American Renaissance.

Dying in dignity

Abstract The question of what might constitute “good dying” is a sensitive subject that is being discussed and is socially and politically controversial. My contribution discusses whether a reference to concepts such as autonomy and dignity in the debate over suicide and euthanasia is in fact convincing. Important impulses for the train of thought stem from Kantian philosophy. I will argue that suicide, as presented by Kant, is not an expression of autonomy, but exactly the opposite: an expression of heteronomy.

Expressing Organisational Autonomy: A Case Study of South African Further Education and Training Colleges

The organisational governance of further education and training colleges in South Africa has been cited as an obstacle to the institutions’ ability to contribute to the developmental needs of the country. In response, the government has instituted major policy reforms since 1996, including a move towards granting greater organisational autonomy to these colleges, with limited success. The purpose of the study was to gain an understanding of the causes of these governance issues by examining the effect of the organisational environment, with specific focus on the power dynamics that characterised that environment between 2010 and 2012. A qualitative research approach was adopted to answer two research questions: (i) How did the concentration of power in the external environment affect the expression of autonomy of further education and training colleges between 2010 and 2012? and (ii) How did the colleges respond to the power dynamics in the external environment? The analysis of data from case studies of two further education and training colleges revealed that the government had applied external control over the institutions, thereby constraining the overt expression of autonomy. However, the colleges were not without agency and were able to respond strategically to demands from the policy environment. Thus, this study offers a counter-narrative in South African literature on governance in vocational colleges, and the authors of this article assert that the failing governance in respect of the case studies was a result of external forces (power dynamics) rather than the internal characteristics of the colleges.

Fodder for Despair, Masquerading as Hope: Diagnosing the Postures of Hope(lessness) at the End of Life

Hope is needed for persons confronting the limits of human life, antagonised by the threats of death. It is needed also for those health and medical professionals constrained by the institution of medicine, determined by market metaphors and instrumental reasoning. Yet, despair can masquerade as hope for such persons when functional hoping for particular outcomes or aims proves futile and aimless. The following will examine such masquerades, while giving attention to particular expressions of autonomy, which persist as fodder for despair in our late modern milieu. The late classical account of Hercules and his death, as well as contemporary reasons for soliciting medical assistance in dying, will focus on the diagnostics of despair, while a Christian account practicing presence, and of hope as a concrete posture enfleshed by habits of patience, among other virtues, will point toward counter-narratives that might sustain persons in times of crisis and enable persons’ flourishing as human beings, even unto death.

Union Heartland: The Midwestern Home Front During the Civil War ed. by Ginette Aley and J. L. Anderson

Reviewed by: Union Heartland: The Midwestern Home Front During the Civil War ed. by Ginette Aley and J. L. Anderson Tim Roberts Ginette Aley and J. L. Anderson, eds., Union Heartland: The Midwestern Home Front During the Civil War. Carbondale: Southern Illinois University Press. 2013. 196 pp. $39.50. One challenge instructors of Civil War history face is to complicate students’ assumptions that the war pitted “The North” against “The South.” Important books have appeared emphasizing the significance of regional differences in the Civil War South.1 Likewise, scholars have sought to rekindle interest, first emphasized by Frederick Jackson Turner, in American regional history.2 But until the appearance of the book under review and a few recent monographs, little Civil War scholarship has focused on what people called “the Northwestern United States,” meaning the antislavery states west of Pennsylvania (2).3 [End Page 173] Union Heartland begins to rectify the situation by presenting seven essays that seek to identify what may have been unique about the Civil War’s impact on the most agricultural part of the Union. An important essay by R. Douglas Hurt provides detailed evidence about the extent and variety of the war’s boon to midwestern agriculture. Military demands for horses, hogs, and grains encouraged farmers (male and female) to expand land development and invest in laborsaving technology; the Civil War spurred northern industrialization by first expanding farming output. Another valuable essay is Brett Barker’s study of local Republican efforts to squelch Democratic war dissent through boycotts and acts of violence against antiwar newspapers. Barker’s point is that while official actions by the Lincoln administration to suspend northerners’ civil liberties may have been measured, as previously argued by Mark E. Neely, unofficial or vigilante censorship of the Democratic press was perhaps widespread and warrants further study.4 Three of the book’s essays show a variety of midwestern women’s wartime experiences. Ginette Aley emphasizes women’s sense of alienation over the departure and uncertain fate of husbands and fathers. She notes that while gender norms of the day generally “defined a woman’s life almost entirely” in terms of her family, women in remote areas of the North were particularly affected (126). Nicole Etcheson and J. L. Anderson then show different outcomes of midwestern women’s sudden solitary circumstances. Etcheson studies how soldiers’ wives who moved in with or near their husbands’ in-laws effectively remained subordinated to their husbands as a result. Anderson, meanwhile, emphasizes women’s new expressions of autonomy in managing farms and family because of “the vacant chair” (148). The book’s other two essays reflect how not all midwesterners were consumed by the war’s sacrifices of family or civil liberties, or even economic windfalls. Michael P. Gray describes the circus-like atmosphere of civilians’ enthrallment with Confederate officers imprisoned on Johnson’s Island near Sandusky, Ohio. Julie A. Mujic, on the other hand, studies University of Michigan students’ class essays, debates, and newspapers to explain how the (male) students rationalized their failure to join the Union military. For these students, “staying in school became the equivalent of fighting the rebels,” and their classes, they asserted, prepared them to lead the country in the anticipated murky postwar era (58). Mujic’s essay could benefit from an epilogue to trace whether any of the students she studied actually played public roles during Reconstruction, but her work shows another layer of [End Page 174] midwesterners’ reactions to war, in addition to the other “battles” elucidated elsewhere in this diverse and welcome collection. Tim Roberts Western Illinois University Macomb, Illinois notes 1. William W. Freehling, The South vs. the South: How Anti-Confederate Southerners Shaped the Course of the Civil War (New York: Oxford University Press, 2001); Daniel Crofts, Reluctant Confederates: Upper South Unionists in the Secession Crisis (Chapel Hill: University of North Carolina, 2014). 2. Edward L. Ayers, Patricia Nelson Limerick, Stephen Nissenbaum, and Peter S. Onuf, All Over the Map: Rethinking American Regions (Baltimore, MD: Johns Hopkins University Press, 1995). As Aley notes, however, this book omitted the Midwest as a significant American region. 3. Jennifer Weber, Copperheads: The Rise and Fall of Lincoln’s Opponents in the...

The anti-fashion transgenre - three examples of subversion from the Croatian scene: Ivana Popovic, Tajci Cekada, and Martina Krizanic

With the three aforementioned examples - of multimedia artists Ivana Popović (1968-2016), Tajči Čekada, and Martina Križanić - I seek to document the anthropology of gender by the aforementioned anti-fashion triad dedicated to the marginal, trans-genre art field. Briefly put, the three artists demonstrate a subversion of anti/fashion as an expression of autonomy in relation to fashion heteronomies and mental uniform of the mainstream, whereby the common link between the artists - elimination of sex/gender attributes - is also notable.

The Benefits of Continuous Leisure Participation in Relocation Adjustment Among Residents of Long-Term Care Facilities.

The rising population of older adults is transforming Taiwan society. Although many long-term care facilities now operate for older adults, the transition from the home environment to long-term facilities may cause multiple issues, including relocation stress syndrome, for new residents. Autonomy is a critical element of the human experience. Leisure, as an expression of autonomy, has been shown to enhance self-image and promote feelings of competence and mastery. The aim of this study was to assess the relationship between participation in leisure activities and adjustment to residential care using the continuity theory. One hundred sixty-three qualified individuals from 11 long-term care institutions were recruited and completed the questionnaire. The sampling criteria for the study were age (55+ years), appropriate cognitive skills, and residency (less than 5 years). Interviews conducted by trained interviewers were used to collect data. Measured outcomes included leisure participation; physical, psychological, and social adjustments; and background information. Cluster analysis, descriptive analysis, multivariate analysis of variance, and least significant difference test were used in analysis. Type of admission (voluntary/mandated) and type of leisure participation significantly affected the level of relocation adjustment success. Four leisure behavior categories were identified, including reduced participation, expanded participation, active participation, and continuing participation. The participants in the active and continuing participation categories had significantly higher psychological adjustment than their peers in the reduced participation category. Moreover, the continuing participation category had a significantly better level of social adjustment than their expanded participation category peers. Continuous and active participation categories had a beneficial outcome in relocation adjustment. The findings support that, in general, residents of long-term care facilities who participate continuously in leisure activities adjust better psychologically and socially to their new life in these facilities than individuals in the other participation categories. As continuity of participation in leisure activities is important for successful aging, institutions should facilitate the continuing leisure behavior of new residents.

PARTICIPANTES DE ENSAIOS CLÍNICOS EM ONCOLOGIA: PERFIL E ASPECTOS ENVOLVIDOS NAS SUAS DECISÕES

Resumo Estudo sobre os participantes de ensaios clínicos na área de oncologia, discutindo o paradoxo entre progresso científico e iniquidade social. Buscou-se conhecer quem são essas pessoas e analisar aspectos envolvidos nas suas decisões, com base em entrevistas e documentos. Houve maior participação feminina. Os participantes tendem a ter poucos anos de estudo formal e baixa renda. A maioria é aposentada e do lar e não tem assistência à saúde privada. Suas decisões giraram em torno da busca pela cura ou melhora, e pela garantia de acesso regular a cuidados integrais de saúde e medicamentos. A assinatura do termo de consentimento livre e esclarecido não garantiu a expressão da autonomia, pois informações essenciais como os objetivos, riscos e cuidados pós-estudo são praticamente desconhecidas. Os participantes da pesquisa tendem a não compreender os objetivos da investigação, ou superestimam os benefícios médicos diretos de sua participação, sem consciência dos riscos envolvidos e do que significa uma pesquisa. Os resultados deveriam incitar ao exercício e ao diálogo mais críticos entre os diferentes atores e instituições envolvidos na área da pesquisa com seres humanos, objetivando promover uma ciência consciente e responsável, que impeça que pessoas sejam colocadas em situação de desigualdade, vulnerabilidade e sofrimento moral.

Flirting with resistance: children’s expressions of autonomy during middle childhood

ABSTRACTPurpose: Developmental research suggests that children’s early non-compliance can be understood as “resistance”, an agentic response to parental control where children express their autonomy within a close relationship context. Research with toddlers and adolescents suggests that children’s resistance strategies can be differentiated using the dimensions of assertiveness, social skill, and overt versus covert expression. This study explores children’s strategies for expressing resistance during the neglected period of middle childhood.Method: Forty children, 9–13 years of age, participated for 1 week in a study focused on children’s experiences of socialization and parent–child relationships. Procedures included a 5-day event diary, and a 1-hour semi-structured interview about the rules and expectations in their home and their strategies of resistance.Results: Thematic analysis identified a rich repertoire of strategies for resisting unwelcome parental demands. These included overt resistance, such as negotiation, argument, and expressions of non-acceptance and covert resistance such as covert transgressions and cognitive non-acceptance of parental demands when compelled to comply.Conclusion: The findings were interpreted as reflecting children’s development of assertiveness and social skill as they expressed their autonomy in the interpersonal context of the interdependent but asymmetrical relationship with their parents.

Barriers to the Prevention of Suicide in Nursing Homes.

The suicide rate in older people is high. Gatekeeper training is recommended for at-risk populations in the detection and management of suicidal residents in nursing homes. This study focuses on how caregivers in nursing homes consider suicide in older people from a social perspective, and to what extent these social representations are an obstacle to the prevention of suicide. This study is both observational and qualitative, and is based on semi-directed one-to-one interviews with caregivers. We met with 18 caregivers from three nursing homes in 2015. We show that the social representations of caregivers working in nursing homes are essentially identical to those of the general population and those found in other studies on paramedics. Suicide is seen as an expression of autonomy, a response to the suffering associated with aging and the living conditions imposed on older people in our society, particularly in nursing homes. Our study highlights the problems inherent to the position of caregiver, in which we can observe a conflict between professional missions and personal ideology. This study confirms the need to continue training on suicide prevention in nursing homes.

ОКРЕМІ АСПЕКТИ ЗАСТОСУВАННЯ ПРИНЦИПУ АВТОНОМІЇ ВОЛІ ДЛЯ ЗОВНІШНЬОЕКОНОМІЧНИХ ДОГОВОРІВ (КОНТРАКТІВ)

This article considers certain issues related to the application of the principle of autonomy of will in foreign economic agreements (contracts). Special attention was drawn to the terms, which are mandatory for the counterparties of a foreign economic agreement when applying this principle. A foreign element must be present in the relationship regulated by the contract. Participants in legal relations may independently choose the law to be applied only in cases provided for by law. The choice of law must be obvious or directly follow from the actions of the parties, the terms of the deal or the circumstances of the case unless otherwise provided by law.It is concluded that there is no time limit to make the autonomy of the will, because the choice of law can be made by the participants in legal relations at any time. A distinction has been made between absolute autonomy of will, which means that the parties can determine any legal order at their discretion and limited autonomy of will, which means that the partiescan choose the legal order relating to the country of the parties.The problem of the conclusive form of expression of autonomy of will in acontract was given detailed consideration, as the case is complicated when the applicable law is not clearly defined. The author defined the difficulties arising when the counterparties of the foreign economic agreement (contract) choose the law of a ‘third’ (neutral) state. In this case it can be difficult for the counterparties to take into account all the consequences of a foreign economic agreement caused by insufficient knowledge of foreign legislation. The author's opinion is expressed about the falsity of contractual practice, when the parties choose the law of the state, the law not related to the country of the parties. Proposals regarding the legislative regulation of the procedure undertaken by the court to clarify the content of this foreign law were made. The absence of this procedure leadto an ambiguous judicial practice, when any courts "avoid" the application of a law other than the law of Ukraine.

An autonomous teaching-learning based optimization algorithm for single objective global optimization

AbstractTeaching-learning based optimization is a newly developed intelligent optimization algorithm. It imitates the process of teaching and learning simply and has better global searching capability. However, some studies have shown that TLBO is good at exploration but poor at exploitation and often falls into local optimum for certain complex problems. To address these issues, a novel autonomous teaching-learning based optimization algorithm is proposed to solve the global optimization problems on the continuous space. Our proposed algorithm is remodeled according to the three phases of the teaching and learning process, learning from a teacher, mutual learning and self-learning among students instead of two phases of the original one. Moreover, the motivation and autonomy of students are considered in our proposed algorithm, and the expressions of autonomy are formulated. The performance of our proposed algorithm is compared with that of the related algorithms through our experimental results. The res...