Greater Duty Research Articles

"We Can Do Anything but We Can't Do Everything": Exploring the Perceived Impact of International Pediatric Programs on U.S. PICUs.

Purpose: Every year, an increasing number of international patients seek medical care in the United States (U.S.), yet little is known about their impact. Based on single institution experiences, we wanted to explore the perceived impact of international pediatric patients on large academic U.S. pediatric intensive care units (PICUs), as they are already taxed systems.Methods: To explore current perceptions, seven geographically diverse institutions who advertise care for international patients on their websites and have ≥24 PICU beds were identified after IRB approval was obtained. We consented and interviewed PICU division chiefs or medical directors from each institution regarding their demographics and international patients. Common themes were identified.Results: Participating institutions were diverse in geographic location, census, and resource allocation strategies. Five of the seven institutions reported the presence of a formal international patient program. Four of those five reported an increase in international patients receiving PICU care over the past 5 years. International patients sought complex surgeries, advanced cancer treatments and metabolic/genetic evaluations. We identified three primary domains that require further exploration and research: (1) cultural and language differences leading to barriers in providing optimal care to international patients (2) institutional financial considerations, and (3) perceived positive and negative impact on the care of local/domestic patient populations.Conclusions: The presence of international programs raises a number of important ethical questions, including whether clinicians have a greater duty to serve residents of the local community as opposed to international patients when resources are limited. Further exploration is warranted.

Murshid Contestation: Betwen Iktisābī and Minhāh Ilāhiyyah

A murshid has a great duty and responsibility to conduct suluk formation (spiritual journey) to his students. So that the murshid are also required to have adequate competence and qualifications, in order to carry out their duties and functions. The functions and duties of the murshid in the tarekat (the path of Islamic Mysticsm) are very important, because only a murshid has the qualifications, abilities and expertise that can carry out their functions correctly, correctly and run accordingly. So that this aspect of ability and expertise will later be discussed as a discussion of the qualifications of a murshid in the tarekat. What is the actual qualification of murshid in the tarekat and what is its function in that proximity. This research is a type of field research. That is with the object of the study of the murshid of the Naqsabandiyyah Khalidiyyah in the sub-district of wedung precisely in the village of Jetak (KH. Abdul Haq), Buko village (KH. Ali Hafidz and KH. Ahmad Dalhar) and Mutih village (KH. Mansur Sanusi). The author collects data using the method of field observation, interviews and documentation. Next, the writer analyzes the data using descriptive analysis and understands the meaning. The results of the study stated that the murshid of the Naqsabandiyyah Khalidiyah tarekat in Wedung District argued that between the murshid tarekat function is hifdz sanad, talqin, tawassul, rabitah, tawajjuh and irsyad. While the qualifications to become murshid, among others; First, a murshid must be someone who is pious and amil bi ilmihi. The second has a clean heart, Third, has completed or khatam dzikir and khalwat tarekat (riyadhah), Fourth, has a murshid sanad, even though the inqitha'us sanad is from its predecessor murshid but continued with other murshid teachers in the same type of tarekat. Fifth, get permission from the murshid teacher. Sixth, knowing the wisdom behind all acts of worship (if possible). Through this research, the author recommends the need to study more about the wider range of murshid tarekat qualifications and not just the Naqsabandiyyah Khalidiyyah tarekat Indonesia. Thus, the form of the murshid qualifications will be found in several comprehensive tarekat

Offline: Is the NHS in crisis?

Offline: Is the NHS in crisis?

Gebe Kadınların Antenatal Testlere Yaklaşımını Etkileyen Faktörler

Objectives: Prenatal screening tests reduce the maternal and perinatal mortality as known. In our study, we aimed to investigate which factors affect the pregnant women most on how to take antenatal screening tests. We planned to evaluate the effects of media on pregnant women’s approach to antenatal screening tests. Materials and methods: 310 pregnant women who were admitted to the pregnancy outpatient clinic within 30 days have been evaluated by a variety of questions. Results: Follow ups of pregnant women by their gynecologists and family doctors increase the level of knowledge for screening tests. Particularly the pregnant women who do not want to take the diabetes screening test have been mostly affected by the media. Conclusion: Clinicians who examine to pregnant women firstly have a great duty to inform about them antenatal screening tests. We need to make arrangements on mediatic explanations that affect the pregnant women negatively about screening tests.

Client confidentiality: Perspectives of students in a healthcare training programme

Background . Confidentiality is an important ethical principle for all health professionals and also has a legal bearing on duty. One of the most difficult issues health professionals face in their daily fieldwork practice is a conflict between their professional duties, as illustrated in keeping a patient’s medical information confidential, and having empathy with a family member’s need to know. This moral dilemma is difficult for students to circumvent and therefore this paper presents healthcare students’ perspectives of confidentiality. Methods . We aimed to explore healthcare students’ views and experiences of confidentiality as an ethical principle by adopting a qualitative explorative approach. Purposeful sampling was undertaken where specific individuals with specific experiences were identified. Data were collected by means of written responses from two open-ended questions and analysed thematically. Two themes emerged. Conclusion . Confidentiality, as with other ethical principles, is an important obligation of a good client-therapist relationship as identified by students. However, the students’ responses illustrate that it cannot be absolute, and cognisance must be taken as to when it is acceptable, and even desirable, to override confidentiality because of conflicting, greater duties.

TURKEYS PERCEPTION FOR ARAB SPRING EXPERIENCE OF SYRIA

Having the civil commotions which started by the beginning of year 2010 in Tunisia, make influence in countries such as Egypt, Libya, Syria; has become factors which started the Arab Spring process in the Middle East. Having Hasan Akleh set himself on fire in 2011 constitutes a start-up phase of this process for Syria. As result of the violence that Assad regime applies on the opponents and civilian population in the country, attracted the focus of international actors on the region. Turkey is one of the countries which is influenced from the civil war in Syria. Turkey experiences refugee crisis and border security problems because of having the longest land border with Syria. Turkey has been imposed with great duties in the context of taking measures to these problems. By Russia's inclusion in the civil war in Syria, the number of actors on the region has increased more. The steps which may be taken in order to establish a security zone and a provisional government constitute the main headlines which are prepared for Syria.

Health in Brazil - optimistic outlook?

Health in Brazil - optimistic outlook?

The Spiritual Home of W. E. Gladstone: Anne Gladstone’s Bible

‘Popery is the religion of Cathedrals’, wrote J.W. Cunningham, the evangelical vicar of Harrow in his novel The Velvet Cushion (1815), ‘– Protestantism of houses’. It is a commonplace in the secondary literature that the household was the citadel of the evangelical version of Protestantism in nineteenth-century England. ‘Evangelicalism’, according to a representative comment by Ian Bradley, ‘was above all else the religion of the home.’ The head of the household conducting family prayers was the embodiment of the evangelical spirit. It is not the purpose of this essay to question that received image, but it does suggest that a clearer picture of the religious atmosphere of the evangelical home can be obtained from sources other than the manuals published for the paterfamilias to read to the assembled household. The books of family prayers tell us what was prescribed; but alternative sources show us what was practised. Spiritual journals, reflective meditations and candid correspondence can often be more revealing. Nowhere, however, is the kernel of household piety more evident than in the Bibles that some zealous believers annotated for their own benefit. The study of the Bible, as Edward Bickersteth, a leading evangelical divine, put it in his book A Scripture Help (1816), was ‘a great and important duty’. When members of evangelical families retired to the privacy of their own rooms, they might spend time in devotional reading of the Scriptures and leave a record of their reflections in the margins. Such Bibles, one of which is to be examined here, are treasuries of authentic domestic spirituality. They show something of the heartbeat of evangelical religion.

“The Duty of the Czar is the Great Duty...”: Exhibition from the Collections of the Russian State Library

On the Exhibition of Books from the Collections of the RSL ““The Duty of the Czar is the Great Duty...” (Romanov Dynasty in the Book Culture of Russia)”, opened to the general public, specialists and everyone interested at the Fedorovsky Hall of the Kemerovo Library.

Editorial: Proceedings and Symposia in CORR ®: What They Are, and Why We Publish Them

Editorial: Proceedings and Symposia in CORR ®: What They Are, and Why We Publish Them

Tadmor’s Ghosts

“You shall not escape us even while you sleep. Your victims’ vengeance will pursue you for blood… Even if you muzzle their complaints they will haunt you even as ghosts… You have poisoned the life of the people, wounded their souls… Wisdom at all times Is to destroy the jail Not to cut off the hand of the jailor. We have completed our little duty From now on we shall begin our great duty: This tyranny shall never recur” (Mamduh Adwan, The Ghoul 1995)Mamduh Adwan (1941-2005) was right eighteen years ago. The people whose lives Hafiz al-Assad had poisoned and whose souls he had wounded would pursue his son for blood. Decades of living with walls that are—not have—ears have produced rage and a demand for vengeance and justice: “From now on we shall begin our great duty: This tyranny shall never recur.” These lines call for revolution. It is not enough to cut off the hand of the jailor. The jail must be destroyed.

Red Schoolhouse, Burning Cross: The Ku Klux Klan of the 1920s and Educational Reform

On a hot afternoon in July 1923, former Dallas dentist and national Ku Klux Klan leader Hiram Evans took the podium at the first annual national meeting of the revived organization. By the time of this meeting, the Klan had again become infamous for its reputation of intolerance and vigilante violence. It had also become enormously popular among native-born white Protestants. In states such as Indiana and Colorado, the Klan briefly seized control of state and local politics. In spite of vigorous and scathing attacks from liberals and minority groups, between three and six million native-born Protestant white men rushed to join the secret order. At least another half-million women joined the Women of the Ku Klux Klan. Some even claimed that President Warren Harding took the membership oath in a secret White House ceremony. The appeal of the organization has been explained by historians as evidence of a variety of cultural trends, including worries over lax Prohibition enforcement, desires to enforce white racial dominance, fears caused by increasing immigration rates and labor unrest, and anxiety about changing cultural mores. While each of these issues was part of the revived Klan's allure, the shrewd “Imperial Wizard” chose another topic to electrify his audience. “The greatest duty of America today,” Evans thundered, “is to build up our educational system.”

No more paper tiger: Promise and peril as HIPAA goes HITECH

The HITECH Act, passed in 2009 by the federal government, deepens the concerns for patient privacy faced by healthcare organizations subject to HIPAA. This article examines the law and demonstrates that healthcare entities are facing greater duties to safeguard patients' protected health information, as well as severe civil and criminal penalties should they fail to do so. In recognition of this heightened liability, healthcare entities must reassess their methods for handling patient data and take action in key areas to ensure that risk is contained.

A Great Duty: Canadian Responses to Modern Life and Mass Culture, 1939-1967 (review)

A Great Duty: Canadian Responses to Modern Life and Mass Culture, 1939-1967 (review)

A Great Duty: Canadian Responses to Modern Life and Mass Culture, 1939-1967

A Great Duty: Canadian Responses to Modern Life and Mass Culture, 1939-1967

A Great Duty: Responses to Modern Life and Mass Culture in Canada, 1939-1967 (review)

A Great Duty: Responses to Modern Life and Mass Culture in Canada, 1939-1967 (review)

Alexander Smith and the Bisexual Poetics of A Life-Drama

In a sense, the binary restriction on culture postures as the precultural bisexuality that sunders into heterosexual familiarity through its advent into culture. From the start, however, the binary restriction on sexuality shows clearly that culture in no way postdates the bisexuality that it purports to repress: It constitutes the matrix of intelligibility through which primary bisexuality itself becomes thinkable. Judith Butler, Gender Trouble Our pulses beat together, and our beings Mixed like two voices in one perfect tune, And his the richest voice. Alexander Smith, A Life-Drama (1) MOST COMMENTATORS ON ALEXANDER SMITH'S A LIFE-DRAMA, FIRST PUBLISHED in biweekly installments in the Critic from March 1, 1852-January 15, 1853 before becoming the lead poem in Smith's debut volume of Poems (1853), (2) make two points: the poem seems to exist more for the sake of the images that constantly disrupt its narrative than for the story itself, and the narrative shifts from transgression to redemption when, abruptly, the poet Walter pledges himself at the end to union with the woman he formerly wronged and to go[ing] forth 'mong men .../... in the armour of a pure intent. / Great duties are before me and songs (Smith, p. 211). In other words, the poem culminates in chivalric masculinity and heterosexual union--compensatory assurance after earlier solecisms against form, taste, and moral decorum. Rarely do nineteenth-century reviewers or recent scholars direct attention to another feature of the text, the origin of Walter's love of image-making, and of his poetic vocation, in an intimate friendship with an unnamed male poet. His achievement of a poem, in contrast--publicly acknowledged work--is tied to a narrative of heterosexual transgression recuperated by heterosexual union. I want to suggest that the two most notable features of Smith's Life-Drama--its preoccupations with image-making and with erotic transgression--are founded on bisexual poetics, the embedding of male-male desire within an unconventional courtship narrative. I here use in the broadest sense to indicate a poet's implied principles. Bisexuality, I argue, is the medium through which Smith imagines the action or plot of his verse drama and also an authorizing principle that allows poet and poem (including its proliferating imagery) to emerge. Bisexuality, defined by its instability and unpredictable sequence of erotic objects, (3) is also associated with a distinctive world view. As Maria Pramaggiore observes, Bisexual epistemologies--ways of apprehending, organizing, and intervening in the world that refuse one-to-one correspondences between sex acts and identity, between erotic objects and sexualities, between identification and desire--acknowledge fluid desires and their continual construction and deconstruction of the desiring subject. (4) However conventionally the poem ends, the epistemology of A Life-Drama is bisexual in the terms Pramaggiore identifies. Indeed, the culmination of the closet drama's bisexual narrative in marriage and armored masculinity exemplifies Judith Butler's arguments about Freud's distinction between infantile bisexuality and subsequent ego development, a distinction that in Freud's work underwrites the interdependence of culture and gender binaries. In A Life-Drama, as in the scenario Butler identifies in her critique of Freud, (5) the very swerve into compulsory heterosexuality at the poem's end is the medium through which the poem's prior investment in bisexuality and bisexual poetics becomes legible. In this essay, accordingly, I trace the bisexual plot of the verse drama, its interweaving of same-sex desire with heterosexual romance, of effeminate men with assertively desiring women. Ultimately the poem's bisexual poetics do more than trouble gender norms, however: they enable Smith to perform Byronism and thereby to mediate a more threatening scandal, the suggestion that a great poet is not born but made by a sponsoring editor and literary critic. …

A Review of Current Health Care Funding Models

As healthcare expenses grow, concern about how government and private agencies decide to allocate funds for healthcare resources and services also grows. Decisions for healthcare funding are not made arbitrarily but are based on sound ethical principles and practical considerations. This article is a review of 5 ethically based healthcare funding models discussed in the literature that are currently used to justify funding choices. If healthcare professionals and managers are better informed about the ethical reasoning behind funding choices, they could better determine which resource allocation alternatives to support. But where should we spend our resources? Although healthcare professionals have a duty to advocate for all healthcare recipients to receive a fair share of resources, the author concludes that our greater duty as a profession is to the good of society as a whole. Balancing allocation decisions by considering all of the competing healthcare funding models and the ethical bases for them is suggested rather than to advocate too strongly for favored models.

Concept, distribution law and formation machanism of inland saline-alkaline wetland

The paper, taking Songliao Plain for example, studied the concept, distribution law and formation mechanism of inland saline-alkaline wetland. The inland saline-alkaline wetland is distributed over the inland region of arid or semi-arid climate; it is the wet or slightly stagnant environment, forming saline-alkaline soil and salt vegetation and making the geogra phical environment fonming complex with an ecosystem of saline-alkaline wetland. The laws of zone nature and non-zone nature control the distribution of the inland saline-alkaline wetland that extensively spreads in north part of China and other countries. The inland saline-alkaline wetland is formed jointly by atmosphere, hydrosphere, lithosphere and biosphere including intellectual sphere. Under the special condition, the artificial activity is possibly the key function. In order to improve the human environment, it is a great duty confronting the whole world to rationally transform the inland saline-alkaline wetland. Therefore, we presented an anti-inland theory to promote the environment transformation.

Incoming President's Address

It is a great honour to me to have been elected to this, the highest office of our Society. I accept the task in the knowledge that there are great duties and tasks to fulfil now and in the coming three years. I was very pleased that it was possible, as President-Elect, to take part in a lot of activities of the Executive Board as well as representing the ISPO Board on the Boards of Interbor and IVO . It has to be stated that many initiatives have been taken in the past three years by the Board members, the Task officers, the National Members Societies and certainly also by the individual members of ISPO. The result is that I can now lead a healthy Society although I am also aware that a rapidly growing society needs a firm structure with flexibility in a form in which each member can feel at home. It will not be possible to make an individual approach to everybody, but the new Board will really try to go on with a philosophy in which constructive ideas may be incorporated. It is with great pleasure to announce that we now have 20 national member societies and nearly 2300 members. New faces have appeared on our Board and in committees. A lot of work has to be continued. We may look forward to the next Triennium with confidence, but with a strong awareness of the task which faces us. We have to work with the International Agencies to raise standards of training of professionals and treatment of patients. We have to continue with activities in the Developing World which have already been formulated and approved by the Executive Board and published in several reports. Of great importance is Education. The President’s Report has given a review of all the activities of the last three years consisting of symposia, congresses, instructional courses and workshops concerning education in prosthetics and orthotics and rehabilitation engineering. In the next Triennium these activities will continue, not only within the Society but also in close co-operation with other societies. A good example is the European Congress on the Advancement of the Rehabilitation Technology, 1990, where the organization will be in the hands of three societies, one of them being ISPO. I would like to stimulate activities on education in the National Member Societies and also stimulate co-operation between different societies. It is evident that with the awareness of the increase in knowledge and the raising of standards the numbers of members of our societies will grow. New initiatives are welcome. Another important subject of education is related to the EEC council directive on the recognition of education of the professions. The ISPO/Interbor Education Commission has to continue its activities. Now we are at the end of a very successful Congress at Kobe, Japan, under the Chairmanship of Professor Tsuchiya and our Secretary-General, Seishi Sawamura. All the Japanese organizers really deserve our deepest gratitude for all the hard work which has been done. The performance was excellent. In every sense, it was a great success both scientifically and socially. I would especially like to express my thanks to Seishi Sawamura. He has given an enormous stimulation to our Japanese friends to fulfil their task, the ISPO World Congress. I would like to express our gratitude by declaring that we will recommend to the next Board Meeting that Seishi Sawarnura will be appointed as the Official Consultant for Asia for ISPO. We are sure an equally successful event awaits us in the United States of America. I urge you to support our American friends by responding to their requests and most of all by your presence in Chicago. I would like to thank John Hughes as President of the Executive Board of ISPO for the Triennium 1986-1989. In the last three years we have worked very closely together as already mentioned on several occasions. His knowledge of the Society, his leadership which has been illustrated by clearness, intelligence and resolution has been greatly in evidence. On behalf of the whole Society I would like to