Permanent Option Research Articles

Unveiling the Teacher Identities of Online EFL Pre-service Teachers

The remote education modality inherited from the global pandemic in early 2020 and the emergence of online schools worldwide led different universities in Colombia to establish pedagogical practicum online as a permanent option. These shifts impact the delivery of FL education and the positioning and self-perception of pre-service teachers as online educators in the post-pandemic landscape. Some previous research has examined how graduate and college in-service teachers developed their identities as online instructors during the global pandemic in early 2020, graduate and college in-service teachers’ construction of their transitional identities as online instructors and compared such newly-constructed roles with their already-established identities in face-to-face (f2f) scenarios; overlooking thus a complete examination of the experiences and factors that shape student-teachers online teacher identity in planned remote training settings in post-pandemic realities. This qualitative case study intended to address the research gap by unveiling the online teacher identities that 16 EFL pre-service teachers constructed throughout their online pedagogical practicum at a public university in Colombia. Data were collected employing whole-class discussions, recorded class observations, focus groups, teacher’s journals, and surveys. The results showed that the student-teachers constructed multiple online teacher identities based on their experiences as technology users and educational software course students. The pre-service teachers also drew on their recent experiences and interactions with their students and the online factors and events themselves present during the synchronous EFL classes in their pedagogical practicum. These results posed noteworthy implications for FL teacher education programs, practicum supervisors, and teacher development. The study's limitations entailed the relatively short timeframe of data collection and the selection of participants not based on a carefully designed and checked test on ICT and software-specific skills that could have played a role in the resulting online teacher identities.

Successful Management of Opioid-refractory Pelvic Cancer Pain Using Continuous Local Anesthetic Infusion via a Tunneled Epidural

Opioid refractory pelvic cancer pain is common and difficult to manage, which often results in analgesic polypharmacy and escalating opioid doses, alongside the use of interventional techniques. However, up-titration of opioids often results in systemic side effects, and interventional procedures have limitations in their duration of action, efficacy, and risk of nerve damage. Therefore, intrathecal pumps have been utilized as a more permanent option for pain management. Their ability to deliver localized therapy using a variety of pharmacological agents makes it an attractive option for cancer pain management. However, they are limited by a need for careful titration, pump volume constraints, and risks of severe side effects. These limitations can be mitigated by targeting the epidural space instead, and we propose the use of a tunneled epidural catheter technique for continuous local anesthetic infusion in opioid-refractory pelvic and abdominal cancer pain. In this case report, we describe a patient with pelvic and abdominal cancer pain due to stage IV sigmoid adenocarcinoma with widespread metastases, who received adequate pain management from a continuous local anesthetic infusion through a tunneled lumbar epidural catheter. Throughout this patient’s hospital admission, their opioid requirements remained the same, and their pain remained well controlled on review in the community one month after discharge. This case demonstrated that epidural catheters with local anesthetic as the sole neuraxial analgesic agent over a short duration could potentially provide preventive analgesia. This case highlights that a local anesthetic tunneled epidural, without addition of neuraxial opioids, is an effective alternative to intrathecal pumps in managing complex cancer pain and has potential for preventive analgesia.

WORK FROM HOME IS BECOMING THE NEW STANDARD OF EMPLOYMENT

When work from home was approved during COVID-19, technologies like digitization, distributed workforces, asynchronous and virtual collaboration, as well as reskilling and upskilling, were already revolutionizing the workplace. The COVID-19 has reduced the many-year gap in digitization since people who work from home accept it more rapidly than they might have in the past. Many jobs now have the permanent option of working from home thanks to COVID-19, even if not all office work can be done from home. Environments that allow employees to work from home promote the creation of operational models that are more digitally enabled, redesigned workspaces that encourage innovation, and enhanced methods of communication. When we opt for the work from home model or a hybrid of it, technology is vital to carrying out your obligations. Due to technology, working from home is now more common than it was in the IT industry before COVID-19. Future employment will change as a result of technology. The epidemic has accelerated Future of Work trends like the development of hybrid models, more attention to EHS (employee health scheme) and increased workplace flexibility. Government offices quickly transformed into digital environments after permitting remote work. Working from home in a hybrid model is an option for about 85% of employees as the new standard and is projected to continue to be so in the future due to the flexibility of working hours. Following the approval of the work-from-home paradigm, tier 2 and tier 3 cities will play a significant role. Workplaces of the future may undergo numerous modifications. We can categorize tasks into those that can be completed at home or in the office depending on the nature of the work.

Patient and Provider Experiences and Views on the Use of Telehealth in Genetics Clinics in Response to the COVID-19 Pandemic.

Introduction: The 2019 Coronavirus Disease (COVID-19) pandemic necessitated a mass transition in genetics clinics nationwide from in-person care to virtual care through telehealth. Before the COVID-19 pandemic, there was limited research on the use of telehealth in genetics specialties. Therefore, the COVID-19 pandemic presented a unique opportunity to study this emerging mode of care delivery in the setting of genetics clinics. This study described the scope of telehealth use in genetics clinics nationally and determined how COVID-19 influenced patients' decisions regarding their genetic care. Methods: Two anonymous surveys for patients and providers were developed. The patient survey was offered online to all genetics patients seen through telehealth at a Manhattan-based practice between March and December 2020. The provider survey was distributed through several listservs to genetics providers nationwide. Results: Patients (n = 242) and providers (n = 150) responded. Telehealth was used in all specialty genetics clinics for both initial and follow-up visits. Telehealth was both effective and satisfactory to patients for both visit types and across specialties; however, Asian and Hispanic/Latino patients had significantly lower mean satisfaction scores compared with White patients (p = 0.03 and 0.04, respectively). Patients appreciated telehealth for its convenience and to avoid COVID-19 exposure. Providers across specialties and provider types preferred telehealth for follow-up rather than initial visits. Several clinic initiatives related to telehealth were identified. Discussion: Telehealth was generally well received by both patients and providers, and is expected to become permanent option in genetics clinics. Further studies are needed to identify barriers to accessing telehealth.

Prediction of Long-Term Geochemical Change in Bentonite Based on the Interpretative THMC Model of the FEBEX In Situ Test

Since nuclear energy is crucial in the decarbonization of the energy supply, one hurdle to remove is the handling of high-level radioactive waste (HLW). Disposal of HLW in a deep geological repository has long been deemed a viable permanent option. In the design of a deep geological repository, compacted bentonite is the most commonly proposed buffer material. Predicting the long-term chemical evolution in bentonite, which is important for the safety assessment of a repository, has been challenging because of the complex coupled processes. Models for large-scale tests and predictions based on such models have been some of the best practices for such purposes. An 18-year-long in situ test with two dismantling events provided a unique set of chemical data that allowed for studying chemical changes in bentonite. In this paper, we first developed coupled thermal, hydrological, mechanical, and chemical (THMC) models to interpret the geochemical data collected in the in situ test and then extended the THMC model to 200 years to make long-term prediction of the geochemical evolution of bentonite. The interpretive coupled THMC model shows that the geochemical profiles were strongly affected by THM processes such as evaporation/condensation, porosity change caused by swelling, permeability change, and the shape of concentration profiles for major cations were largely controlled by transport processes, but concentration levels were regulated by chemical reactions, and the profiles of some species such as pH, bicarbonate, and sulfate were dominated by these reactions. The long-term THMC model showed that heating prolongs the time that bentonite becomes fully saturated in the area close to the heater/canister; however, once the bentonite becomes fully saturated, high concentrations of ions in bentonite near the heater, which was observed in the field test, will disappear; illitization continues for 50 years but will not proceed further.

Early childhood home visiting’s initial transition to virtual visits in response to the COVID-19 pandemic

BackgroundA reliance on in-home service delivery rendered early childhood home visiting vulnerable to the disruptions caused by the COVID-19 pandemic. Local programs transitioned rapidly from in-home visits to virtual contact with families. ObjectivesTo assess how local programs adapted to changes in staffing, supervision, and connecting with families and the prevalence and strength of associations of program, home visitor, and family-level factors influencing local programs’ transition to virtual visits using interactive video conferencing (IVC). The study also assessed whether adaptations and factors for IVC varied by use of an evidence-based model of home visiting and federal funding. MethodsThis national, cross-sectional study used a short, web-based survey to elicit local programs’ operational adaptations to social distancing policies, and challenges they encountered in transitioning to virtual contact with families. A total of 1154 program managers completed the survey, reporting on 1310 unduplicated, model-specific, local programs. Responding programs were located throughout the United States and represented over 30 different home visiting models. ResultsLocal programs swiftly transitioned to alternatives to in-home visits to maintain contact with families. While programs quickly transitioned to remote visits, they reported challenges in connecting with families via IVC. Major challenges in local program resources, visitor and family receptivity and technology were associated with significantly fewer families reached by IVC. Implementing an evidence-based model and federal funding support were associated with adapting to changes in staffing, supervision, and connecting with families by IVC. While programs reported more technology challenges for families than for visitors, major challenges in visitor technology also impacted the percent of families reached by IVC. ConclusionsWith its reach into communities experiencing disparities, home visiting is well-positioned to serve the families most adversely impacted by COVID-19. This survey demonstrated that programs swiftly transitioned to alternatives to in-home visits to maintain contact with families. This study highlighted major challenges in access to technology for families and the significant impacts of visitor and family technology challenges on reaching families by IVC. Strategies for ensuring access to technology are necessary to decrease disparities in access to home visiting. As home visiting programs adopt IVC as a more permanent option for service delivery, additional research is needed to determine the implications for reaching families, achieving model fidelity, addressing staff and family concerns, preparing the workforce to deliver IVC services effectively, and addressing enduring challenges to the use of IVC.

Keeping children within the family: Changing patterns in the use of special guardianship orders

Special Guardianship Orders (SGOs) provide family courts with an alternative to adoption, typically through permanent placement within the extended family. Using court administrative data, this study charts the use of SGOs as a way of promoting stability and recovery for these vulnerable children who cannot remain safely with their parents.
 The study cohort is based on administrative population data produced routinely by Cafcass and accessed via the Secure Anonymised Information Linkage (SAIL) Databank at Swansea University. The unit of analysis is children subject to s.31 care and supervision proceedings in England between 2007/08 and 2021/22, providing a retrospective observational window of fifteen years. Descriptive statistics were used to compare SGOs to other permanency final legal orders (placement, child arrangements, supervision and no order), and survival modelling was employed to look at stability over time and return to court. Finally, regional and over time variations in the data were examined.
 The percentage of children placed on a SGO as a proportion of all children subject to s.31 proceedings rose from 12% to 18% between 2011/12 and 2021/22. Over the same period the percentage of children with a placement order that frees the way for adoption fell from 24% to 14%. This shift in pattern was more pronounced than for any other legal order we examined for children unable to remain with birth parents. The highest usage per region was in the North East and London and the lowest was in the Midlands. We estimate that 9% of children on SGOs would return to court within 10 years. Older children (5-17 years old) were more likely to return to court after SGOs than younger children.
 The study showed that SGOs have become a main route out of public care, outstripping the use of placement orders. These findings have major implications for policy and practice. They demonstrate that special guardianship provides a stable and sustainable permanency option for children unable to remain with their birth parents.

Categorizing Patient Selection, Outcomes, and Indications in a Decade of 405 Profunda Artery Perforator Flaps.

Autologous tissue is the only permanent option for breast reconstruction. Whereas abdominal tissue remains popular, considering alternative donor sites ensures comprehensive care tailored to a patient. The thigh has been established as an excellent choice in autologous reconstruction. The authors present a 10-year experience with 405 profunda artery perforator (PAP) flaps. An institutional review board-approved 10-year retrospective review of all patients treated with PAP flaps for breast reconstruction was performed. Procedures were carried out by 2 surgeons at the same institution. PAP flaps were divided into 4 consecutive groups with approximately 100 flaps in each group. Demographics, indications, intraoperative data, postoperative complications, revisions, and patient-reported outcomes were recorded and analyzed. A total of 207 patients (405 PAP flaps) were included. This accounted for 17.2% of all breast reconstruction flaps. A total of 55% of patients underwent a multiflap procedure. The average flap weight was 354.3 g (±117.2), which decreased significantly over time ( P < 0.001). Rates of major complications were 9.6% wounds, 4.4% seromas, 4.7% hematomas, and 3.5% infections. Total flap loss was 2%, 67% of which were in stacked cases. Satisfaction routinely improved from before to after surgery. As available flap donor sites continue to evolve, tailoring breast reconstruction to the individual patient is standard in centers of excellence. The PAP flap has emerged as an excellent choice for autologous-based breast reconstruction through use of proper patient selection and surgical technique. Therapeutic, IV.

Miniaturized Annular Sensor Aids in Well Integrity, Production Monitoring

_ This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper OTC 31160, “Intelligent Pipe: A New Monitoring Solution for Your Wells,” by Francois-Xavier Bulard, Vallourec; Emmanuel Tavernier, OpenField Technology; and Antoine Deroubaix, Vallourec, at al. The paper has not been peer reviewed. Copyright 2021 Offshore Technology Conference. Reproduced by permission. _ The integration of a pressure and temperature sensor element in tubulars is possible as the result of microelectromechanical systems (MEMS) technology. Low-power consumption combined with an adapted transmission technology allows use of this technology inside an oil and gas well. Operators can use embedded sensors to access previously inaccessible well areas in real time. The qualification of this technology is completed to ensure the integrity of the system and its long-term viability. The complete paper presents the development, qualification, and applications of an intelligent tube solution using the described technology. Technology Description The development of this solution was the result of a partnership between OpenField Technology and Vallourec. While one section of the complete paper is dedicated to qualification tests performed during the development of the intelligent-pipe solution, this synopsis concentrates on the design of the solution and its potential deployment. The concept involves positioning a microsensor on the outside of a mandrel that can measure nearby annulus pressure, temperature fluids, or formation behavior. This system is composed of a pressure and temperature sensor connected to a battery module and a transmitting coil. This system (sensor, battery, and coil) is doubled to meet customer requirements for redundancy. Each mandrel contains two distinct monitoring modules. Positioned in each string of a well, this monitoring module tracks pressure and temperature changes at different depths throughout the well life cycle. This module is simple to install and is run with the casing string like any other oil and gas tubular-goods pipe. This module is set up for the entire life of the well, with two options for data retrieval: a temporary option with the use of a logging tool and a permanent option with the use of a specific tubing-transmission mandrel (Fig. 1). This tubing-transmission mandrel is connected to the surface by an electrical cable and designed to permanently supply power to the other casing module located at the same depth. The tubing-transmission mandrel furthermore ensures data retrieval from each sensor. The operating principle of the solution is based on the fact that each casing module is connected by an electromagnetic field to a logging tool or a tubing-transmission mandrel. This electromagnetic link is ensured by using a nonmagnetic (high-alloy) material for the casing module. This nonmagnetic material allows the electromagnetic field to pass from the tubing string up to the larger casing where monitoring is performed. It defines the horizontal transmission of the solution (as opposed to the vertical transmission) that is ensured by the use of a permanent downhole electrical cable connected to the surface. This cable brings power from the surface to the tubing-transmission mandrel in the case of deployment of the permanent option for data retrieval and allows data retrieval from the monitoring devices connected to this tubing mandrel. Horizontal transmission is only ensured if the different tubing and casing mandrels meet certain horizontal alignment tolerances.

Determinants of the choice of permanent options: The Case of European Groups

Determinants of the choice of permanent options: The Case of European Groups

If and to What Extent Does Organizational Learning Culture Predict Turnover Intentions of Telecommuting Call Center Agents?

This study focuses on measuring the relationship between organizational learning culture (OLC) and turnover intentions of telecommuting call center agents. Although many studies involve the call center industry from different perspectives, the literature is scant in studies that have assessed the relationship between OLC and turnover intent in telecommuting call center agents. Call centers exist in almost every organization worldwide. Organizations have centralized their customer service process through computer￾based technologies allowing call center agents to work from home. In addition, in the post-COVID-19 era, telecommuting has become a permanent option for many call center employees. Indeed, in the call center industry, telecommuting has become an essential part of the business strategy that seeks to attract new and maintain current employees. In the call center industry, learning is a factor that influences job satisfaction and turnover intentions. Specifically, OLC increases job satisfaction and performance in telecommuting call center agents, influencing employees’ turnover intentions. The study’s findings indicate that OLC is a needed factor that helps lower turnover intentions of telecommuting call center agents in the United States.

Sterilized and Satisfied: Outcomes of Childfree Sterilization Obtainment and Denials

As more women choose to forgo motherhood, childfree women and people assigned female at birth (AFAB) are important to study, particularly given pronatalist ideals that can make the choice not to have children difficult to exercise. Although temporary contraception prevents motherhood, physicians sometimes discourage or deny women access to more permanent options, including sterilization, due to their belief that childfree women and those AFAB will regret their decision. From a reproductive justice framework, we examined psychological outcomes of sterilization approval and denials among a sample of 154 childfree women and nonbinary people AFAB who sought and either obtained or were denied sterilization. Participants completed measures of psychological well-being, self-esteem, and sexual quality of life. Childfree participants who obtained sterilization reported higher self-esteem, better sexual quality, and higher well-being than childfree individuals who were denied the procedure. Neither age nor time since making the sterilization request accounted for the differences between the groups in terms of sexual quality of life and psychological well-being. Collectively, these findings offer the first empirical evidence of the potential outcomes among childfree women seeking sterilization.

Update on the Practical Role of Echocardiography in Selection, Implantation, and Management of Patients Requiring Left Ventricular Assist Device Therapy.

Echocardiography is a valuable tool for management of patients with a left ventricular assist device (LVAD). We present an updated review on the practical applications of the role of echocardiography for pre- and postoperative evaluation of patients selected. The LVAD is a temporary or permanent option for patients with advanced heart failure who are unresponsive to other therapy. Use of the device has its own risks, and implantation remains a complex procedure. Transthoracic and transesophageal echocardiography are useful tools for patient evaluation and monitoring both peri- and postoperatively, as we previously presented. Assessment of left and right ventricular function, complications such as thrombus formation or intracardiac shunting, and valvular disease are all important in this assessment. This also aids in predicting postoperative complications. Placement of the device is confirmed intraoperatively, and subsequent ramp studies are used to determine optimal device settings. Right ventricular (RV) failure is the most common postoperative complication and preoperative evaluation of its function is crucial. Studies suggest that tricuspid annular plane systolic excursion, RV fractional area change, and RV global longitudinal strain are strong predictors of RV failure; LV ejection fraction, size, and end-diastolic diameter are also important markers. Aortic regurgitation and mitral stenosis must always be corrected prior to LVAD placement. However, direct visualization before and after implantation, especially to rule out potential contraindications such as thrombi, cannot be overemphasized. Ramp studies remain an integral part of device optimization and may result in greatermyocardial recovery than previously realized.

Enduring Familial Relationships and Identity Preservation Make Simple Adoption the Preferred Permanency Option for Children in Out-of-Home Care

ABSTRACT Large numbers of children in Australia are in long-term out-of-home care (OOHC). Legal frameworks available for their care are long-term foster care, guardianship, and plenary adoption. Views of individuals with OOHC or adoption experience on these legal frameworks were explored via an online survey. A legal framework called simple adoption, which makes children legal members of adoptive families without legally excising them from birth families, was also considered. The respondents (N = 1019) evaluated aspects of these frameworks as strengths or weaknesses from which scores were calculated. Overall, simple adoption had the highest strength score, followed by plenary adoption, guardianship, and long-term foster care. The highest weakness score was for long-term foster care, followed by guardianship, plenary adoption, and simple adoption. That simple adoption enabled enduring familial relationships between children and their adoptive families while retaining legal identity and legal connection with birth families contributed to its favourable evaluation. IMPLICATIONS The legal severance of children from birth families and the supplanting of legal identity that occurs in plenary adoption makes this form of adoption unacceptable to many. Simple adoption, allowing for children to be full legal members of both their adoptive and birth families and preserving legal identity, makes it attractive to individuals with a variety of experience backgrounds. An exploration of legislative reform to allow for simple adoption in Australia should be undertaken.

The decay of traditional education: A case study under covid-19

This study examined the effect of e-learning compared to traditional education on student achievement and satisfaction, and to find out if COVID-19 is the first step for creating a society without a school, an online survey was conducted. The study sample consisted of 125 Palestinian bachelor’s degree students from different universities in the Republic of China and the Arab Gulf states. The study took place during the first half of the pandemic’s academic year, from the end of February to the end of August. 2020. The findings revealed that there are no statistically significant differences between the E-learning and traditional learning concerning students’ achievement based demographic variables (university years and scientific specialization), and the student’s satisfaction variable from (teaching staff style, educational programs provided, and quality). The study indicated that e-learning has proven its feasibility during the pandemic, so it should not be excluded and underestimated. Some third world societies still prefer traditional education, but e-learning should be a permanent option that is not limited to times of crisis; Educational institutions should recognize e-learning as a fait accompli, as is the case in many developed countries. This study recommended the necessity of recognizing e-learning and enhancing this style of study by allocating specific budgets and specialized technical and educational cadres. It also recommended adopting a hybrid education pattern by integrating e-learning and F2F education.

"We can't do without it": Parent and call-handler experiences of video triage of children at a medical helpline.

Pediatric out-of-hours calls are common, as parents worry and seek reassurance and shared responsibility. Nevertheless, most children assessed in this context are not seriously ill. Conventional telephone triage lacks visual cues and is further limited by third part communication in calls concerning children. We investigated implementation of video triage in two previous studies. The aim of the present study was to investigate 1) How video triage versus telephone triage in children was experienced by parents and call-handlers, and 2) call-handlers' evaluation of the video triage projects. We triangulated data from surveys and interviews in five sub-studies. Sub-study 1: Parents' experience of video triage reported in closed-ended questionnaire items using quantitative analysis; Sub-study 2: Parents' experience of video triage reported as questionnaire free-text using qualitative content analysis; Sub-study 3: Call-handlers' experience of video triage reported in closed-ended questionnaire items using quantitative analysis; and Sub-studies 4 and 5: Individual interviews of call-handlers' experience of 1) video triage using thematic analysis and 2) the video triage project using process evaluation. Most parents' comments regarding video triage were positive (n = 164, 83%). Video triage was perceived as reassuring and reducing the likelihood of misunderstandings and unnecessary hospital visits. Call-handlers experienced that video triage improved patient assessment and caller reassurance. Some call-handlers complained that the time allocated for study participation was inadequate and requested a more accessible video set-up. Both parents and call-handlers were significantly more satisfied and reassured after video triage than after telephone triage and suggested video triage as a permanent option. Video triage was appreciated by parents and call-handlers and was recommended as a permanent option. The call-handlers suggested that designated time for participation in the studies would have been desirable in this busy call-center. We recommend video triage as a contemporary solution in out-of-hours service.

Genital fashioning: Postfeminist discourse and mediating understandings of choice

Female genital fashioning practices, a term encompassing a range of temporary and permanent options for cosmetic genital alteration, are becoming an increasingly prominent part of contemporary beauty regimes. Drawing on a series of 11 small focus groups and 10 interviews with 34 Australian women aged 18–30, this paper explores the ways that cisgender young women negotiate a combination of social pressures, pleasures and influences in their decisions to engage with genital fashioning. These pressures are described by women to emanate from broad social norms, sexual partners, family members, and peer groups. The women in this study demonstrate a nuanced and critical awareness of the cultural context which they inhabit but deploy postfeminist narratives of self-care and enjoyment to make sense of genital fashioning practices. The paper contributes to scholarship on postfeminism by demonstrating the ways that women creatively use the discursive tools available to enable critical reflection on notions of choice. At the same time, the findings in this study constitute an empirical contribution to critiques of postfeminism to reveal the limitations of postfeminist reasoning which ultimately works to curtail or impede the identification of structural problems and constraints.

Understanding quality of contraceptive services from women’s perspectives in Gujarat, India: a focus group study

ObjectivesUnderstanding quality of contraceptive care from clients’ perspectives is critical to ensuring acceptable and non-harmful services, yet little qualitative research has been dedicated to this topic. India’s history of using...

Permanency Decisions in Child Welfare: A Qualitative Study

Abstract This article presents findings from an exploratory in-depth qualitative research project with seventeen child welfare professionals exploring their permanency decisions with regards to Looked after Children. Thinking aloud-protocols and semi-structured interviews, in conjunction with a specifically constructed vignette were used to explore the permanency decisions of child welfare workers. Findings from this innovative research suggest that different decisions were taken by participants based on viewing the same vignette. However, even though the decisions differed, they clustered around the more interventionist options with most favouring adoption and foster care despite viable alternatives offered. There was broad consistency related to the rationale for the decisions taken, but this did not translate into a consistent permanency option being chosen. Possible reasons to account for this are that the decisions were heuristically constructed, idiosyncratic to individual inclinations and influenced by factors other than the individual needs of the service user. The implications of this are that children and families do not get a consistent and reliable response to their permanency needs. We therefore recommend the greater use of structured decision-making tools in permanency decisions to increase their objectivity and consistency.

Inside the lived perspective of life after spinal cord injury: a qualitative study of the desire to live and not live, including with assisted dying.

Qualitative. The objective of this study was to examine whether individuals with a SCI would have considered Medical-Assistance-in-Dying (MAiD) following their SCI and whether these individuals felt they would have been able to make an informed decision about this potentially permanent option early in their experience. Manitoba, Canada. Participants with varying neurological levels of SCI and classification were included. The time since SCI ranged from <6 months to >50 years. A focus group of five individuals was conducted first to calibrate questions. Twenty-three participants were then individually interviewed. Participants' responses were transcribed and coded into themes. Half of the participants reported having suicidal ideation within the first 2 years of experiencing a SCI. However, no participants thought that they would have been able to make an informed decision about MAiD during this time. Most participants reported that they were able to adapt and reframe their lives to alter their views. There was higher agreement that MAiD should be available for individuals who had experienced a reframed, informed view. This study indicates that people with SCI do not feel that informed decision making about ending their life can be made early after SCI despite high levels of reported suicidal ideation in that early time frame. A reframing process helps to facilitate informed decisions about living with a SCI. The reframing process is correlated with opportunities of rehabilitation, peer mentor support, and re-integration into the community.