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Artiklen tager afsæt i en forståelsesramme informeret af teori om paradokser i organisering. På den baggrund tydeliggøres det, hvordan deltagere i arbejdsfællesskaber stilles overfor grundlæggende dilemmaer, som kalder på det, vi benævner dilemmatænkning. Formålet er at undersøge, hvordan dilemmatænkning, som en praksisorienteret metode, kan bidrage med en lærende respons på komplekse problemstillinger, der i øvrigt udfordrer det psykosociale og organisatoriske arbejdsmiljø. Udgangspunktet er, at det psykosociale arbejdsmiljø er præget af komplekse problemstillinger, der kalder på løbende undersøgelse og læring. Gennem en case på en hospitalsafdeling, hvor sygeplejersker håndterer kronisk syge patienter, viser artiklen, at det i et samspil mellem sygeplejerskerne og forskerne bliver muligt at genfortolke konkret oplevede belastningsmæssige problemstillinger som dilemmaer, der ikke kan finde en Enten-Eller-løsning. Gennem en kollektiv og lærende dialog udforsker sygeplejerskerne dilemmaerne i lyset af de paradokser, som er indlejret i den sociotekniske organisering. Dilemmatænkning bidrager dermed til afindividualisering og en øget fælles forståelse for de indlejrede forskellige muligheder, der er i at tilgå opgaverne.

The Cox model is one of the most used statistical models in medical research. It models the hazard rate of an event and its association with covariates through hazard ratios. In the simple setting without competing risks nor time-dependent covariates, there exists a one-to-one mathematical connection between the hazard rate and the risk of experiencing the event within any given time period (e.g., 5 years). This makes it possible to conclude that a covariate associated with a hazard ratio above one is associated with a higher risk of event. Although it is becoming widely known that this connection is lost in the presence of competing risks, it seems that fewer users of the Cox model are aware that this connection is also lost when using time-dependent covariates. In other words, it seems still widely unknown that, when using a time-dependent Cox model, a hazard ratio estimated above one does not necessarily mean that there is a higher risk. Hence, this note aims to clarify why this is not the case with a detailed pedagogical example.

BACKGROUND: Cladribine is a nucleoside analogue interfering with synthesis and repair of DNA. Treatment with cladribine leads to a preferential reduction in lymphocytes, resulting in profound depletion of B-cells with a rapid recovery of naïve B-cells, while T-cell show a lesser but long-lasting depletion It is approved for treatment of relapsing multiple sclerosis (MS). Cladribine tablets 3.5 mg/kg bodyweight are administered in two yearly treatment courses, each including two treatment series lasting 4 or 5 days, one at the start of the first month and the other at the start of the second month.OBJECTIVE: To describe treatment patterns of cladribine in a real-world setting.METHODS: Registry based observational cohort study with prospectively enrolled cases from December 2017 through June 2021. The data source is The Danish Multiple Sclerosis Registry, which is a near complete nationwide population-based registry. Outcomes were length of the treatment, preceding and following treatments, treatment response, and safety data.RESULTS: In total 268 patients had started therapy with cladribine tablets, 89 men and 179 women, with a median age of 40 years (interquartile range (IQR) 32-48. The disease course was relapsing-remitting MS in 97.8% of the patients, and at treatment start the median time from disease onset was 8.1 years (IQR 4.2-14.5) and EDSS 2.5 (IQR 1.5-3.5). Thirty-four patients (12.7%) were treatment naïve while 56 (20.9%) had received one previous disease-modifying therapy (DMT), 67 (25.0%) two, and 111 (41.4%) three or more previous DMTs. In total, 214 (80.0%) patients had completed the full treatment of two courses of cladribine, while 54 (20.0%) had received only one course of cladribine tablets. The median follow-up time after cladribine initiation was 34.7 months (IQR 23.3-43.7). Compared with an annualized relapse rate (ARR) of 0.67 (95% CI [0.56, 0.79]) in the year prior to start of cladribine, ARR was reduced to 0.11 (95% CI [0.08, 0.15]) in year 0-2 after 3-month re-baseline with cladribine (84.8% reduction). Adverse events, reported in 44 (16.4%) of the patients, were mild or moderate, and herpes zoster was only reported in 2 patients. In total, 30 (11.2%) patients discontinued cladribine treatment, of whom 7 (2.6%) discontinued because of adverse effects and 12 (4.5%) discontinued because of disease activity.CONCLUSION: In this nationwide review of all Danish patients starting therapy with cladribine tablets in a real-world setting, cladribine treatment was safe, and the therapeutic response was as expected from previous clinical trials. A prolonged observation period is necessary to assess the long-term benefit and risk of cladribine.

Crystallisation fouling is a challenge in numerous applications. To mitigate fouling we need to determine the basic mechanisms involved in the process. While ex situ techniques have been widely used in previous studies, they cannot capture complex dynamic effects. We conducted an in situ investigation of the dynamic effects of crystallisation fouling in a steel pipe (length 3 cm, diameter 3 mm) using X-ray micro-computed tomography (µCT) over more than six days. We employed a custom-developed image reconstruction algorithm, which ensured high spatiotemporal resolution from a laboratory instrument. We quantified the evolving fouling using advanced segmentation techniques of 4D images. To understand how the pipe interface structure impacts reactive transport, the experimental geometries of the flow system were used to perform computational fluid dynamic simulations. These new data allowed us to identify three growth phases: initiation, expansion, and densification

Artiklen argumenterer for, at jo mere praksis er involveret i at udforske og definere problemstillinger i deres arbejdsliv, des bedre er mulighederne for, at der konstrueres relevante forståelser og handlekompetence. Artiklen benævner denne teoretiske og metodiske tilgang som den lærende kortlægning. Denne står i kontrast til traditionelle surveybaserede kortlægningstilgange, der definerer problemstillinger på en abstrakt og dekontekstualiseret måde. Den lærende kortlægning er baseret på aktionsforskning og læringsteori, der vægter deltagernes involvering i udviklingen af problemstillinger. Læring skabes transaktionelt i mødet mellem forsker- og arbejdspraksis og er inspireret af pragmatismen. Metodisk er den lærende kortlægning baseret på en række delprocesser, der både inddrager deltagernes erfaringer og viden - og forskningsbaseret viden, der perspektiverer og forstyrrer deltagernes erfaringer. Ved at skabe forstyrrelser og kritisk udforske eksisterende erfaringer, skabes nye erkendelser og betydningsindhold både for deltagerne og forskerne. Det er erkendelser, der ikke ville kunne begribes gennem traditionel dataindsamling. I det metodiske design anvendes bl.a. udsagnskort, perspektivsamtaler og spejling. Gennem analyse af én ud af 17 cases i et samarbejdsprojekt mellem et universitet og arbejdspladser, vises eksemplarisk hvilke processer, erkendelser og rekonstruktioner af problemforståelser, der etableres. Afslutningsvis diskuteres styrker og udfordringer ved den lærende kortlægning.

Exercise facilitates cerebral lactate uptake, likely by increasing arterial lactate concentration and hence the diffusion gradient across the blood brain barrier. However, non-specific β-adrenergic blockade by propranolol has previously reduced the arterio-jugular venous lactate difference (AVLac) during exercise, suggesting β-adrenergic control of cerebral lactate uptake. Alternatively, we hypothesize that propranolol reduces cerebral lactate uptake by decreasing arterial lactate concentration. To test that hypothesis, we evaluated cerebral lactate uptake taking changes in arterial concentration into account. Nine healthy males performed incremental cycling exercise to exhaustion with and without intravenous propranolol (18.7 ± 1.9 mg). Lactate concentration was determined in arterial and internal jugular venous blood at the end of each workload. To take changes in arterial lactate into account we calculated the fractional extraction (FELac) defined as AVLac divided by the arterial lactate concentration. Arterial lactate concentration was reduced by propranolol at any workload (p-1 during maximal exercise without and with propranolol, respectively. While AVLac and FELac increased during exercise (both P < 0.05), they were both unaffected by propranolol at any workload (P = 0.68 and P = 0.26) or for any given arterial lactate concentration (P = 0.78 and P = 0.22). These findings support that, while propranolol may reduce cerebral lactate uptake, this effect reflects the propranolol-induced reduction in arterial lactate concentration and not inhibition of a β-adrenergic mechanism within the brain. We hence conclude that cerebral lactate uptake during exercise is directly driven by the increasing arterial concentration with work rate.

Objective In 2020, the coronavirus disease 2019 (COVID-19) pandemic exposed existing stressors in the neurosurgical care infrastructure in the United States. We aimed to detail innovative technologic solutions inspired by the pandemic-related restrictions that augmented neurosurgical education and care delivery. Methods Several digital health and audiovisual innovations were implemented, including use of remote video technology to facilitate inpatient consultations and outpatient ambulatory virtual visits, optimize regional hospital neurosurgical coverage, expand interdisciplinary patient management conferences (i.e., tumor board), and further enhance the neurosurgical resident education program. Enterprise patient experience data were queried to evaluate patient satisfaction following the switch to virtual visits. Results Between January 2020 and April 2021, use of virtual visits more than doubled in the Department of Neurosurgery. A survey of 10,772 patients following ambulatory visits showed that virtual visits were equal if not better in providing satisfactory patient care than in-person visits. After switching our interdisciplinary spine tumor board to a virtual meeting, we increased surgeon participation and attendance by 49.29%. Integration of remote audiovisual technology in resident didactics and clinical training improved our ability to provide comprehensive and personalized educational experiences our trainees. Conclusions Digital health technology has improved neurosurgical care and comprehensive training at our institution. Investment in the technologic infrastructure required for these remote audiovisual services during the COVID-19 pandemic will facilitate the expansion of neurosurgical care provision for patients across the United States in the future. Governing bodies within organized neurosurgery should advocate for the continued financial and licensing support of these service on a national fiscal and policy level.

Deep-brain stimulation (DBS) is an effective treatment for patients suffering from otherwise therapy-resistant psychiatric disorders, including obsessive-compulsive disorder. Modulation of cortico-striatal circuits has been suggested as a mechanism of action. To gain mechanistic insight, we monitored neuronal activity in cortico-striatal regions in a mouse model for compulsive behavior, while systematically varying clinically-relevant parameters of internal-capsule DBS. DBS showed dose-dependent effects on both brain and behavior: An increasing, yet balanced, number of excited and inhibited neurons was recruited, scattered throughout cortico-striatal regions, while compulsive grooming decreased. Such neuronal recruitment did not alter basic brain function such as resting-state activity, and only occurred in awake animals, indicating a dependency on network activity. In addition to these widespread effects, we observed specific involvement of the medial orbitofrontal cortex in therapeutic outcomes, which was corroborated by optogenetic stimulation. Together, our findings provide mechanistic insight into how DBS exerts its therapeutic effects on compulsive behaviors.

BackgroundThe natural selection responsible for the observed blood group frequency differences between populations remains debatable. The ABO system has been associated with several diseases and recently also with susceptibility to COVID-19 infection. Associative studies of the RhD system and diseases are sparser. A large disease-wide risk analysis may further elucidate the relationship between the ABO/RhD blood groups and disease incidence.MethodsWe performed a systematic log-linear quasi-Poisson regression analysis of the ABO/RhD blood groups across 1,312 phecode diagnoses. Unlike prior studies, we determined the uniqueness of each individual ABO blood group as opposed to using blood group O as the reference. Moreover, we used up to 41-years of nationwide Danish follow-up data, and a disease categorization scheme specifically developed for diagnosis-wide analysis. Further, we determined associations between the ABO/RhD blood groups and the age at the first diagnosis. Estimates were adjusted for multiple testing.ResultsThe retrospective cohort included 482,914 Danish patients (60.4% females). The incidence rate ratios (IRRs) of 101 phecodes were found statistically significant between the ABO blood groups, while the IRRs of 28 phecodes were found statistically significant for the RhD blood group. The associations included cancers and musculoskeletal-, genitourinary-, endocrinal-, infectious-, cardiovascular-, and gastrointestinal diseases.ConclusionsWe found associations of disease-wide susceptibility differences between the blood groups of the ABO and RhD systems, including cancer of the tongue, monocytic leukemia, cervical cancer, osteoarthrosis, asthma, and HIV- and hepatitis B infection. This may indicate that the ABO/RhD blood groups are the results of a selective pressure driven partly by robustness to disease. We found marginal evidence of associations between the blood groups and disease onset.FundingNovo Nordisk Foundation and the Innovation Fund Denmark

I de formende konflikter på arbejdsmarkedet i slutningen af det 19. århundrede var indfl ydelse i arbejdet et centralt konfliktpunkt, i Danmark og i den industrialiserede verden i øvrigt. Arbejdsgivere og fagforeninger var i konflikt om, hvem der havde retten til at lede og fordele arbejdet. Med Septemberforliget i 1899 blev Danmark det første land i verden, hvor der blev indgået et nationalt kompromis om indfl ydelse. Arbejdsgiverne vandt ledelsesretten, og fagforeningerne vandt retten til at forhandle løn og arbejdsvilkår og indgå overenskomster om disse spørgsmål (Galeson, 1955, Christensen et al., 2015). Dermed var spørgsmålet om indflydelse dog langt fra afklaret. I årtierne efter Septemberforliget tilkæmpede fagforeningerne sig gradvist mere indflydelse. Indflydelsen på løn og arbejdsforhold blev udbygget. Overenskomstsystemet blev mere omfattende. Medarbejderne fik ret til at vælge tillidsrepræsentanter, som arbejdsgiverne havde pligt til at inddrage i beslutningsprocesserne. Samarbejdsudvalg og senere arbejdsmiljøudvalg blev etableret. Endelig fik medarbejdere i aktieselskaber ret til at vælge repræsentanter til selskabernes bestyrelser. I tiden efter 2. verdenskrig voksede en anden mere konsensusorienteret strømning til udvikling af indflydelse i arbejdet frem. Denne strømning har siden forgrenet sig i variationer og antaget mange forskellige navne, bl.a. Human Relations og Human Resources, Socioteknik, High Performance Work Systems samt Workplace Innovation. En af grundlæggerne var Kurt Lewin, som allerede i 1940erne blev kendt for sin formulering af principper for en involverende arbejdsorganisation og demokratisk ledelse (Lewin et al., 1939). Socioteknikken, som blev udviklet i 1950erne, havde som målsætning at udvikle en arbejdsorganisation, hvor hensynet til det sociale system og det teknisk/økonomiske system var ligeværdigt (Trist & Bamforth, 1951). En sådan ligeværdighed kunne etableres i en arbejdsorganisation, hvor medarbejderne havde en stor grad af autonomi i et gruppeorganiseret arbejde, samtidig med at medarbejderne havde ansvar overfor virksomheden.

AimsOverweight is associated with increased risk of atrial fibrillation (AF), but the impact of overweight and AF recurrence after ablation is less clear. Despite this, an increasing number of AF ablations are carried out in overweight patients. We investigated the impact of body mass index (BMI) on AF recurrence rates after ablation.Methods and resultsThrough Danish nationwide registers, all patients undergoing first-time AF ablation between 2010 and 2018 were identified. Exposure of interest was BMI. The primary outcome was recurrent AF, defined from either any usage of antiarrhythmic medication, AF hospitalization, cardioversion, or re-ablation. A total of 9188 patients were included. Median age and interquartile range was 64 (60–75) in the normal-weight group and 60 (53–66) in the morbidly obese. There was an increase in comorbidity burden with increasing BMI, including a higher prevalence of heart failure, chronic obstructive pulmonary disease, diabetes, and hypertension. At 1- and 5-year follow ups, recurrence rates of AF increased incrementally by BMI categories. The hazard ratios and 95% confidence intervals of recurrent AF after ablation were 1.15 (1.07–1.23), 1.18 (1.09–1.28), and 1.26 (1.13–1.41) in overweight, obese, and morbidly obese, respectively, compared with normal-weight patients. Procedure duration and X-ray dose exposure also increased with increasing BMI.ConclusionFollowing AF ablation, recurrence rates of AF increased incrementally with increasing BMI. Therefore, aggressive weight management pre ablation in overweight patients could potentially provide substantial benefits and improve short- and long-term outcomes after ablation.

To evaluate readmission, complication, and nonscheduled contact rates to the out-patient clinic within the first 3 months following total ankle replacement in patients planned for overnight admission. Data were collected retrospectively on all patients treated during the period the December 11, 2015 to the December 1, 2019 with 3 months of follow-up for all patients. In the study 116 patients were included. No difference in patient characteristics, readmission rates, complication rates or number of nonscheduled contacts to the outpatient clinic was found between patients discharged after 1 day when compared to those admitted >1 day. Around 58.6% was discharged as planned. The overall readmission and complication rates were 2.6% and 6.0% respectively, 20.7% had a nonscheduled contact to the out-patient clinic. No differences in prevalence of the different complications, reasons for readmission or reasons for contact to the out-patient clinic were found between overnight admission and inpatient admission. Total ankle placement with overnight admission is safe, but patient selection with a thorough plan for analgesics after discharge and optimal cast appliance is necessary.

BACKGROUND The eustachian valve is rarely involved in bacterial endocarditis. Patients who present with bacteremia and evidence of organic septic emboli should raise the suspicion of endocarditis as a possible differential diagnosis. This case series describes 2 unique cases of eustachian valve endocarditis (EVE) in patients who had a history of intravenous drug use; although 63% of EVE is caused by Staphylococcus aureus, the causative agent in our first case was methicillin-resistant Staphylococcus epidermidis (MRSE), which is only the third reported case of EVE caused by Staphylococcus epidermidis. Of note, the previous 2 cases of MRSE EVE were also found to be associated with cardiovascular hardware. CASE REPORT The first case of the series describes EVE by MRSE with an endovascular graft acting as the nidus of infection. Second case of EVE was caused by methicillin-sensitive Staphylococcus epidermidis (MSSA), the source of bacteremia being a rectovesicular abscess. Although initial transthoracic echoes were negative in both cases, subsequent transesophageal echoes were able to detect vegetations on the eustachian valves. Treatment included 4-6 weeks of culture-directed antibiotic therapy for both of our cases. CONCLUSIONS EVE may be an under-diagnosed sequelae of staphylococcal bacteremia, especially in the intravenous drug abuse population, further reinforcing the importance of systemically visualizing all cardiac valves, including the eustachian valves, while performing echocardiography.

BACKGROUND: Bleeding safety in relation to use of systemic fluconazole and topical azoles among patients with atrial fibrillation treated with apixaban, rivaroxaban, or dabigatran is insufficiently explored, despite clinical relevance and several reports suggesting associations.METHODS: Using nationwide Danish registers, we identified patients with atrial fibrillation initiated on apixaban, rivaroxaban, or dabigatran from 2012-2018. We investigated associations between bleeding incidents and systemic fluconazole or topical azole treatment using a case-crossover design with 30-day exposure windows and reported odds ratios (OR) with 95% confidence intervals (CI).RESULTS: We included 32,340 (36%), 32,409 (36%), and 24,940 (28%) patients initiated on apixaban, rivaroxaban, and dabigatran, respectively. Patients on apixaban were older (median age: 77 years; interquartile range [IQR] 70-84) compared with rivaroxaban users (median age: 75 years; IQR 68-82) and patients on dabigatran (median age: 73 years; IQR 66-80). Apixaban users had a significantly increased risk of bleeding following exposure to systemic fluconazole: odds ratio (OR) 3.5; 95% confidence interval (CI), 1.4-10.6. No increased risk was found among rivaroxaban and dabigatran users: ORs of 0.9 (95% CI, 0.2-3.0) and 1.7 (95% CI, 0.5-5.6), respectively. As to bleeding risk pertaining to topical azole exposure among apixaban, rivaroxaban, and dabigatran users, no association was found, with corresponding ORs of 0.8 (95% CI, 0.5-1.3); 1.3 (95% CI, 0.9-2.1); and 1.2 (95% CI 0.8-1.8), respectively.CONCLUSION: In patients with atrial fibrillation on either apixaban, rivaroxaban, or dabigatran, an association between an elevated bleeding risk and use of systemic fluconazole was found among patients on apixaban. We found no increased risk of bleeding following co-exposure to topical azoles.

ObjectiveGastrointestinal bleeding (GIB) risk in relation to concomitant treatment with non-vitamin K oral anticoagulants (NOAC) and oral glucocorticoids is insufficiently explored. We aimed to investigate the short-term risk following coexposure.MethodsThis is a register-based, nationwide Danish study including patients with atrial fibrillation on NOACs during 2012–2018. Patients were defined as exposed to oral glucocorticoids if they claimed a prescription within 60 days prior to GIB. We investigated the associations between GIB and oral glucocorticoid exposure, reporting HRs via a nested case–control design and absolute risk via a cohort design. Matching terms were age, sex, calendar year, follow-up time and NOAC agent.Results98 376 patients on NOACs (median age: 75 years (IQR: 68–82), 44% female) were included, and 16% redeemed at least one oral glucocorticoid prescription within 3 years. HRs of GIB were increased comparing exposed with non-exposed patients (ConclusionsConcomitant treatment with NOACs and oral glucocorticoids was associated with a short-term rate and risk increase of GIB compared with patients only on NOACs. This could have implications for clinical management, necessitating closer monitoring or other risk mitigation strategies during episodes of cotreatment with oral glucocorticoids.

Background Virtual visits (VVs) are a modality for delivering health care services remotely through videoconferencing tools. Data about patient and physician experience in using VVs are limited. Objective The purpose of this study was to assess patient and physician experience with the use of VVs in cardiac electrophysiology. Methods We performed a prospective survey of cardiac electrophysiology patients and physicians who participated in an outpatient VV from December 2018 to July 2019. Results One-hundred consecutive VVs were included. Sixty-four patients elected to complete a survey. Patients rated their experience as either excellent/very good in scheduling a VV (87%), seeing their physician of choice (100%), transmitting arrhythmia data (88%), rating their physician's ability to communicate (98%), asking all questions (98%), rating the level of care received (98%), paying for the cost of a VV (67%), and rating their overall level of satisfaction (98%). Thirty-eight of 64 patients (59.4%) preferred a VV for their next visit, 12 of 64 (18.8%) preferred an in-office visit, 13 of 64 (20.3%) responded that their decision for a virtual or office visit depended on indication, and 1 of 64 (1.6%) had no preference. A total of 14 cardiac electrophysiologists participated in 100 VVs. Nine visits were not included due to technical difficulty. Physician responses to survey questions were rated as excellent/very good in the ability to communicate (92%), accessing monitoring data (95%), and overall level of satisfaction (98%). Conclusion In our small study population, most patients and physicians prefer VVs. Convenience, cost, and reason for follow-up were important determinants that affected both patient and physician preference.

Arbejdsliv udfolder sig gennem organisering af forskelle og bliver til via fletværk af mennesker, deres identitet, materialitet og, viden, som knyttes sammen via brug af ord, handlinger, redskaber og teknologi. På kanten af buzzwords tales, der i organisationer om komplementaritet og synergi. Forskelle skaber innovation. Forskelle giver muligheder for samskabelse. At arbejde kreativt fx ved at tænke ud af boksen, er synonymt med, at normalitet og sædvane bør udfordres og forskelle omfavnes. Således hentes inspiration til udvikling gennem nogen eller noget, som er forskelligt fra dét vi allerede kender, fra gentagelser og rutiner. Processen indebærer ambivalente potentialer og risici, hvor arbejdslivet på den ene side kan erfares udviklende, lærende og berigende, men omvendt også kan erfares konfliktfyldt, udmattende, eroderende og belastende.

Background: In observational studies, case reports, and animal studies, amiodarone has been associated with incident cancer. Objective: The purpose of this study was to examine whether a dose–response relationship between amiodarone use and the risk of cancer could be ascertained in a large nationwide study cohort. Methods: Using nationwide registers, we included all Danish patients with atrial fibrillation (AF) treated with amiodarone from 1996 to 2014. Exposure was defined both by categories and as a continuous variable of the cumulative defined daily doses (cDDDs) of amiodarone. The associations between amiodarone cDDD and incident cancer, as well as organ-specific types of cancer (skin, liver, lung), were estimated using multivariable Cox regression models and reported as hazard ratios (HR) with 95% confidence intervals (CI) and using cubic restricted spline plots. Results: We included 18,503 patients with a median follow-up time of 8.1 years (interquartile range [IQR] 4.3–12.4). Median age was 70 years (IQR 63–77). A total of 2974 individuals developed cancer during follow-up. We found no association between increasing amiodarone exposure (cDDD 181–400 and cDDD >400) and the hazard of incident cancer (HR 0.95; 95% CI 0.87–1.04; and HR 1.01; 95% CI 0.92–1.10) with reference to patients with cDDD

Ethos, det græske ord for ’sædvane’, og etik beskæftiger sig som regel med at udforske det gode i den menneskelige praksis, handling eller adfærd. Eftersom at arbejde er at virke, at skabe, og dermed beskæftige sig med praksis og handling, må etik og etiske spørgsmål allerede i udgangspunktet være vævet ind i arbejdslivets mangfoldige udtryks- og udfoldelsesformer. Som det vil fremgå, er afsættet for denne indledning dermed, at etik altid i udgangspunktet er vævet ind i arbejdslivets praksisser. Det behøver dog slet ikke at være ensbetydende med, at vi indtager et hverken refl ekteret eller refl eksivt forhold til de etiske perspektiver. Som det vil fremgå i det følgende, er det faktisk oftere det modsatte, der er tilfældet: etiske spørgsmål forbliver tavse og urefl ekterede. Det etiske er altid til stede, men er ofte foldet ind i arbejdslivets praksisser. Etiske perspektiver er vævet ind i den måde fagprofessioner handler på; den måde organisationer bliver kønnede; de opfordringsstrukturer som bæres ind med nye teknologier; den måde forandringsprocesser (u)intenderet ændrer på magtfordelingen på osv. Dette temanummer bidrager med at åbne op for nogle få af de sorte bokse, som netop etiske spørgsmål udgør inden for arbejdslivsområdet. De forskellige bidrag tjener som potentielle eksemplariske cases på, hvordan vi andre kan anlægge etiske perspektiver på vores egne dilemmaer og paradokser inden for arbejdslivet. Det vil formentlig også allerede i indledningen stå klart, at den største udfordring ved at rejse et tema som etik i arbejdslivet er, at det bogstavelig talt er et Sisyfos arbejde, fordi etiske spørgsmål ingen absolutte eller essentielle svar kan give. At det synes at være et Sisyfos arbejde kan være årsagen til, at etik fylder så relativt lidt: Opgaven med at drøfte etiske perspektiver synes at være en uendelig opgave, som ingen absolutte svar giver og derfor meget let kan blive oplevet som en akademisk eller fi losofi sk øvelse. På samme tid, er etiske spørgsmål paradoksalt nok også allestedsnærværende, fordi de handler om vores hverdagspraksisser og fordi de, som nævnt ovenfor, er vævet ind i vores omgang med hinanden.