Search

Now almost 50 years old, the woonerf is challenged with social and technical deterioration, poor energy performance, misalignment of demographics and typology and an overall negative image. Because the housing stock consists of 20% of woonerf residents, there is considerable reason to seek for a solution to make this type of neighbourhood future-proof. In this national task to renovate and adapt entire neighbourhoods, there is another issue to consider: our linear consumption trends. The consequence of the linear economy is a worldwide waste crisis, pollution, and the depletion of finite resource. That is why we need to switch to circular consumption. Which means going from a take-make-dispose system to an economy in which resources are circulated. This project therefore combines the challenge of future-proofing the woonerf and the transition to circular consumption into a test case that aims to experiment with the woonerf as a circular neighbourhood. The final product is a research-informed design for the neighbourhood Goedewerf in Almere Haven., Architecture, Urbanism and Building Sciences | Heritage & Architecture

Ethical climate (EC) has been broadly described as how well institutions respond to ethical issues. Developing a tool to study and evaluate EC that aims to achieve sustained improvements requires a contemporary framework with identified relevant drivers. An extensive literature review was performed, reviewing existing EC definitions, tools and areas where EC has been studied; ethical challenges and relevance of EC in contemporary paediatric intensive care (PIC); and relevant ethical theories. We surmised that existing EC definitions and tools designed to measure it fail to capture nuances of the PIC environment, and sought to address existing gaps by developing an EC framework for PIC founded on ethical theory. In this article, we propose a Paediatric Intensive Care Ethical Climate (PICEC) conceptual framework and four measurable domains to be captured by an assessment tool. We define PICEC as the collective felt experience of interdisciplinary team members arising from those factors that enable or constrain their ability to navigate ethical aspects of their work. PICEC both results from and is influenced by how well ethical issues are understood, identified, explored, reflected on, responded to and addressed in the workplace. PICEC encompasses four, core inter-related domains representing drivers of EC including: (1) organisational culture and leadership; (2) interdisciplinary team relationships and dynamics; (3) integrated child and family-centred care; and (4) ethics literacy. Future directions involve developing a PICEC measurement tool, with implications for benchmarking as well as guidance for, and evaluation of, targeted interventions to foster a healthy EC.

Rationing in health care is controversial, and even more so in pediatrics. Children are an inherently vulnerable group because they are reliant on their parents and caregivers to make decisions in their best interests and have no political voice. Historically, there has been general acceptance of the need to ration healthcare at a systems level, however there is controversy over whether healthcare professionals should be involved in rationing at the bedside. The COVID-19 pandemic has highlighted that bedside rationing is unavoidable, at least in times of extreme resource scarcity. Internationally, there has been significant ethical analysis and guideline development to guide intensive care rationing decisions in the event that resources are overwhelmed. This paper explores the principles underlying distributive justice in healthcare rationing and discusses how these were operationalized in ethical guidelines for the COVID-19 pandemic. In fact, rationing is unavoidable and occurs constantly in everyday nursing and medical ICU practice, often in mundane and uncontroversial ways. Some argue that these everyday decisions are not true rationing decisions, but resource allocation, or stewardship decisions. We argue there are no clear lines between resource allocation and rationing decisions, rather that they occur on a spectrum. These everyday rationing decisions are particularly susceptible to personal biases that are often implicit. Due to the subtle and constant nature of most everyday rationing decisions, specific guideline development will rarely be practical or appropriate. However, it is possible to develop other processes to improve decision making. There are a variety of strategies we recommend for this including, encouraging reflective practice; developing explicit frameworks that promote collaborative decision making; being transparent about resource allocation and rationing decisions with colleagues, patients, and families; and promoting a workplace culture

The global 2019 coronavirus disease (COVID-19) pandemic has led to major challenges in clinical decision making when the demand for intensive care exceeds local capacity. In order to promote consistent, transparent, objective and ethical decision making, the Australian and New Zealand Intensive Care Society (ANZICS) formed a committee to urgently develop guidelines outlining key principles that should be utilised during the pandemic. This guidance is intended to support the practice of intensive care specialists during the COVID-19 pandemic and to promote the development of local admission policies that should be endorsed by health care organisations and relevant local authorities.

In this paper, we present two grounds for arguing that abortion should be decriminalised. First, we consider the implications of the fact that the long-standing ethical debate concerning the morality of abortion has to date proven intractable. We maintain that because the philosophical literature has failed to demonstrate conclusively that views either for or against abortion’s moral acceptability are false, the matter remains at a stalemate in terms of rational debate, contributing to the ongoing absence of political and popular consensus about the issue in our society. In these circumstances, we argue, the law should adopt a minimalist position by not imposing criminal sanctions for abortion. Second, we present evidence, often neglected in the moral debates about abortion, that the risks of carrying a fetus to term and of delivery are substantial for a woman. Most laws recognise that, should her life be endangered by her pregnancy, a woman’s right to life shall prevail. However, the impacts of carrying a fetus to term and delivery on a woman are not restricted to the risks to her life, but extend to significant permanent changes to her body, and include risks of injury that are not negligible. We argue that a woman should not be compelled to take these risks by laws prohibiting abortion, when no conclusive argument exists against the morality of abortion. We also address, albeit briefly, the issue of late term abortion.

In Canada, American Sign Language (ASL) has become increasingly popular and, in fact, there has been some indication that the Canadian government is considering making ASL the country’s third official language. Each province has a separate education system, but in Manitoba, a provincial ASL curriculum has been developed and approved for public high schools. In order to offer the Grade 9-12 ASL courses, instructors are needed; however, most of those currently teaching ASL have not completed a Bachelor of Education degree, which is required to teach in public schools. The purpose of this research study was to describe the skills, experience, training and qualifications of individuals currently teaching ASL in Manitoba, and to identify skills/qualifications they feel are most important in training individuals to teach ASL. Information gathered from their responses to survey questions was used to make conclusions and recommendations aimed at establishing certification standards for ASL teachers. The results suggest ASL teachers are engaged in providing quality instruction and are interested in improving their level of knowledge to become even better teachers. A significant number of the teachers responding to this survey were qualified teachers, but had never taught in public high schools. This indicates a need to investigate the awareness on the part of school divisions that the Grade 9-12 ASL courses are available and their interest in, and commitment to, offering them in their schools.

In Canada, American Sign Language (ASL) has become increasingly popular and, in fact, there has been some indication that the Canadian government is considering making ASL the country’s third official language. Each province has a separate education system, but in Manitoba, a provincial ASL curriculum has been developed and approved for public high schools. In order to offer the Grade 9-12 ASL courses, instructors are needed; however, most of those currently teaching ASL have not completed a Bachelor of Education degree, which is required to teach in public schools. The purpose of this research study was to describe the skills, experience, training and qualifications of individuals currently teaching ASL in Manitoba, and to identify skills/qualifications they feel are most important in training individuals to teach ASL. Information gathered from their responses to survey questions was used to make conclusions and recommendations aimed at establishing certification standards for ASL teachers. The results suggest ASL teachers are engaged in providing quality instruction and are interested in improving their level of knowledge to become even better teachers. A significant number of the teachers responding to this survey were qualified teachers, but had never taught in public high schools. This indicates a need to investigate the awareness on the part of school divisions that the Grade 9-12 ASL courses are available and their interest in, and commitment to, offering them in their schools.

Objectives To quantify the presence, purpose, function, governance and funding of clinical ethics services (CES) in tertiary paediatric hospitals in Australia and New Zealand. Design, setting and participants A descriptive, quantitative survey was conducted across eight paediatric hospitals. Main Outcome Measures Responses from survey questions on the presence, purpose, function, governance and funding of the CES. Results Seven of eight tertiary paediatric hospitals identified access to CES. Regarding purpose and function, all CES provided clinical case consultation, six of seven provided education and training, six of seven assisted with organisational policy and guideline development and four of seven undertook original ethics research. There was wide variation in how case consultations were conducted, reported and documented. With respect to governance and funding, all CES reported to their hospital executive and only one CES reported having a dedicated, albeit small, budget. Conclusions Heterogeneity in the process of case consultation and CES policy content exists across the organisations studied. There is consistency with the broader values that underpin CES such as their multidisciplinary nature and level of training required for key staff. There is an apparent lack of formal budgetary support from health services for CES activities, with support derived mostly from staff who contribute their time in addition to their primary roles.

We report two cases of spotted black snake (Pseudechis guttatus) envenoming. One patient experienced localised burning pain around the bite and developed nausea, vomiting, diarrhoea, upper abdominal cramping and diaphoresis. He was treated with intravenous fluids and antiemetics, but no antivenom, and was discharged 23 hours after the bite. The second patient developed a severe headache, blurred vision and mild nausea, associated with severe pain and swelling of the bitten limb that took 4 days to resolve. No antivenom was given and the patient had no sequelae. Neither patient developed significant coagulopathy, myolysis or neuromuscular paralysis. Bites by this species appear to cause effects similar to those of the more common red-bellied black snake (P. porphyriacus).