Healthcare expenditures account for approximately 9% of GDP in OECD countries and are on an upward trajectory (OECD, 2017). This significant financial burden, combined with an aging global population and increasing demand, emphasizes the imperative for sustained research and innovation to enhance health system efficacy. Key to this transformation are technological advancements, including digital health, which presents novel opportunities for improvement. Emerging digital health technologies, such as virtual consultations, complex imaging procedures, and electronic medical records, are fundamental to modern healthcare (...) infrastructures. However, significant gaps remain in the evaluation and understanding of these innovations, especially for nascent technological areas. This thesis addresses this subject, aiming to delineate how individuals and institutions can bolster their evaluative capabilities, strategic decision-making, and planning for the deployment of emerging digital healthcare technologies. The research methodology amalgamates theoretical exploration, literature scrutiny, and empirical examinations, presenting an integrated perspective that intersects the disciplines of Management & Decision Science, Technology & Innovation, and Health Economics & Outcomes Research. From an applied perspective, this research focuses on developing evidence within the context of pediatric healthcare in Canada — a context notably underrepresented in healthcare management research, despite its disproportionate per capita expenditure. Technologically, the predominant focus is on applications in virtual reality (VR) and three-dimensional (3D) printing and virtualization, though with the aspiration of ensuring the generalizability of results. The current thesis is structured to parallel the progression of the research itself, as three distinct phases; this begins with a comprehensive Background that contextualizes the initial intent, exploring the relationship between technology, innovation, and health outcomes. In this phase, each academic discipline is analyzed to identify base theoretical underpinnings for the research. The second phase of this work includes five empirical studies, each preceded by context-specific literature reviews for the respective technological domain, providing insight into the current state of evidence related to value-based assessment and economic evaluation in that area. Empirical studies included a randomized controlled trial and a cost consequences assessment of VR for pre-procedural preparation for medical imaging. Additionally, novel applications of 3D printing and virtualization are critically analyzed, accompanied by a multi-case study on the implementation of 3D printing in pediatrics, a cost-consequences study of applications for thoracoabdominal surgeries, and an outcomes study on the use of 3D virtualization in medical education during the COVID-19 pandemic. The final phase of this research includes the critical analysis and synthesis of findings into a proposal for a novel value-based assessment and decision-making framework specific to emerging health innovations; this framework integrates insights and resources for clinicians, administrators, and policymakers. The outcomes of this research are skewed toward Knowledge Users, but also aims to advance the theoretical basis for health technology assessment (HTA). (shrink)

The American Journal of Bioethics, Volume 12, Issue 9, Page 57-59, September 2012.

Out of a reassertion of old ways, this book presents a new blueprint for future professional conduct.

The purpose of this paper is to engage with the readers in a theoretical reflection on nursing practices in forensic psychiatric settings. In this paper, we argue that practices of exclusion in forensic psychiatric settings share some common ground with Agamben's description of sovereign power and, consequently, the possible creation of zones of exception in this environment. The concept of exception is, therefore, purposely used to shift our thinking, highlight the political forces surrounding exclusionary practices in forensic psychiatric nursing, and (...) explore the ethical tensions that arise for nurses who become entangled in the control of these zones of exception. We argue that ethical and political discussions regarding this phenomenon are necessary if we wish to further understand the complexities of this field of practice and promote constructive change. (shrink)

In the theoretical description of prospect theory, distinct sets of parameters can control the curvature of the value function and the shape of the probability weighting function. There is one for the gain domain and one for the loss domain. However, in most estimations, behaviour over losses is assumed to perfectly reflect behaviour over gains, through a unique set of parameters. We examine the consequences of relaxing this simplifying assumption in the context of Tanaka et al.’s (Am Econ Rev 100(1):557–571, (...) 2010) risk-elicitation procedure based on multiple price lists. We show that subjects’ behaviour for gains is mostly reflected for losses at the aggregate and individual levels, and is consistent with the distinctive prospect theory fourfold pattern. Reflection is only partial as the mean curvature of the value function is slightly less convex for losses than it is concave for gains. These results are robust to a high-stake context. However, we demonstrate that assuming reflection can have huge consequences on loss-aversion measures. Incidentally, we also highlight the existence of a strong, negative and persistent pure loss-frame effect on elicited loss aversion. We recommend that future practitioners and modellers are particularly cautious about the loss-aversion values they obtain or use because these are especially sensitive to parametric assumptions and framing. (shrink)

Der Eröffnungsband der neuen Reihe „Studien zu Literatur und Religion / Studies on Literature and Religion“ bilanziert das seit einigen Jahren wieder spürbar gewachsene Forschungsinteresse an Religion und Literatur und erörtert an konkreten Beispielen und Schlüsselthemen von der Antike bis zur Gegenwart systematische Perspektiven für die zukünftige Forschung. Neben wissenschaftshistorischen Darstellungen widmen sich die Beiträge namhafter Vertreter aus Kultur-, Literatur-, Religionswissenschaft und Theologie Grundfragen u.a. nach Ritualität und Subjektivität, Mimesis und Fiktionalität, aber auch Konfessionalität und Transkulturalität, die Zusammenhänge wie Abgrenzungen (...) von Religion und Literatur deutlich werden lassen. (shrink)

In the Canadian forensic psychiatric context, the concepts of risk and dangerousness interact, intersect, and morph into the notion of significant threat to the safety of the public. Stemming from the results of a critical ethnography of the Ontario Review Board, this article unpacks the central role of forensic psychiatric nursing, as an example of a 'psych' discipline (e.g., psychiatry and psychology), in a system that is built to produce risky persons and to legitimize their detention and supervision. By using (...) excerpt of interviews conducted with nurses, ethnographic observations of Review Board hearings, and other documentary artifacts, the findings illustrate how rationalizations of risk and dangerousness are contingent on space, time, and observer. Depending on the time of the assessment or on the health‐care professional who performs it, different elements including, but not limited to, mental illness, interpersonal relationships, financial instability, and sexual vulnerability, are relied upon in very fluid, interchangeable, and discretionary ways to justify findings of dangerousness. Such a dynamic expands the reach of psychiatry's legitimacy at identifying risky conduct and controlling risky persons to domains very loosely associated with the notion of dangerousness. The work of Foucault and Castel provides the theoretical backdrop on which rests the discussion and the implications for nursing. (shrink)

Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment.Methods: Multilevel multinomial regression analysis controlling for age, gender, ethnicity, and (...) referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; meanAge = 13.66 years] using anonymised administrative data from young people's mental health services.Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement. Similarly, they were less likely to transfer or end treatment for other reasons than by case closure due to mutual agreement.Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services. (shrink)

The presence of an aesthetic judgment in an anthropological, scientific study may seem incongruous. One would think that the human body should be approached only in terms of ‘objective’ criteria of functionality and measurable proportions. However, to our surprise, two adjectives keep coming up in Buffon’s description of the human body in his Histoire naturelle de l’Homme: ‘beautiful’ and ‘ugly’. To be sure, it is possible to determine that a person is beautiful through measurements and observations of bodily and facial (...) symmetry, but most often, these proportions are not enough to explain why we find a person beautiful. How does Buffon think about beauty when he writes the Natural History of Man? Does he understand it as a classificatory tool based on an objective system of measurement, or does he use his personal preference? On what criteria does he judge the physical aspect of the varieties in the human species? (shrink)

Background:Psychiatric nurses are regularly confronted with the uses and effects of control interventions such as mechanical restraints. Although there are evident tensions in the literature regarding the use of mechanical restraints, very little research has focused on the lived and embodied experience of their use, whether from the patient’s perspective or the perspective of nursing staff responsible for their application.Research aims: to gain access to the bodily phenomenon of being placed in mechanical restraints; to give voice to the intimate experiential (...) understanding of this experience; and through phenomenological interpretation, to understand the subjective processes and meaning-making of this experience.Research design:For this research, we adopted a distinctly ethics-oriented application of the methodology known as interpretative phenomenological analysis, that is, the interpretive dimension of the research focused on ethical practice in mental healthcare – one that is informed by experiential accounts of the lived body.Participants and research context:A total of 40 in-depth semi-structured, nondirected interviews with both nurses and patients we conducted to meet the aims of this article. Participants were recruited from an inpatient psychiatric unit of a Canadian general hospital.Ethical considerations:The research received research ethics board clearance from both the hospital where the study took place and the University of Ottawa.Findings:The comparative analysis is presented under the following headings: context of care, meaning of quality of care, emotional reactions and nurse–patient relationship, meeting the needs and need for alternatives.Discussion/conclusions:The research findings are discussed in light of current literature and implications for practice. (shrink)

Né en 1921, Edgar Morin est un penseur connu, mais heureusement pas toujours reconnu dans les milieux scientifiques. Sa ronflante Méthode, qui établit que les effets d’une action échappent souvent à son auteur en provoquant des conséquences méconnues, comble surtout des médias trop heureux d’avoir sous la main un théoricien tout-terrain aux analyses grandiloquentes. D’ailleurs, la femme, l’entreprise, le football, la France, l’Europe, les pays de l’est, les pays arabes, le monde... sont, pour Edgar Morin, complexes. En quelques années, Edgar (...) Morin a ainsi réussi à amener la gauche à jeter Marx et ses analyses tranchées aux poubelles de l’Histoire. Car avec Edgar Morin, c’est beaucoup plus complexe et parfois même un tantinet ésotérique. Il est donc insensé de faire preuve de volontarisme politique. (shrink)

Humanism in forensic psychiatry: the use of the tidal nursing model The humanist school of thought, which finds resonance in many conceptual models and theories designed to guide nursing practice, needs to be understood in the context of the total institution, where the individual is subjected to a mortification of the self, and denied autonomy. This article will engage in a critical reflection on how humanism has influenced nursing theorists and the subsequent production of conceptual models and theories, especially as (...) they relate to the field of forensic psychiatric nursing. Although humanism provides optimism for nurse–patient relations, this article explores the incapability of such a philosophy to acknowledge the power relationships between individuals and its inability to explain the day‐to‐day realities experienced in forensic nursing, where the possibility of interpersonal violence reshapes nursing care. The tidal model will be discussed in detail as an example of a recently developed humanistic nursing model. Viewed from this perspective, it is clear that humanistic philosophy and its subsequent models of care are in discordance with the highly specialized field of forensic nursing. (shrink)

S'ils défendent des thèse originales, les écologistes partagent pourtant, parfois, les mêmes auteurs de prédilection que les centristes, les socialistes ou les anarchistes! Ce constat n'est pas le fait d'un rapprochement hasardeux mais le fruit d'une enquête inédite et sans précédent menée auprès des leaders écologistes français, invités à définir les contours théoriques de l'écologie politique.

Essentielle au droit, la question de la valeur n'a pourtant jamais été prise au sérieux. Et pour cause, dans le sillage des sciences empiriques, la pensée juridique moderne s'est accommodée d'une épistémologie d'après laquelle toute proposition juridique est réputée vraie ou fausse si elle décrit un état de chose « réel ». Conçu comme un ensemble de faits sociaux, objectivement identifiables, le droit s'appréhende comme une discipline promouvant des idéaux scientifiques, dont la neutralité axiologique de l'observateur. Dans ces conditions, la (...) valeur, indémontrable puisqu'elle n'est pas un fait, est renvoyée aux confins du droit. Cet ouvrage vise à souligner l'articulation fondamentale entre la discipline juridique et le concept de valeur qui en constitue le pivot, et à proposer une définition juridiquement satisfaisante de cet objet central pour le droit. (shrink)

The vertebrate nervous system performs the most complex functions of any organ system. This feat is mediated by dedicated assemblies of neurons that must be precisely connected to one another and to peripheral tissues during embryonic development. Motor neurons, which innervate muscle and regulate autonomic functions, form an integral part of this neural circuitry. The first part of this review describes the remarkable progress in our understanding of motor neuron differentiation, which is arguably the best understood model of neuronal differentiation (...) to date. During development, the coordinate actions of inductive signals from adjacent non‐neural tissues initiate the differentiation of distinct motor neuron subclasses, with specific projection patterns, at stereotypical locations within the neural tube. Underlying this specialisation is the expression of specific homeodomain proteins, which act combinatorially to confer motor neurons with both their generic and subtype‐specific properties. Ensuring that specific motor neuron subtypes innervate the correct target structure, however, requires precise motor axon guidance mechanisms. The second half of this review focuses on how distinct motor neuron subtypes pursue highly specific projection patterns by responding differentially to spatially discrete attractive and repulsive molecular cues. The tight link between motor neuron specification and axon pathfinding appears to be established by the dominant role of homeodomain proteins in dictating the ways that navigating motor axons interpret the plethora of guidance cues impinging on growth cones. BioEssays 23:582–595, 2001. © 2001 John Wiley & Sons, Inc. (shrink)