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The Thing-in-Itself has been contentious issue within Kantian philosophy. Initially, it seems like an unfortunate side-effect of Kant’s distinction between phenomena and noumena. This article deals with this issue in a different manner, attempting to re-situate the Thing-in-Itself within Kantian philosophy, albeit from an anthropological rather than a critical angle. The anthropological works of Kant fully recognize that subjectivity and lived experience, as well as a thoroughgoing cognitive gradualism are necessary to “orient ourselves in thinking”. By reading the importance of the Thing-in-Itself from the anthropological viewpoint of Otto Friedrich Bollnow and the Kyoto School philosophy of Ueda Shizuteru, I argue that in all its negativity, the Thing-in-Itself constitutes the outer expanse of thought. Connecting this exposition with contemporary thinking on actancy and ecology, and following the Romantic tradition represented by Schopenhauer and Schelling, I argue that the Thing-in-Itself can be grasped indirectly and non-conceptually. As such, it constitutes the ground of thought. This insight makes Kant’s initially problematic concept directly relevant for our current ecological predicament, through which we realize the necessity for epistemic humility and embracing the unknown or the noumenal dimension that we cannot conceptually represent.

Background: Medical consultations with older patients often include triadic conversations and decision-making processes involving physicians, patients, and family members. The presence of family members may change the communication dynamics and therefore increase the complexity of the consultation and decision-making process. Objective: This study explored associations between physicians' shared decision-making (SDM) behaviour and patients' and family members' participation in the decision-making process. Methods: Using an observational design, we analysed 95 recorded consultations between medical specialists, patients aged ≥65 years, and accompanying family members at a Dutch hospital. The OPTIONMCC was used to assess the physicians' SDM behaviour and patients' and family members' levels of involvement in SDM. Results: We found a strong positive correlation between physicians' behaviour and patients' and family members' participation in SDM (0.68 and 0.64, respectively, p

Abstract Background Informal care is an essential part of support provided in the homecare setting. To ensure effective healthcare provision, good communication and collaboration between informal and formal care providers are crucial. To achieve this aim, it is necessary to have a clear understanding of the perspectives of all stakeholders. In the scientific literature, limited knowledge is available regarding family members’ opinions about their involvement in care. To date, no instruments have been developed that accurately measure these opinions. This study aims to elucidate the opinions of family members about their involvement in nursing care. Methods A cross-sectional survey approach was employed. The methodological steps in this study were (1) convert the Families’ Importance in Nursing Care–Nurses’ Attitudes (FINC-NA) from a nurses’ perspective to a family perspective and thus develop the Families’ Importance in Nursing Care–Families’ Opinions (FINC-FO) and (2) measure families’ opinions regarding their involvement in home nursing care. The questionnaire was sent to 3,800 patients with activated patient portals, which accounts for about 17% of the total patient base. Responses were received from 1,339 family members, a response rate of 35%. Results The developed FINC-FO questionnaire showed homogeneity and internal consistency. The results of the questionnaire indicate that family members consider it important to be involved in care and that they wish to be acknowledged as participants in discussions about care (planning) but are less inclined to actively participate in the provision of care by nurses. Family members expressed less explicit opinions about their own support needs. Factors such as level of education, type of partnership, and amount of care provided are seemingly associated with these opinions. Conclusions Family members in the homecare setting wish to be involved in discussions about care (planning). The transition in care from primarily formal to more informal care necessitates an awareness and clear definition—on part of both healthcare professionals and families—of their respective roles in the provision of care. Communication about wishes, expectations, and the need for support in care is essential to ensure quality of care and that the family can sustain caregiving.

Much research on collaborative learning focuses on working together on tasks that are designed with collaboration in mind. However, teachers may ask children to collaborate on single player tasks as well, given a scarcity of available computers in the classroom or assuming that children can learn from each other and motivate each other. In the current study, we studied the conversations of primary school children (N = 64; 39 girls, 25 boys) working together in dyads in an adaptive single-player math learning environment (Math Garden). We aimed to investigate (1) how dyads collaborate across two math tasks aimed at practicing different math skills (arithmetic vs. reasoning skills) embedded within Math Garden and (2) whether collaborative activities differed across the two math tasks. We studied both individual utterances as well as episodes of social metacognitive interactions between the dyad members. We found that children engaged in activities important for successful collaboration, such as relational and metacognitive activities. Moreover, we identified social metacognitive episodes, meaning that children regulated their groups’ learning and that the regulatory processes which took part within the collaborative learning session cannot be reduced to individual activities. We conclude that children engage in collaborative activities when working together on single player tasks. And, in line with previous research, these collaborative activities differed across games, highlighting that collaborative learning is shaped by the task at hand.

OBJECTIVE: Some individuals with bipolar disorder (BD) experience manic and depressive symptoms concurrently, but data are limited on symptom mixity in older age bipolar disorder (OABD). Using the Global Aging & Geriatric Experiments in Bipolar Disorder Database, we characterized mixity in OABD and associations with everyday function. METHODS: The sample (n = 805), from 12 international studies, included cases with both mania and depression severity ratings at a single timepoint. Four mixity groups were created: asymptomatic (A), mixed (Mix), depressed only (Dep), and manic only (Man). Generalized linear mixed models used mixity group as the predictor variable; cohort was included as a random intercept. Everyday function was assessed with the Global Assessment of Functioning score. RESULTS: Group proportions were Mix (69.6%; n = 560), followed by Dep (18.4%; n = 148), then A (7.8%; n = 63), then Man (4.2%; n= 34); levels of depression and mania were similar in Mix compared to Dep and Man, respectively. Everyday function was lowest in Mix, highest in A, and intermediate in Man and Dep. Within Mix, severity of depression was the main driver of worse functioning. Groups differed in years of education, with A higher than all others, but did not differ by age, gender, employment status, BD subtype, or age of onset. CONCLUSIONS: Mixed features predominate in a cross-sectional, global OABD sample and are associated with worse everyday function. Among those with mixed symptoms, functional status relates strongly to current depression severity. Future studies should include cognitive and other biological variables as well as longitudinal designs to allow for evaluation of causal effects.

This study investigated macro-level navigation patterns in children's hypermedia learning, and how they related to task structure and learning outcomes. For this purpose, 5th and 6th grade learners performed a hypermedia assignment in which a high (n=57) versus a low (n=54) level of structure was provided. By means of qualitative analyses of their navigation activities, 6 macro-level navigation patterns were distinguished: linear reading, selective reading, video viewing, massed writing, late onset writing, and unpredictable reading. Results showed that the linear reading pattern was more frequent in the high structure environment, and that both the high structure environment and the linear reading pattern were associated with the highest quality of the children's written assignments. Navigation patterns and task structure did not clearly predict children's declarative knowledge gains or knowledge transfer. These findings show that there are multiple ways to navigate through a hypermedia environment, but that these are not all equally successful for learning. Moreover, the provided task structure in the environment may affect the occurrence of successful navigation patterns.

ObjectiveLiterature on older-age bipolar disorder (OABD) is limited. This first-ever analysis of the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) investigated associations among age, BD symptoms, comorbidity, and functioning.MethodsThis analysis used harmonized, baseline, cross-sectional data from 19 international studies (N = 1377). Standardized measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), and Global Assessment of Functioning (GAF).ResultsMean sample age was 60.8 years (standard deviation [SD] 12.2 years), 55% female, 72% BD I. Mood symptom severity was low: mean total YMRS score of 4.3 (SD 5.4) and moderate-to-severe depression in only 22%. Controlled for sample effects, both manic and depressive symptom severity appeared lower among older individuals (p's

BackgroundThe quality of care given by EMS staff is in part monitored by routine review of deployment reports that the providers must complete after each deployment. The assessment consists of determining whether a deployment was performed in a medically correct manner and thus whether the clinical reasoning process was appropriate. The time used during the deployment is also measured, as there are often time limits for performing different parts of the deployment and these must be adhered to. One might question whether measuring the time spent really gives insight into the quality of care, and if it might not be more useful to see how that time was spent. We therefore conceived a study to map the EMS care process and evaluate this process in relation to the time used.MethodsWe used a focused ethnographic study design. Video recordings of EMS deployments in combination with semi-structured interviews of the EMS providers involved, were thematically analysed. This led to insights into the EMS care process and the embedded clinical reasoning. By categorising the professional activities we identified we were able to define a model that describes in general the EMS care process. We reported the first part of this study in which we developed this so called SPART model in a separate paper. In this second part of the study we determined the execution time within a deployment and measured the frequency of occurrence and the duration of the identified activities. We interpreted the operational content and the time variables both qualitatively and quantitatively. We also determined the distribution of activities over the three deployment operational periods (response, on-scene and transport period).ResultsUsing the SPART model, we gained insight into the different activities' nature, order, and duration. We could qualitatively judge the effectiveness of the clinical reasoning process, i.e., the quality of care delivered. Generally, the studied cases were followable, and the clinical reasoning process was medically logical. The diagnostic process sometimes continued after the clinical decision, which was not medically logical. Remarkably, this never changed the clinical decision. Although this could negatively affect the quality of care, we found no clinical evidence that this was the case.ConclusionOur findings demonstrated that the quality of care in EMS can be measured by using the SPART model to evaluate EMS deployments. We concluded that qualitative judgment was more important than quantitative evaluation. Interpreting the order of different activities led to the clearest understanding of the clinical reasoning process. It was concluded that knowledge of the exact time used per activity and, in total, had the least impact on understanding the clinical reasoning process.

BackgroundThe fluid balance is a critical parameter in intensive care units (ICU) as it provides information about the patient's volume status. However, the accuracy of fluid balance measurements is often compromised due to the complexity and repetition of actions involved. Additionally, the fluid balance could be recalculated for insensible fluid loss. Weighing is an alternative method to estimate the patient's volume status. Built-in scales in beds make patient weighing easier and less time-consuming, allowing clinicians to intervene more quickly on existing treatments.AimThis study compares fluid balance, and body weight changes over time in ICU patients. Furthermore, it seeks to determine the degree of congruence between the fluid balance corrected for insensible fluid loss and daily body weight in ICU patients.MethodsA single-center observational study was conducted in an ICU of a university hospital. All consecutive patients admitted to a bed with an integrated weighing scale were eligible. Exclusion criteria were (1) body weight ≥254,4 kilograms; (2) oral nutrition; (3) a flush catheter or balance; (4) only a single weight measurement; (5) delta body weight change of ≥5kg in 12 hours. Weights and fluid balances were obtained every 12 hours.ResultsWe obtained 2282 measurements (n = 187 patients). The correlation between weight and fluid balance was weak (r = 0.274). After adjusting the fluid balance for insensible fluid loss, the correlation remained weak (r = 0,268). Bland Altman analysis revealed a wide confidence interval for both the fluid balance and corrected fluid balance versus weight.Conclusion and implications of key findingsThis study shows a weak correlation between weight and fluid balance. Therefore, when monitoring the volume status in the ICU, fluid balance and weight should both be taken into account. This two-pronged approach is crucial because it provides more control over erroneous fluid balance or weighing measurements.

Abstract Background China faces a serious shortage of competent nurses who can address the healthcare needs of older people in an ageing society. Chinese higher education institutes face serious challenges when it comes to developing new curricula that are capable of educating sufficient numbers of competent gerontological nurses. Therefore, the aim of this research study was to identify and verify competencies for gerontological nurses in China that are needed to provide nursing care for the growing number of older people in all care settings. This study takes into account the possible opportunities that trends and developments may offer in the near future. Methods In this study, a two-phase research design was used. The first phase concerned needs analysis, including a situational analysis, a trend analysis and a competence analysis. This process resulted in a draft competence framework. The second phase addressed the verification of the competence framework through a two-round Delphi study with a panel of Chinese and European experts. This process led to the final competence framework. Results The final competence framework for gerontological nursing in China included six competencies divided into 13 essential and five relevant learning outcomes. The competencies are: ‘providing gerontological care’, ‘communication and collaboration’, ‘organization of gerontological nursing care’, ‘health promotion’, ‘evidence-based nursing and lifelong learning’ and ‘professional behaviour’. Conclusion The framework comprehensively covers the six core competencies that nurses who care for older people should possess. These competencies are well-embedded in a Chinese context. The framework therefore offers concrete, practical suggestions for the competencies and skills that nursing graduates will need to work in current and future professions related to gerontological nursing education and practice.

Abstract Background Patients are increasingly expected to take an active role in their own care. Participation in nursing documentation can support patients to take this active role since it provides opportunities to express care needs and preferences. Yet, patient participation in electronic nursing documentation is not self‐evident. Objective To explore how home‐care patients perceive their participation in electronic nursing documentation. Methods Semi‐structured interviews were conducted with 21 home‐care patients. Interview transcripts were analysed in an iterative process based on the principles of reflexive inductive thematic analysis. Results We identified a typology with four patient types: ‘high need, high ability’, ‘high need, low ability’, ‘low need, high ability’ and ‘low need, low ability’. Several patients felt a need for participation because of their personal interest in health information. Others did not feel such a need since they trusted nurses to document the information that is important. Patients' ability to participate increased when they could read the documentation and when nurses helped them by talking about the documentation. Barriers to patients' ability to participate were having no electronic devices or lacking digital skills, a lack of support from nurses and the poor usability of electronic patient portals. Conclusion Patient participation in electronic nursing documentation varies between patients since home‐care patients differ in their need and ability to participate. Nurses should tailor their encouragement of patient participation to individual patients' needs and abilities. Furthermore, they should be aware of their own role and help patients to participate in the documentation. Patient or Public Contribution Home‐care patients were involved in the interviews.

Background: The quality of care given by EMS staff is in part monitored by routine review of deployment reports that the providers must complete after each deployment. The assessment consists of determining whether a deployment was performed in a medically correct manner and thus whether the clinical reasoning process was appropriate. The time used during the deployment is also measured, as there are often time limits for performing different parts of the deployment and these must be adhered to. One might question whether measuring the time spent really gives insight into the quality of care, and if it might not be more useful to see how that time was spent. We therefore conceived a study to map the EMS care process and evaluate this process in relation to the time used. Methods: We used a focused ethnographic study design. Video recordings of EMS deployments in combination with semi-structured interviews of the EMS providers involved, were thematically analysed. This led to insights into the EMS care process and the embedded clinical reasoning. By categorising the professional activities we identified we were able to define a model that describes in general the EMS care process. We reported the first part of this study in which we developed this so called SPART model in a separate paper. In this second part of the study we determined the execution time within a deployment and measured the frequency of occurrence and the duration of the identified activities. We interpreted the operational content and the time variables both qualitatively and quantitatively. We also determined the distribution of activities over the three deployment operational periods (response, on-scene and transport period). Results: Using the SPART model, we gained insight into the different activities' nature, order, and duration. We could qualitatively judge the effectiveness of the clinical reasoning process, i.e., the quality of care delivered. Generally, the studied cases were followable, and the clinical reasoning process was medically logical. The diagnostic process sometimes continued after the clinical decision, which was not medically logical. Remarkably, this never changed the clinical decision. Although this could negatively affect the quality of care, we found no clinical evidence that this was the case. Conclusion: Our findings demonstrated that the quality of care in EMS can be measured by using the SPART model to evaluate EMS deployments. We concluded that qualitative judgment was more important than quantitative evaluation. Interpreting the order of different activities led to the clearest understanding of the clinical reasoning process. It was concluded that knowledge of the exact time used per activity and, in total, had the least impact on understanding the clinical reasoning process. [ABSTRACT FROM AUTHOR]

Abstract Background The time that nurses spent on documentation can be substantial and burdensome. To date it was unknown if documentation activities are related to the workload that nurses perceive. A distinction between clinical documentation and organizational documentation seems relevant. This study aims to gain insight into community nurses’ views on a potential relationship between their clinical and organizational documentation activities and their perceived nursing workload. Methods A convergent mixed-methods design was used. A quantitative survey was completed by 195 Dutch community nurses and a further 28 community nurses participated in qualitative focus groups. For the survey an online questionnaire was used. Descriptive statistics, Wilcoxon signed-ranked tests, Spearman’s rank correlations and Wilcoxon rank-sum tests were used to analyse the survey data. Next, four qualitative focus groups were conducted in an iterative process of data collection - data analysis - more data collection, until data saturation was reached. In the qualitative analysis, the six steps of thematic analysis were followed. Results The majority of the community nurses perceived a high workload due to documentation activities. Although survey data showed that nurses estimated that they spent twice as much time on clinical documentation as on organizational documentation, the workload they perceived from these two types of documentation was comparable. Focus-group participants found organizational documentation particularly redundant. Furthermore, the survey indicated that a perceived high workload was not related to actual time spent on clinical documentation, while actual time spent on organizational documentation was related to the perceived workload. In addition, the survey showed no associations between community nurses’ perceived workload and the user-friendliness of electronic health records. Yet focus-group participants did point towards the impact of limited user-friendliness on their perceived workload. Lastly, there was no association between the perceived workload and whether the nursing process was central in the electronic health records. Conclusions Community nurses often perceive a high workload due to clinical and organizational documentation activities. Decreasing the time nurses have to spend specifically on organizational documentation and improving the user-friendliness and intercommunicability of electronic health records appear to be important ways of reducing the workload that community nurses perceive.

BackgroundFamily engagement in care for adult inpatients may improve shared decision making in the hospital and the competence and preparedness of informal caregivers to take over the care at home. An important strategy to involve family members in hospital care processes is to include them in (ward) rounds, also called 'family-centered rounds'(FCRs).ObjectivesSummarize the evidence regarding the added value of FCRs from the perspectives of patients, family, and healthcare professionals.MethodsA review protocol was registered a priori with PROSPERO (number CRD42022320915). The electronic databases PubMed, CINAHL, and PsycInfo were searched for English-written systematic reviews with a focus on FCRs. The results and methods were presented in line with the PRISMA guidelines, and the methodological quality of the included reviews was assessed using the adapted version of the AMSTAR tool.ResultsOf the 207 initial records, four systematic reviews were identified covering a total of 67 single studies, mainly performed in critical and pediatric care. Added values of FCR were described at review level, with references to single studies. All four systematic reviews reported an improvement in satisfaction among patients, family, and healthcare professionals, whereby satisfaction is linked to improved communication and interaction, improved situational understanding, inclusion of family in the decision-making process, and improved relationships within the care situation.ConclusionAlthough only limited research has been conducted on the value of FCRs in the adult non-critical care setting, and despite the existence of a variety of outcome measures, the results available from the pediatric and acute care setting are positive. The findings of the sole study in an adult non-critical patient population are in line with these results. Further research in adult non-critical care is required to verify its effects in this setting.

Abstract Background Clinical reasoning is a crucial task within the Emergency Medical Services (EMS) care process. Both contextual and cognitive factors make the task susceptible to errors. Understanding the EMS care process’ structure could help identify and address issues that interfere with clinical reasoning. The EMS care process is complex and only basically described. In this research, we aimed to define the different phases of the process and develop an overarching model that can help detect and correct potential error sources, improve clinical reasoning and optimize patient care. Methods We conducted a focused ethnography study utilizing non-participant video observations of real-life EMS deployments combined with thematic analysis of peer interviews. After an initial qualitative analysis of 7 video observations, we formulated a tentative conceptual model of the EMS care process. To test and refine this model, we carried out a qualitative, thematic analysis of 28 video-recorded cases. We validated the resulting model by evaluating its recognizability with a peer content analysis utilizing semi-structured interviews. Results Based on real-life observations, we were able to define and validate a model covering the distinct phases of an EMS deployment. We have introduced the acronym “SPART” to describe ten different phases: Start, Situation, Prologue, Presentation, Anamnesis, Assessment, Reasoning, Resolution, Treatment, and Transfer. Conclusions The “SPART” model describes the EMS care process and helps to understand it. We expect it to facilitate identifying and addressing factors that influence both the care process and the clinical reasoning task embedded in this process.

Abstract Background Prognostic assessments of the mortality of critically ill patients are frequently performed in daily clinical practice and provide prognostic guidance in treatment decisions. In contrast to several sophisticated tools, prognostic estimations made by healthcare providers are always available and accessible, are performed daily, and might have an additive value to guide clinical decision-making. The aim of this study was to evaluate the accuracy of students’, nurses’, and physicians’ estimations and the association of their combined estimations with in-hospital mortality and 6-month follow-up. Methods The Simple Observational Critical Care Studies is a prospective observational single-center study in a tertiary teaching hospital in the Netherlands. All patients acutely admitted to the intensive care unit were included. Within 3 h of admission to the intensive care unit, a medical or nursing student, a nurse, and a physician independently predicted in-hospital and 6-month mortality. Logistic regression was used to assess the associations between predictions and the actual outcome; the area under the receiver operating characteristics (AUROC) was calculated to estimate the discriminative accuracy of the students, nurses, and physicians. Results In 827 out of 1,010 patients, in-hospital mortality rates were predicted to be 11%, 15%, and 17% by medical students, nurses, and physicians, respectively. The estimations of students, nurses, and physicians were all associated with in-hospital mortality (OR 5.8, 95% CI [3.7, 9.2], OR 4.7, 95% CI [3.0, 7.3], and OR 7.7 95% CI [4.7, 12.8], respectively). Discriminative accuracy was moderate for all students, nurses, and physicians (between 0.58 and 0.68). When more estimations were of non-survival, the odds of non-survival increased (OR 2.4 95% CI [1.9, 3.1]) per additional estimate, AUROC 0.70 (0.65, 0.76). For 6-month mortality predictions, similar results were observed. Conclusions Based on the initial examination, students, nurses, and physicians can only moderately predict in-hospital and 6-month mortality in critically ill patients. Combined estimations led to more accurate predictions and may serve as an example of the benefit of multidisciplinary clinical care and future research efforts.

Not all our intentions translate into actions, as our capacity to act may be influenced by a variety of mental and biochemical factors. In this article, we present a comprehensive account of how neuro-immunological processes affect our intentional abilities and our capacity to act. We do so by extending the theory of thought-shapers (TTS) through the notion of action-shapers and combining this theory with the essential embodiment thesis (EE). This thesis about the mind-body relation says that human minds are necessarily and completely embodied. Action-shapers dynamically constitute the action-space of individuals, affecting their capacity to take action or to select one course of action over another. We highlight the effects and interactions of neuro-immunological effective processes in the body to demonstrate how they shape the action-space. In this article, we consider neuro-immunological effective processes that influence the gut-brain axis, chronic stress, high levels of sugar intake, the amygdala and the effects of prolonged stress. We investigate the effects of these processes on the perception and on the capacity to form intentions and act on them. We conclude the paper by providing a concise account of action-shapers, in which we attempt to summarize the line of argumentation and provide suggestions for further research.

Abstract Background Patient participation in nursing documentation has several benefits like including patients’ personal wishes in tailor-made care plans and facilitating shared decision-making. However, the rise of electronic health records may not automatically lead to greater patient participation in nursing documentation. This study aims to gain insight into community nurses’ experiences regarding patient participation in electronic nursing documentation, and to explore the challenges nurses face and the strategies they use for dealing with challenges regarding patient participation in electronic nursing documentation. Methods A qualitative descriptive design was used, based on the principles of reflexive thematic analysis. Nineteen community nurses working in home care and using electronic health records were recruited using purposive sampling. Interviews guided by an interview guide were conducted face-to-face or by phone in 2019. The interviews were inductively analysed in an iterative process of data collection–data analysis–more data collection until data saturation was achieved. The steps of thematic analysis were followed, namely familiarization with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and reporting. Results Community nurses believed patient participation in nursing documentation has to be tailored to each patient. Actual participation depended on the phase of the nursing process that was being documented and was facilitated by patients’ trust in the accuracy of the documentation. Nurses came across challenges in three domains: those related to electronic health records (i.e. technical problems), to work (e.g. time pressure) and to the patients (e.g. the medical condition). Because of these challenges, nurses frequently did the documentation outside the patient’s home. Nurses still tried to achieve patient participation by verbally discussing patients’ views on the nursing care provided and then documenting those views at a later moment. Conclusions Although community nurses consider patient participation in electronic nursing documentation important, they perceive various challenges relating to electronic health records, work and the patients to realize patient participation. In dealing with these challenges, nurses often fall back on verbal communication about the documentation. These insights can help nurses and policy makers improve electronic health records and develop efficient strategies for improving patient participation in electronic nursing documentation.

The Thing-in-Itself has been contentious issue within Kantian philosophy. Initially, it seems like an unfortunate side-effect of Kant's distinction between phenomena and noumena. This article deals with this issue in a different manner, attempting to re-situate the Thing-in-Itself within Kantian philosophy, albeit from an anthropological rather than a critical angle. The anthropological works of Kant fully recognize that subjectivity and lived experience, as well as a thoroughgoing cognitive gradualism are necessary to "orient ourselves in thinking". By reading the importance of the Thing-in-Itself from the anthropological viewpoint of Otto Friedrich Bollnow and the Kyoto School philosophy of Ueda Shizuteru, I argue that in all its negativity, the Thing-in-Itself constitutes the outer expanse of thought. Connecting this exposition with contemporary thinking on actancy and ecology, and following the Romantic tradition represented by Schopenhauer and Schelling, I argue that the Thing-in-Itself can be grasped indirectly and non-conceptually. As such, it constitutes the ground of thought. This insight makes Kant's initially problematic concept directly relevant for our current ecological predicament, through which we realize the necessity for epistemic humility and embracing the unknown or the noumenal dimension that we cannot conceptually represent. [ABSTRACT FROM AUTHOR]

Abstract Background Students living with a chronically ill family member may experience significant pressure, stress, and depression due to their caregiving situation. This may also lead to them delaying or dropping out of school when the combination of being a caregiver and their education program are too demanding. This survey study aims to explore the consequences for students of bachelor or vocational education programs when they are growing up with a chronically ill family member and the influence of various background characteristics and risk factors. Methods A survey was sent to 5997 students (aged 16–25 years) enrolled in bachelor or vocational education programs in the north of the Netherlands. The content of the survey was based on a literature study and consultation with experts. Descriptive statistics, Chi-square tests, and logistic regression analyses were performed. Results A total of 1237 students (21%) responded to the survey. A sub group of 237 (19%) students (mean age 21(2.2); 87% female) identified themselves as growing up with a chronically ill family member. More than half (54.9%) of these students indicated that they experienced negative consequences in daily life. A significant association (OR .42, p

On the supposition that one’s ethics and politics are fundamentally dignitarian in a broadly Kantian sense—as specifically opposed to identitarian and capitalist versions of Statism, e.g., neoliberal nation-States, whether democratic or non-democratic—hence fundamentally non-coercive and non-violent, then is self-defense or the defense of innocent others, using force, ever rationally justifiable and morally permissible or obligatory? We think that the answer to this hard question is yes; correspondingly, in this essay we develop and defend a theory about the permissible use of force in a broadly Kantian dignitarian moral and political setting, including its extension to non-violent civil disobedience in the tradition of Martin Luther King, Jr; and perhaps surprisingly, we also import several key insights from Samurai and Martial Arts ethics into our theory.

Abstract Background There is increasing awareness that, besides patient survival, Quality of Life (QOL) is a relevant outcome factor for patients who have a chronic disease. In haemodialysis (HD) patients, intradialytic hypotension (IDH) is considered one of the most frequent complications, and this is often accompanied by symptoms. Several studies have investigated QOL in dialysis patients, however, research on the association between intradialytic symptoms and QOL is minimal. The goal of this study was to determine whether the occurrence of IDH has an influence on the perception of QOL. Methods During 3 months, haemodynamic data, clinical events, and interventions of 2623 HD-sessions from 82 patients were prospectively collected. The patients filled out a patient-reported intradialytic symptom score (PRISS) after each HD session. IDH was defined according to the EBPG as a decrease in SBP ≥20 mmHg or in MAP ≥10 mmHg associated with a clinical event and need for nursing interventions. Patient’s self-assessment of QOL was evaluated by the 36-Item Short-Form Health Survey. Results There were no significant associations between the mental summary score or the physical summary score and the proportion of dialysis sessions that fulfilled the full EBPG definition. A lower PRISS was significantly associated with the proportion of dialysis sessions that fulfilled the full EBPG definition (R = − 0.35, P = 0.0011), the proportion of dialysis sessions with a clinical event (R = − 0.64, P = 0.001), and the proportion of dialysis sessions with nursing interventions (R = − 0.41, P = 0.0001). The physical component summary and mental component summary were significantly negatively associated with the variable diabetes and positively with PRISS (P = 0.003 and P = 0.005, respectively). UF volume was significantly negatively associated with mental health (P = 0.02) and general health (P = 0.01). Conclusions Our findings suggest that the EBPG definition of IDH does not capture aspects of intradialytic symptomatology that are relevant for the patient’s QOL. In contrast, we found a significant association between QOL and a simple patient-reported intra-dialytic symptom score, implying that how patients experience HD treatment influences their QOL.

Objectives We report on the acceptability, feasibility, dose-response relationship and adherence of two nutritional strategies to improve mood (multinutrient supplements; food-related behavioural activation (F-BA)) studied in a randomised controlled depression prevention trial (the Multi‐country cOllaborative project on the rOle of Diet, Food‐related behaviour, and Obesity in the prevention of Depression (MooDFOOD) Trial). We also assessed baseline determinants of adherence and assessed whether better adherence resulted in lower depressive symptoms.Design Randomised controlled trial with a 2×2 factorial design conducted between 2015 and 2017.Setting Germany, the Netherlands, UK and Spain.Participants Community sample of 1025 overweight adults with elevated depressive symptoms without a current episode of major depressive disorder. Main eligibility criteria included age (18–75 years), being overweight or obese, and having at least mild depressive symptoms, shown by a Patient Health Questionnaire Score of ≥5. A total of 76% of the sample was retained at the 12-month follow-up.Interventions Daily nutritional supplements versus pill placebo or an F-BA therapy, delivered in individual and group sessions versus no behavioural intervention over a 1-year period.Primary and secondary outcome measures Primary outcome: self-reported acceptability of the interventions. Secondary outcomes: adherence and self-reported depressive symptoms.Results Most participants reported that the F-BA was acceptable (83.61%), feasible to do (65.91%) and would recommend it to a friend (84.57%). Individual F-BA sessions (88.10%) were significantly more often rated as positive than group F-BA sessions (70.17%) and supplements (28.59%). There were statistically significant reductions in depressive symptoms for those who both adhered to the F-BA intervention and had a history of depression (B=−0.08, SE=0.03, p=0.012) versus those who had no history of depression. Supplement intake had no effect on depressive symptoms irrespective of adherence.Conclusions F-BA may have scope for development as a depression prevention intervention and public health strategy but further refinement and testing are needed.Trial registration number NCT02529423.

This study investigated macro-level navigation patterns in children’s hypermedia learning, and how they related to task structure and learning outcomes. For this purpose, 5th and 6th grade learners performed a hypermedia assignment in which a high (n=57) versus a low (n=54) level of structure was provided. By means of qualitative analyses of their navigation activities, 6 macro-level navigation patterns were distinguished: linear reading, selective reading, video viewing, massed writing, late onset writing, and unpredictable reading. Results showed that the linear reading pattern was more frequent in the high structure environment, and that both the high structure environment and the linear reading pattern were associated with the highest quality of the children’s written assignments. Navigation patterns and task structure did not clearly predict children’s declarative knowledge gains or knowledge transfer. These findings show that there are multiple ways to navigate through a hypermedia environment, but that these are not all equally successful for learning. Moreover, the provided task structure in the environment may affect the occurrence of successful navigation patterns.

PurposeAccurate measurement of body temperature is important for the timely detection of fever or hypothermia in critically ill patients. In this prospective study, we evaluated whether the agreement between temperature measurements obtained with TAT (test method) and bladder catheter-derived temperature measurements (BT; reference method) is sufficient for clinical practice in critically ill patients.MethodsPatients acutely admitted to the Intensive Care Unit were included. After BT was recorded TAT measurements were performed by two independent researchers (TAT1; TAT2). The agreement between TAT and BT was assessed using Bland-Altman plots. Clinical acceptable limits of agreement (LOA) were defined a priori (ResultsIn total, 90 critically ill patients (64 males; mean age 62 years) were included. The observed mean difference (TAT-BT; ±SD, 95% LOA) between TAT and BT was 0.12°C (-1.08°C to +1.32°C) for TAT1 and 0.14°C (-1.05°C to +1.33°C) for TAT2. 36% (TAT1) and 42% (TAT2) of all paired measurements failed to meet the acceptable LOA of 0.5°C. Subgroup analysis showed that when patients were receiving intravenous norepinephrine, the measurements of the test method deviated more from the reference method (p = NS).ConclusionThe TAT is not sufficient for clinical practice in critically ill adults.

Purpose: The purpose of this paper is to explore the characteristics of talent in relation to international business to facilitate selection and development of talent in human resources (HR) and human resource development (HRD). Design/methodology/approach: A mixed method design was used: focus groups with business professionals to identify the characteristics of highly talented international business professionals (HTIBP), resulting in a concept profile; Delphi study for validation; systematic comparison of the open coding results to existing literature to identify characteristics of talent. Findings: A specific and concise profile of HTIBP has been developed. This profile has five domains: achieving results; communicating; innovating; self-reflecting; seeing patterns and interrelationships in a global context. From literature cross-referencing, we have identified innovating, being creative and having a drive to achieve results are most distinguishing for HTIBP. Practical implications: The paper facilitates an ongoing discussion about what constitutes talent, and offers new perspectives for companies to consider when selecting and developing talent. Originality/value: The conceptual contribution of the paper offers a fresh and practical empirical perspective on what talent entails.

Abstract Background Over the past few years, the complexity of the health care system in which nurses are required to practice has increased considerably, magnifying the need for excellent professionals with a specific set of knowledge, skills and attitudes. However, the characteristics that distinguish an excellent nurse have not yet been clarified. The aim of this study was to determine nurses’ perspectives regarding characteristics associated with an excellent nurse in order to elicit a conceptual profile. Method A focus group design followed by Delphi panel content validation was utilized. Information regarding nurses’ perspectives was derived from six focus group discussions comprising 19 nurses involved in hospital practice and 24 nurses with experience in mental health care. The analysis of the focus group discussions resulted in nine domains whereby content validity was achieved with contributions from a Delphi panel survey with 26 professionals. Results As determined by the survey, a combination of these specified aspects characterize an excellent nurse: analytical, communicative, cooperative, coordinating, disseminates knowledge, empathic, evidence-driven, innovative and introspective. Conclusion Determining what establishes an excellent nurse according to experienced nurses is valuable as this information can influence the broadening curriculum for educating future nurses to meet the needs in the professional field, contributing to the quality of care. This conceptual profile can be used as a reference guide for supervisors and professionals to personally improve their clinical practice as well as for education.

Abstract Background Caregiving by family members of elderly with chronic conditions is currently intensifying in the context of an aging population and health care reform in the Netherlands. It is essential that nurses have attention for supporting roles of family caregivers of older patients and address family caregiving aspects on behalf of the continuity of care. This study aims to explore what aspects of family caregiving were addressed during planned discussions between nurses, patients and family caregivers in the hospital. Methods Qualitative descriptive research was conducted using non-participant observation and audio-recordings of planned discussions between nurses, older patients and their family caregivers as they took place in the hospital. Through purposive sampling eligible patients (≥ 65 years) with one or more chronic conditions were included. These patients were admitted to the hospital for diagnostics or due to consequences of their chronic illness. Retrospective chart review was done to obtain patient characteristics. Data were collected in November/December 2013 and April/May 2014 in four hospitals. Qualitative content analysis was performed using the inductive approach in order to gain insight into addressed aspects of family caregiving. Results A total of 62 patients (mean age (SD) 76 years (7.2), 52% male) were included in the study, resulting in 146 planned discussions (62 admission and discharge discussions and 22 family meetings). Three themes were identified regarding addressed aspects of family caregiving. Two themes referred to aspects addressing the patients’ social network, and included ‘social network structure’ and ‘social network support’. One theme referred to aspects addressing coordination of care issues involving family caregiving, referred to as ‘coordination of care’. Conclusions During discussions nurses mostly addressed practical information on the patients’ social network structure. When specific family caregiving support was addressed, information was limited and nurses did not seem to explore the nature of the family support. Patients discharge and after care needs were addressed occasionally as aspects of coordination of care. Current nursing policies could be evaluated on nursing and family oriented theories. Implications for education could include mirroring study findings with nurses in a group discussion to enhance their awareness on family caregiving aspects.

Background: There is strong evidence for a bidirectional association between depression and obesity. Several biological, psychological, and behavior-related factors may influence this complex association. Clinical impression and preliminary evidence suggest that patients with a diagnosis of major depressive disorder may endorse very different depressive symptom patterns depending on their body weight status. Until now, little is known about potential differences in depressive symptoms in relation to body weight status.Objective: The aim of this analysis is the investigation of potential differences in depressive symptom clusters (mood symptoms, somatic/vegetative symptoms, and cognitive symptoms) in relation to body weight status.Methods: Cross-sectional baseline data were derived from two large European multicenter studies: the MooDFOOD Trial and the NESDA cohort study, including persons with overweight and obesity and normal weight reporting subthreshold depressive symptoms (assessment via Inventory of Depressive Symptomatology Self-Report, IDS-SR30). Different measures for body weight status [waist-to-hip ratio (WHR) and body mass index (BMI)] were examined. Propensity score matching was performed and multiple linear regression analyses were conducted.Results: A total of n = 504 individuals (73.0% women) were analyzed. Results show that more somatic/vegetative depressive symptoms, such as pain, change in appetite and weight, gastrointestinal symptoms, and arousal-related symptoms, were significantly associated with both a higher BMI and higher WHR, respectively. In addition, being male and older age were significantly associated with higher WHR. Mood and cognitive depressive symptoms did not yield significant associations for both body weight status measures.Conclusions: Somatic/vegetative symptoms and not mood and cognitive symptoms of depression are associated with body weight status. Thus, the results support previous findings of heterogeneous depressive symptoms in relation to body weight status. In addition to BMI, other body weight status measures for obesity should be taken into account in future studies.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02529423.

Common methods to detect phlebitis may not be sufficient for patients in the intensive care unit (ICU). The goal of this study was to investigate the feasibility of infrared (IR) thermography to objectively detect phlebitis in adult ICU patients. We included a total of 128 adult ICU-patients in a pilot and subsequent validation study. Median [interquartile range] age was 62 [54-71] years and 88 (69%) patients were male. Severity of phlebitis was scored using the visual infusion phlebitis (VIP)-score, ranging from 0 (no phlebitis) to 5 (thrombophlebitis). The temperature difference (ΔT) between the insertion site and a proximal reference point was measured with IR thermography. In 78 (34%) catheters early phlebitis and onset of moderate phlebitis was observed (VIP-score of 1-3). In both the pilot and the validation study groups ΔT was significantly higher when the VIP-score was ≥1 compared to a VIP-score of 0 (p