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While there is high patient acceptance for clinical staff discussing issues regarding spirituality with hospital inpatients, it is not clear which staff member patients prefer for these discussions. This unique exploratory study investigated inpatient preferences regarding which staff member should raise the topic of spirituality. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia (n = 897), with a subset invited to participate in qualitative interviews (n = 41). Pastoral care staff (32.9%) were the preferred staff members with whom to discuss spiritual issues, followed by doctors (22.4%). Qualitative findings indicated that individual characteristics of the staff member are more important than their role.

ObjectivesThe aim was to identify determinants of nurse spiritual/existential care practices toward end-of-life patients. Nurses can play a significant role in providing spiritual/existential care, but they actually provide this care less frequently than desired by patients.MethodsA systematic search was performed for peer-reviewed articles that reported factors that influenced nurses’ spiritual/existential care practices toward adult end-of-life patients.ResultsThe review identified 42 studies and included the views of 4,712 nurses across a range of hospital and community settings. The most frequently reported factors/domains that influenced nurse practice were patient-related social influence, skills, social/professional role and identity, intentions and goals, and environmental context and resources.Significance of resultsA range of personal, organizational, and patient-related factors influence nurse provision of spiritual/existential care to end-of-life patients. This complete list of factors can be used to gauge a unit's conduciveness to nurse provision of spiritual/existential care and can be used as inputs to nurse competency frameworks.

While patients value engagement concerning their spirituality as a part of holistic healthcare, there is little evidence regarding the preferred way to engage in discussions about spirituality. This study investigated inpatient preferences regarding how they would like spirituality to be raised in the hospital setting. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia (n = 897), with a subset invited to participate in qualitative interviews (n = 41). There was high approval for all proposed spiritual history prompts (94.0–99.8%). In interviews, the context dictated the appropriateness of discussions. Findings indicated a high level of patient acceptability for discussing spirituality in healthcare. Further research and more detailed analysis is required and proposed to be undertaken.

The headgroup (H) stratum (sometimes called the polar region) of membrane bilayers is a relevant yet poorly understood solvation phase for small molecules and macromolecules interacting with the membranes. Solvation of compounds in bilayer strata is characterized experimentally by wide- and small-angle X-ray scattering, neutron diffraction, and various NMR techniques. The quantification is tedious and only available for a limited set of small molecules. Our recently published model of liposome partitioning of small molecules shows that solvation of compounds in the H-stratum of fluid phosphatidylcholine (PC) bilayers correlates well with their solvation in hydrated diacetyl phosphatidylcholine (DAcPC), and solvation in the core (C) depends in a similar way on that in n-hexadecane. These two correlations became a basis for a model describing the location of compounds in the H- and C-strata and at the connecting interface as a nonlinear function of the fragment solvation characteristics of the compounds. In this study, refractivity of hydrated DAcPC phases with varying water contents was measured and polarity was determined using the steady-state fluorescence of indole and Nile Red. The results were compared with the published data obtained by other techniques for PC bilayers in liposomes or on solid supports. The demonstrated qualitative agreement, as well as the polarity and refractivity dependencies on the DAcPC concentration, supports the suitability of hydrated DAcPC as the H-stratum surrogate. Interestingly, depending on hydrations typical for the H-strata of fluid PC bilayers, the dielectric constant could decrease significantly from 31.0 to 7.3 for 16 and 8 water molecules per headgroup, respectively. Although additional experiments are needed for confirmation, this observation could help set proper dielectric constant magnitudes in continuum-based computational models of accumulation and crossing of the PC bilayers with varying hydration levels thanks to the temperature or the structure of fatty acid chains.

One defining characteristic of service-learning as a pedagogical tool is its focus on reflection. Within service-learning programmes, students engage collaboratively with one another and community members, and are encouraged to reflect on the various aspects of their experience. The author argues that reflection is crucial for its contribution to service-learning, as a teaching methodology, and to service-learning’s cognitive, affective and social impact. Part of service-learning’s impact is its contribution to the development of inclusive attitudes and predispositions towards inclusiveness among school students and tertiary students, particularly pre-service teachers. The chapter recognises inclusivity as an element of quality teaching that helps students make connections with contexts outside the classroom, engage with different perspectives and ways of knowing and to accommodate all their peers and all those being offered service. The chapter recommends a particular approach to the expansion of thinking and practice that inclusivity requires, one based on the methodology of the Philosophy in Schools movement, which has its genesis in the work of John Dewey. That approach uses the mechanism of the Community of Inquiry to structure reflective activities in a way that facilitates the development of students’ critical and creative thinking and their capacity for substantive dialogue. Within the Community of Inquiry students are encouraged to engage with differing and perhaps novel perspectives as they respond to real-life service-learning experiences. Well-facilitated reflection gives students the opportunity to develop skills and dispositions conducive to deep understanding of concepts and issues that arise in discussion. It also helps to raise awareness of preconceptions and attitudes that can undermine inclusiveness in education. The chapter draws the conclusion that rigorous reflection serves as a stimulus to act to implement inclusive practices within service-learning projects on the basis of well-justified reasoning.

This chapter presents play as an uplifting but nonetheless complex and elusive ideal, which notoriously resists definition. To greater or lesser extents, depending upon social, cultural and economic conditions, play is recognised as an essential and fundamental aspect of human behaviour and culture. This chapter explores play from both developmental and cultural perspectives, particularly focussing on considerations of play within an educational paradigm. While there are undeniable instrumental benefits, both intellectually and socio-culturally, in using play educationally, the limitations of this developmental focus are addressed. The chapter recognises that a dedicated focus on the use of play for instrumental purposes may undermine its intrinsic personal and interpersonal benefits. Somewhat analogously, play within a commercialised context may also undermine its invigorating possibilities and perhaps conceal malevolence or bias. The chapter concludes by drawing attention to those aspects of play that make for a richer comprehension of its role in human development and in education.

The personal recollections and reflections on play and playfulness of Denise Proud, a Murri woman from Queensland Australia, are the stimulus for this chapter’s exploration of Aboriginal understandings and attitudes towards play. Recounting her childhood experiences, Proud explains the role and significance of ‘muck-about’ play and making fun in Aboriginal life and introduces the concept of Darn Najun Burri. Darn Najun Burri, which emphasises empathetic engagement with others and the capacity to imagine oneself in the place of the other, is connected with the concept of grace and an imperative towards gratitude and counting one’s blessings. The significance of these concepts of ‘muck-about’ and of Aboriginal approaches to play in general is explored first within Aboriginal culture and secondly for the contribution they can make to broadening understandings of play, to best practice in early childhood education and to educational initiatives more generally in non-indigenous settings.

Solvation of drugs in the core (C) and headgroup (H) strata of phospholipid bilayers affects their physiological transport rates and accumulation. These characteristics, especially a complete drug distribution profile across the bilayer strata, are tedious to obtain experimentally, to the point that even simplified preferred locations are only available for a few dozen compounds. Recently, we showed that the partition coefficient (P) values in the system of hydrated diacetyl phosphatidylcholine (DAcPC) and n-hexadecane (C16), as surrogates of the H- and C-strata of the bilayer composed of the most abundant mammalian phospholipid, PC, agree well with the preferred bilayer location of compounds. High P values are typical for lipophiles accumulating in the core, and low P values are characteristic of cephalophiles preferring the headgroups. This simple pattern does not hold for most compounds, which usually have more even distribution and may also accumulate at the H/C interface. To model complete distribution, the correlates of solvation energies are needed for each drug state in the bilayer: (1) for the H-stratum it is the DAcPC/W P value, calculated as the ratio of the C16/W and C16/DAcPC (W for water) P values; (2) for the C-stratum, the C16/W P value; (3) for the H/C interface, the P values for all plausible molecular poses are characterized using the fragment DAcPC/W and C16/W solvation parameters for the parts of the molecule embedded in the H- and C-strata, respectively. The correlates, each scaled by two Collander coefficients, were used in a nonlinear, mass-balance based model of intrabilayer distribution, which was applied to the easily measurable overall P values of compounds in the DMPC (M = myristoyl) bilayers and monolayers as the dependent variables. The calibrated model for 107 neutral compounds explains 94% of experimental variance, achieves similar cross-validation levels, and agrees well with the nontrivial, experimentally determined bilayer locations for 27 compounds. The resulting structure-based prediction system for intrabilayer distribution will facilitate more realistic modeling of passive transport and drug interactions with those integral membrane proteins, which have the binding sites located in the bilayer, such as some enzymes, influx and efflux transporters, and receptors. If only overall bilayer accumulation is of interest, the 1-octanol/W P values suffice to model the studied set.

In the article 'After-birth abortion: why should the baby live?' arguments are made in favour of the moral permissibility of intentionally killing newborn infants, under particular conditions. Here we argue that their arguments are based on an indefensible view of personhood, and we question the logic of harm and interest that informs their arguments. Furthermore, we argue that the conclusions here are so contrary to ordinary moral intuitions that the argument and conclusions based upon it-including those which defend more mainstream methods of abortion-should be treated with immediate suspicion.

This scholarly and engaging text focuses on John Milton’s poetry and prose as the locus of a hermeneutic model of the interpretation of meaning which is radically different from modern scientific understandings of interpretation as a matter of discovery or the uncovering of knowledge. Milton’s reader is seen as invited to recognise and empowered to understand his texts in a process which violates the commonsense opposition between intention and expression. The standard that Adam articulates in Paradise Lost is ‘‘the standard of intention maintained in unity with expression, inwardness with outwardness’’ (p. 91). Fleming criticises both strong intentionalism and the exclusion of strong intentionalism as interpretative principles; the former because it undermines the stability it appears to promise and the latter because it cannot overcome the prima facie plausibility of the intentionalist impulse. While trivial expressions might be usefully analysed on a strong intentionalist model, ‘‘the more worth saying something is—the more it makes a genuine contribution to our understanding—the less we can plan, form, or intend it before we start to say it’’ (p. 117). In matters of great significance, Fleming emphasises that we find out what we mean as we express ourselves. He argues that strong intentionalism is inimical to Milton’s depictions of the ideal exoteric conscience since strong intentionalism is esoteric, consisting in an interpretative penetration from outward appearance to an underlying or inward reality. Milton’s dramas construct an ideal in which intentional secrets must be displayed for all to see if its sincerity is genuine. As Fleming puts it, Milton is drawn ‘‘to the secret as open’’ (p. 108). This creates a paradox upon which Fleming elaborates via a theory of conscience. He argues that the seventeenth-century English Protestant

Playworkers in the UK work with school-aged children to support their play. The practice is underpinned by a set of principles that establish playwork's professional and ethical framework. These principles create a number of contradictions for practice that have an ethical dimension. This chapter offers a modest exploration that seeks to reconfigure taken-for-granted assumptions that have become common-sense truths. It is modest in the sense that it marks an experimental and initial playing with ideas that are different for the author: philosophy as an activity in the midst of it. The chapter analyses the notion of the autonomous rational agent implicit in the Playwork Principles' understanding of both play and playwork so as to reconfigure playwork as relational, affective and affecting, embodied, situated and not reducible to representations in language. The chapter concludes with some tentative suggestions for what might be called dispositions for an ethics for playwork.

The literature on friendship reveals particular tensions within the notion of friendship; tensions such as that between the significance of similarity by comparison with difference within the relationship; or the tension between liking a friend for his traits and qualities and liking him uniquely. The work of Jacques Derrida in The Politics of Friendship helps to elucidate the first of these tensions, beginning with an examination of the claim sometimes attributed to Aristotle: ‘O, my friends, there is no friend’ to argue that friendship as fraternity can become the schema that democracy adopts for the future. This paper explores and argues for the inter-relatedness of two questions about friendship in the context of politics: Can friendship act as a model for political community? And is friendship itself a political relationship? It argues that while both these questions can be answered in the affirmative, those answers create value by providing a guide that can support the development of our complex identities as mature individuals and citizens.

Among the competency standards stipulated by the Australian Nursing and Midwifery Council for graduating students are competencies in moral and ethical decision making and ethics education within professions such as nursing has traditionally focussed on these competencies, on raising ethical awareness and developing skills of analysis and reasoning. However, ethics education in tertiary settings places less emphasis on developing students' capacities to act on their values. This paper explains and explores the adoption of Dr. Mary Gentile's curriculum (the Giving Voice to Values curriculum).which specifically focuses on developing students' capacities to act on their values. The curriculum (Gentile, 2010) assists students and professionals to explore, script and rehearse responses which build upon their capacity to respond in accordance with their own values in complex workplace settings in which they face conflicts of value and belief. The paper firstly examines the theoretical underpinnings of the Giving Voice to Values (GVV) curriculum. It then presents the integration and evaluation phase of a Project inspired by the GVV methodology, using a case study approach within two areas of an undergraduate nursing curriculum. As a pilot project, this initiative has provided signposts to further curriculum development and to research pathways within the UNDA School of Nursing, by highlighting students' uncertainties regarding their own professional values, and their intense struggles to voice their values within health care contexts.

This chapter explores the relationship between friendship and happiness from a philosophical perspective, recognizing that philosophical concepts inform the psychological literature. It argues for a similarity between happiness and friendship which is related to the role of intentionality in each phenomenon, since both are characterised by an uncertain mix of desire and expectation on one hand which impacts upon the possibilities for satisfaction on the other. The etymology of the word happiness suggests the sense in which our happiness is not entirely under our control and is therefore in a complex relationship with affect; while the achievements of friendship are taken to include the capacity to respect difference and an expectation that we will experience disappointment as well as pleasure, given that some conflict will arise. Friendship provides a unique context within which we can appreciate both our similarities and differences from others, our potency and yet our limitations and vulnerability in relations with others. In this sense friendship is connected both with positive affect and with Aristotelian eudaimonia, which associates happiness with the good things of life, with flourishing and good fortune but also goes beyond the immediate satisfactions of life to consist in having what is valuable for its own sake.

This chapter takes an interdisciplinary approach combining expertise in sports management and in philosophy to examine the premises underpinning the contested claim that professional athletes have a special obligation to be role models both within and beyond the sporting arena. Arguments for and against the claim are briefly addressed, as a prelude to identifying and elucidating a set of factors relevant to a consideration of this alleged special obligation. The chapter considers understandings of sport, play and athleticism from an ethical perspective and examines their relationship to professionalism to determine the extent to which ethical imperatives can logically be upheld or undermined within the professional context. The chapter concludes that professional athletes cannot be expected to be able to respond to the demand that they act as role models within and beyond the sporting arena unless the tensions implicit within that demand are articulated. The chapter calls for recognition of the complexity of ethical decision-making in the context of professional sport and recommends that the training of professional athletes should prepare them to deal with this complexity. Recognition of the complexity of decision-making with the professional sporting context suggests the need for further research into optimal training strategies for young professional athletes and into the genesis and reasonableness of the demand that such athletes act as role models both within and beyond the sporting arena.

Surrogate phases have been widely used as correlates for modeling transport and partitioning of drugs in biological systems, taking advantage of chemical similarity between the surrogate and the phospholipid bilayer as the elementary unit of biological phases, which is responsible for most of the transport and partitioning. Solvation in strata of the phospholipid bilayer is an important drug characteristic because it affects the rates of absorption and distribution, as well as the interactions with the membrane proteins having the binding sites located inside the bilayer. The bilayer core can be emulated by n-hexadecane (C16), and the headgroup stratum is often considered a hydrophilic phase because of the high water content. Therefore, we tested the hypothesis that the C16/water partition coefficients (P) can predict the bilayer locations of drugs and other small molecules better than other surrogate systems. Altogether 514 PC16/W values for nonionizable (458) and completely ionized (56) compounds were collected from the literature or measured, when necessary. With the intent to create a fragment-based prediction system, the PC16/W values were factorized into the fragment solvation parameters (f) and correction factors based on the ClogP fragmentation scheme. A script for the PC16/W prediction using the ClogP output is provided. To further expand the prediction system and reveal solvation differences, the fC16/W values were correlated with their more widely available counterparts for the 1-octanol/water system (O/W) using solvatochromic parameters. The analysis for 50 compounds with known bilayer location shows that the available and predicted PC16/W and PO/W values alone or the PC16/O values representing their ratio do not satisfactorily predict the preference for drug accumulation in bilayer strata. These observations indicate that the headgroups stratum, albeit well hydrated, does not have solvation characteristics similar to water and is also poorly described by the O/W partition characteristics.

Introduction Opinions about satisfaction with care are rarely solicited from children. This study's purpose was to compare children's ratings of patient satisfaction with outpatient care to ratings given by parents. Method This descriptive and comparative survey study compared responses of a convenience sample of children and adolescents (n = 116) who received care at two metropolitan pediatric subspecialty clinics with their parents' responses (n = 115). Ratings were obtained using the "Satisfaction with Child Healthcare Survey," an instrument adapted with permission from the "Kids Count Survey" developed at McMaster Health Center in Ontario, Canada. Additionally, three open-ended questions were solicited and analyzed for major themes. Results There was moderate significant correlation between child-teen and parent scores. Parents rated care significantly higher than did the children. Children's responses to open-ended questions varied somewhat from their parents' opinions on various aspects of clinic visits. Discussion Findings suggested that having parents evaluate children's care may not accurately represent the views of children and teens. Findings supported children and teens' ability to provide valuable perceptions about care that can inform clinic improvement processes.