Limited Autonomy Research Articles

Balancing Demands: Determinants of Burnout Reported by Fellows in Pulmonary and Critical Care Medicine.

Background: Burnout is common among physicians who care for critically ill patients and is known to contribute to worse patient outcomes. Fellows training in pulmonary and critical care medicine (PCCM) have risk factors that make them susceptible to burnout; for example, clinical environments that require increased intellectual and emotional demands with long hours. The Accreditation Council for Graduate Medical Education has recognized the increasing importance of trainee burnout and encourages training programs to address burnout.Objective: To assess factors related to training and practice that posed a threat to the well-being among fellows training in PCCM and to obtain suggestions regarding how programs can improve fellow well-being.Methods: We conducted a qualitative content analysis of data collected from a prior cross-sectional electronic survey with free-response questions of fellows enrolled in pulmonary, PCCM, and critical care medicine training programs in the United States. Fellows were asked what factors posed a threat to their well-being and what changes their training program could implement. Responses were qualitatively coded and categorized into themes using thematic analysis.Results: A total of 427 fellows (44% of survey respondents) completed at least one free-response question. The majority of respondents (60%) identified as male and white/non-Hispanic (59%). The threats to well-being and burnout were grouped into five themes: clinical burden, individual factors, team culture, limited autonomy, and program resources. Clinical burden was the most common threat discussed by fellows. Fellows highlighted factors contributing to burnout that specifically pertained to trainees including challenging interpersonal relationships with attending physicians and limited protected educational time. Fellows proposed solutions addressing clinical care, changes at the program or institution level, and organizational culture changes to improve well-being.Conclusion: This study provides insight into factors fellows report as contributors to burnout and decreased well-being in addition to investigating fellow-driven solutions toward improving well-being. These solutions may help pulmonary, PCCM, and critical care medicine program directors better address fellow well-being in the future.

Communications from the Field: the Tale of Two Gujjar Communities

Sharma discusses the micropolitics of pastoral nomads in the Indian Himalayas and Pir Panjals. She looks at the contrasting positions and experiences with governmentality of two different nomadic pastoral communities, the Gujjar and Bakkarwal in Jammu and Kashmir, and the Van Gujjar in Uttrakhand. The Jammu and Kashmir was brought to the international attention by an unprecedented move on Aug 5, 2019, when the Indian government deoperationalized Articles 370 and 35A of the Indian constitution, thus revoking the status of limited autonomy historically granted to Jammu and Kashmir, India's only Muslim majority state. However, the pastoral nomadic Gujjar and Bakkarwal have survived in the region under considerable hardship for over three decades, caught in the crossfire of separatists and Indian armed forces but receiving little attention from the media.

COVID-19 and Disenfranchised Grief.

Although death is an inherent part of life, for many it is a terrifying event, which awareness is often to be avoided at all costs (1). However, with the daily updates of COVID-19 cases and deaths, the confrontation with human mortality and physical fragility is unavoidable. Over 100 million confirmed cases and over 2 million confirmed deaths worldwide have been recorded (2). The COVID-19 pandemic is a health crisis unprecedented in contemporary history. Furthermore, an estimate of 9 bereaved family members results from each COVID-19 death (3). Recent evidence indicates that, due to the circumstances in which deaths in the COVID era occur—unexpected and shocking deaths, social distancing, restrictions in visits in healthcare facilities and in funerals—another epidemic is on the rise: prolonged grief disorder (PGD) [e.g., (4)]. PGD is characterized by persistent and pervasive longing for, or preoccupation with the lost one, as well as severe emotional pain (such as, guilt, anger, or sadness), difficulty accepting the death, emotional numbness, a sense that a part of them has been lost, an inability to experience positive mood and difficulty participating in social activities (International Classification of Diseases-11, (5)). With each death that occurs, there are loved ones who will be deeply impacted by the loss, particularly at a time when, due to sanitary restrictions, they may experience limited autonomy, and resourcefulness when coping with their grief. The awareness of these limitations heighten the risk of grievers experiencing their grief as disenfranchised to a degree. Kenneth Doka first formally introduced the notion of disenfranchised grief in 1989 and defined it as the process in which the loss is felt as not being “openly acknowledged, socially validated, or publicly mourned” (1989, p. xv). This experience of grief might pose difficulties in terms of emotional processing and expression, as one may not recognize his/her right to grieve, and in terms of social support, by diminishing the opportunity to freely express their emotions, and to obtain expressions of compassion and support (6). Given the challenges that the disenfranchisement of grief might add to the bereavement experience, it is important to reflect on the risk for this experience in the context of the COVID-19 circumstances. In this opinion paper we aim to frame this in light of the felt limitations in autonomy and resourcefulness in the COVID-19 bereaved, either imposed externally, or internally (self-disenfranchisement).

Parcel delivery cost minimization with time window constraints using trucks and drones

AbstractWe propose a model for solving a parcel delivery problem with a fleet of trucks embedded with drones. When appropriate, drones are loaded with a parcel, launched directly from the truck, and sent to a client. Afterward, the drones autonomously return to the truck to be replenished and recharged. Inspired by the case of a large European logistics provider, the proposed modeling framework confronts realistic delivery problems involving time windows, limited drone autonomy, and the eligibility of clients to be served by drones. The considered global cost function includes fixed daily vehicle fares, driver wages, and the fuel and electricity consumption to power trucks and drones. To solve the problems at hand, we propose a mixed‐integer linear programming formulation and an adaptive large neighborhood search. Moreover, we introduce an efficient modeling framework to manage the numerous synchronization constraints induced by the simultaneous use of trucks and drones. We analyze the benefits of this new transportation concept for delivery problems involving up to 100 parcels. Results show that truck‐and‐drone solutions can reduce costs up to 34% compared to traditional truck‐only delivery. From a managerial perspective, we show that a certain percentage of client locations must be reachable by drone to make truck‐and‐drone solutions competitive (i.e., if the fixed costs of the drones are compensated for by the savings on truck routes) and compare the cost structures of truck‐and‐drone versus truck‐only solutions.

Dort, Doleantie and Church Order

This article attends to the relationship between minor and major assemblies as prescribed by the foundational principles of Reformed church polity proposed by Mary-Anne Plaatjies-Van Huffel. It reviews the limited autonomy of local congregations and the authority of broader assemblies in the Church Order of Dordrecht (1618/19), the touchstone of Dutch Reformed church polity. It considers the challenge to historic Reformed church polity posed by the ecclesiology of the Doleantie, a secession from the Nederlandse Hervormde Kerk (NHK) in 1886 under the leadership of Abraham Kuyper. Finally, it evaluates a contemporary church order (of the United Reformed Churches in North America), that explicitly codifies Doleantie ecclesiology. The church order fails to embody the principles of Reformed church polity set forth by Plaatjies-Van Huffel. This article concludes that it cannot be considered a Reformed church order.

Governance of Urban Green Spaces across Latin America - Insights from Semi-Structured Interviews to Managers Amid COVID-19

The COVID-19 pandemic has brought unprecedented challenges to managers of urban green spaces. As suggested by findings from 18 structured interviews from six Latin American countries reported in this paper, managers in Latin America have not been able to take the most advantage of available green space during the COVID-19 lockdown. At the core of this inability is a governance characterized by dependence on political will, lack of continuity due the non-existence of civil service, limited autonomy, insufficient budgets, absence of formal paths to fund themselves, shortage of technical know-how, and insufficient citizens' involvement. Thus, while a criticism to management of urban green spaces in developed cities is its focus on recreational services -with no attention to other ecosystem services-, management in Latin America is heavily constrained by funds that barely afford maintenance of basic infrastructure -with exceptions that we highlight in the manuscript. Consequently, managers of urban green spaces across Latin America have not successfully implemented adaptation measures that, for instance, European counterparts have -e.g. traffic management, information campaigns. In addition, these governance capabilities pose the risk of maladaptation. For instance, many managers in Latin America have formally resorted to a full closure of their premises during the COVID-19 lockdown but they have not successfully enforced such a closure, which likely has brought undesirable effects -e.g. more overcrowding than under a controlled no-closure scenario. We provide public policy recommendations, and a list of research questions specific to Latin America -an understudied region when it comes to both governance of urban green spaces, and the role of urban green spaces during the COVID-19 pandemic.

Combinatorial Properties for the Green Vehicle Routing Problem

This work provides a theoretical study of the Green Vehicle Routing Problem (G-VRP), which is an NP-hard problem that generalizes the Vehicle Routing Problem (VRP) and integrates it with the green logistics. In the G-VRP, electric vehicles with limited autonomy can recharge at Alternative Fuel Stations (AFSs) to keep visiting customers. This problem was introduced by [3] and approached later by [4], and [5], all of which consider that consecutive AFSs visits are not allowed, i.e., a solution cannot have an edge between two AFSs. In this work, two G-VRP versions are investigated, (i) where consecutive AFSs visits are not allowed, and (ii) where consecutive AFSs visits are allowed, i.e., a solution may have an edge between two AFSs. This research proposes combinatorial properties and lower bounds which have the potential to strengthen the mathematical formulations for both G-VRP versions, thus improving exact solution methodologies.

Институциональная муниципальная реформа в России: акторы и их стратегии (на примере «малой» реформы МСУ)

One of the main democratic institutions in Russia is local selfgovernment (LSG). This institution is characterized by instability of legal regulation, which is reflected in regular changes and amendments to existing laws. The most significant transformation of the Institute of LSG was in 2003–2009, when the «big» municipal reform was carried out. In 2014, a «small» reform of the LSG was launched, which made it possible to introduce a two-level system of city administration. The new model of local government organization operates only in three cities – Chelyabinsk, Makhachkala and Samara. The purpose of the article is to understand the reasons for the transition of some cities to a new system of organization of local government. The conceptual foundations of the article are the structure-oriented approach of D. North, the «distributional» theory of institutional changes of G. Libecap, and the political and economic approach of D. Acemoglu and G. Robinson's. The research is based on the theory of reforms by J. Roland. The author concluded that limited political autonomy at the bodies and local self-government officials, the lack of mayors during the period of reforms Governor-cartridge a result of the change of the head of the region, the timing of the reform with the end of the term of powers of authorities and local selfgovernment officials, as well as the inclusion of regional authorities compensatory strategies for the urban ruling elite, are factors, which contributed to the implementation of institutional reform. It is shown that the obstacles that prevented the «small» reform of the local government act of political autonomy from consolidated municipal ruling elite, interested in preserving the status quo; the existence of an urban political machine; the lack of compensation of the urban ruling elite for losses which are due to the implementation of the reform; the discrepancy between the time of the reform by the end of the term of authorities and local self-government officials.

Город Екатеринбург как глобальный актор в современных международных отношениях

The research aims to study a city as an actor in international relations. A city used to be seen as an object by researchers through the theories of paradiplomacy, global cities, and new regionalism. The research goal is to show that the city has the potential and resources for being an independent participant of international relations. To explain this process, the concept of actorness is used. The variety of approaches is shown to represent actorness as an attribute of an independent participant of international relations. Due to the absence of a universal set of parameters for the city's actorness, a new model with such factors as identity, practical goal-setting, recognition, and facts of activity, is proposed. City’s actorness is considered in detail on the example of Yekaterinburg, which has implemented it in its international practices. The research base covers documents of the city council of Yekaterinburg and its departments, news reports on the city's international activities and international events, interviews with former representatives and employees of the city administration. The conclusion was made about the evolution of the city's international activities, which, while maintaining limited autonomy, is subject to close collaboration with the Sverdlovsk region.

Mothers in a 'Strange Land': Migrant Women Farmers' Reproductive Health in the Brong-Ahafo Region of Ghana.

As a coping strategy towards climate variability, smallholders from the Upper West Region (UWR) migrate to rural farming areas in the Brong-Ahafo Region (BAR) of Ghana in search of better livelihoods. Although previous migrations were seasonal and maledominated, recent migrations have become permanent and involve more women migrating. Despite these changing dynamics, little is known about the effects of internal migration on women's reproductive health in rural migration destinations. Using qualitative methods, we explored migrant women farmers' reproductive health experiences in BAR. Findings from our study reveal that migrant women face limited autonomy in family planning decisions, lack access to maternal and general health care services, and have limited social support in the migration destination. Our findings contribute to the migration literature and highlight the unique reproductive health challenges of agrarian migrant women in rural receiving societies of Ghana.

A Double Swath Configuration for Improving Throughput and Accuracy of Trait Estimate from UAV Images.

Multispectral observations from unmanned aerial vehicles (UAVs) are currently used for precision agriculture and crop phenotyping applications to monitor a series of traits allowing the characterization of the vegetation status. However, the limited autonomy of UAVs makes the completion of flights difficult when sampling large areas. Increasing the throughput of data acquisition while not degrading the ground sample distance (GSD) is, therefore, a critical issue to be solved. We propose here a new image acquisition configuration based on the combination of two focal length (f) optics: an optics with f = 4.2 mm is added to the standard f = 8 mm (SS: single swath) of the multispectral camera (DS: double swath, double of the standard one). Two flights were completed consecutively in 2018 over a maize field using the AIRPHEN multispectral camera at 52 m altitude. The DS flight plan was designed to get 80% overlap with the 4.2 mm optics, while the SS one was designed to get 80% overlap with the 8 mm optics. As a result, the time required to cover the same area is halved for the DS as compared to the SS. The georeferencing accuracy was improved for the DS configuration, particularly for the Z dimension due to the larger view angles available with the small focal length optics. Application to plant height estimates demonstrates that the DS configuration provides similar results as the SS one. However, for both the DS and SS configurations, degrading the quality level used to generate the 3D point cloud significantly decreases the plant height estimates.

Local Self-Governments and the Vertical Division of Power

Local self-governments cannot be defined as entities against the state, nor do they merely assist in executing the central will. The significance of local self-governments lies in their role in the division and balancing of powers. In light of the principle of subsidiarity, the need for autonomy through decentralisation necessarily leads to the central bodies of the state being marginalised in these matters, in a sense, the latter lose their ability to solve the issues raised within their own sphere of competence.From a certain point of view, this can even be considered a vertical division of power. The division of executive power between the public administration subordinated to the Government and independent local self-governments, does not call into question the local self-government’s affiliation with the executive power. As such, it is practically an internal division of powers. In essence, it manifests itself as a kind of limited autonomy, which – due to the unity of the state – subsists only within the confines of the relevant laws.In light of the foregoing, jointly applied principles lead to a vertical division of power. Power is divided, which, nonetheless, does not mean that one sovereign body limits another; it is rather the case of the state restraining itself by virtue of the principle of democracy.

Designing “National Day of Service” Projects to Promote Volunteer Job Satisfaction

National Day of Service (NDS) volunteering events have become common, yet little is known about how the design of such events affects volunteer satisfaction. This relationship is important because volunteer satisfaction ensures a strong volunteer base for special events and promotes sustained volunteerism. We explore how the design of NDS projects promotes volunteer job satisfaction. Our approach to the research question is informed by work design theory. Based on interview, participant observation, and focus group data from an NDS in the Netherlands, the findings suggest that nonprofit organizations can elicit volunteer job satisfaction by designing NDS projects that create a sense of added value, support productivity, and make volunteers feel comfortable. Designing NDS projects that incorporate task significance, symbolic social support, feedback from others, beneficiary contact, task identity, project preparation, physically demanding work, social support, and limited autonomy help to achieve these goals.

Dilemmas of nudging in public health: an ethical analysis of a Danish pamphlet.

Nudging has been discussed in the context of public health, and ethical issues raised by nudging in public health contexts have been highlighted. In this article, we first identify types of nudging approaches and techniques that have been used in screening programmes, and ethical issues that have been associated with nudging: paternalism, limited autonomy and manipulation. We then identify nudging techniques used in a pamphlet developed for the Danish National Screening Program for Colorectal Cancer. These include framing, default nudge, use of hassle bias, authority nudge and priming. The pamphlet and the very offering of a screening programme can in themselves be considered nudges. Whether nudging strategies are ethically problematic depend on whether they are categorized as educative- or non-educative nudges. Educative nudges seek to affect people's choice making by engaging their reflective capabilities. Non-educative nudges work by circumventing people's reflective capabilities. Information materials are, on the face of it, meant to engage citizens' reflective capacities. Recipients are likely to receive information materials with this expectation, and thus not expect to be affected in other ways. Non-educative nudges may therefore be particularly problematic in the context of information on screening, also as participating in screening does not always benefit the individual.

Codifier le divorce international : Quelques remarques sur le projet GEDIP

The EU legislator has modified once again the so-called Brussels 2 bis Regulation. The new regulation 2019/1111 adds new provisions on parental responsibility and child abduction, but leaves those on divorce largely untouched. To the contrary, the GEDIP, an expert group of academics in private international law from across Europe, has established an indepth proposal for a new regulation on divorce. This paper analyzes the proposal which seeks to modernize and improve the current situation that has been widely criticized. The proposed regulation covers choice of law, jurisdiction and recognition. It allows limited party autonomy, both in jurisdiction and choice of law, and suggests significant improvements of the provisions on objective jurisdiction. It also recommends a recognition mechanism that would apply to judgements from third States and provides for a comprehensive set of rules concerning private divorces.

Incremento de la autonomía de un vehículo eléctrico Dayang CHOK-S a través de la utilización de paneles solares

La limitada autonomía de los vehículos eléctricos representa uno de los principales problemas para su comercialización. Por esta razón es importante incrementar su autonomía, generando de esta manera una alternativa de solución a estos inconvenientes. Es necesario entonces, promover la utilización de este tipo de automóviles, dado que su uso disminuye notablemente el grado de dependencia del petróleo, promoviendo así el uso de las energías renovables. La implementación de paneles solares en los automóviles eléctricos es una respuesta al incremento de su autonomía, ya que permite aprovechar una fuente inagotable de energía (solar), permitiendo de esta forma reducir la contaminación ambiental, haciendo que el vehículo eléctrico se vuelva más atractivo para los usuarios. Este artículo detalla la implementación de un panel solar de 350 W en un vehículo eléctrico Dayang CHOK-S bajo diferentes condiciones meteorológicas, obteniendo como resultado el incremento de su autonomía en hasta un 33 % con respecto a su autonomía real. Además, en algún punto dado, este porcentaje podría incrementar bajo condiciones de radiación solar bastante altas. Los resultados demuestran que la carga de las baterías es directamente proporcional a la cantidad de radiación solar; es decir, a mayor radiación solar, mayor va a ser la carga de las baterías del automóvil.

Quality assurance and accreditation in Afghanistan: exploring sensemaking and sensegiving in policy implementation

ABSTRACT This research investigated the implementation of accreditation at public teaching and research universities in Afghanistan. A qualitative multi-case study design was used to interview 46 individuals from five universities. The findings revealed that participants conceptualise quality assurance and accreditation as organisational sensemaking that emphasises contextual circumstances in exploring meaning construction. Accreditation is a community effort at research universities while engagement with accreditation seemed partial at teaching universities given that only the leadership and quality assurance units were involved in the process. The implications are that (a) a serious involvement of senior leadership in the process maximises employees’ engagement with accreditation and (b) factors such as limited budget and autonomy, scarce resources, lack of awareness and resistance of academic staff challenge accreditation in Afghanistan universities. The study recommends an increased budget and autonomy for universities, management training for university leaders and revision of the accreditation framework to be flexible to teaching and research universities.

Burnout and associated factors among Greek substance use disorder treatment providers during economic crisis

Crisis and austerity in Greece could have influenced the risk of burnout among substance use disorder treatment providers. We aimed to investigate the prevalence of burnout and its associated factors among Greek substance use disorder treatment providers during economic crisis. A cross-sectional study was conducted in 2016. In particular, employees at the substance use treatment program of Athens (n = 180), a branch of the Greek Organization against Drugs were invited to participate. Almost all participants reported medical supplies shortages related to the economic crisis. Increasing job demands, staff reduction and limited job autonomy were independent risk factors for burnout. These factors are crisis-related. In conclusion, we found high rates of burnout among substance abuse treatment personnel in Greece. These respondents are a bellwether of the effects of economic crisis. Economic crisis can produce a profound negative effect on health care.

Trends in Abortion Policies in Low- and Middle-Income Countries.

The decision to terminate a pregnancy is not one that is taken lightly. The need for an abortion reflects limited sexual autonomy, ineffective or lack of access to contraceptive options, or a health indication. Abortion is protected under human rights law. That notwithstanding, access to abortions continues to be contested in many parts of the world, with vested interests from politically and religiously conservative states, patriarchal societies, and cultural mores, not just within local contexts but also within a broader geopolitical context. Criminalization of a women's choice not to carry a pregnancy is a significant driver of unsafe procedures, and even where abortions are provided legally, the policies remain constrained by the practice or by a lack of coherence. This review outlines the trends in abortion policy in low- and middle-income countries and highlights priority areas to ensure that women are safe and able to exercise their reproductive rights.

Kicking the Habit: What Makes and Breaks Farmers' Intentions to Reduce Pesticide Use?

There is a growing concern in society about the continuing intensive usage of pesticides in farming and its effects on environmental and human health. Insight in the intentions of farmers to reduce pesticide use may help identify pathways towards farming systems with reduced environmental impacts. We used the Reasoned Action Approach to identify which social-psychological constructs determine farmers' intentions to decrease pesticide use. We analysed 681 responses to an online survey to assess which constructs drive intention, and identified which beliefs pose barriers and drive the motivation of farmers to decrease pesticide use. Our results show that the intention to reduce pesticide use is strongly determined by whether other farmers also act. Furthermore, farmers perceive limited capacity and autonomy to reduce pesticide use, and motivations to reduce pesticide use were based on environmental considerations. Finally, decreasing pesticide use was considered risky, but the relative importance of risk attitude was offset by the environmental considerations of farmers. This indicates that farmers need successful examples of how to decrease pesticide use, either via exchange with peer farmers or knowledge provisioning on alternative pest control methods. These insights may be useful to direct policy making to influence farmers' intentions to decrease pesticide use.