The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

La teoría de los diferenciales de Salomon Maimon, la pregunta quid juris y la posibilidad de la metafísica como ciencia

Este trabajo estudia la teoría de los diferenciales de Salomon Maimon como respuesta a la cuestión quid juris y a la vez como clave para la fundamentación de la posibilidad de la metafísica como ciencia. Se reconstruye primero la crítica de Maimon al tratamiento kantiano de la pregunta quid juris. Luego, se analiza la respuesta del propio Maimon a esa pregunta, para establecer finalmente cómo tal respuesta abre el camino para la explicación de la posibilidad de la metafísica como ciencia.

Music therapy, in tuning at the end of life

In this article music therapy is presented as a helpful tool to support the persons (and their relatives) living at the end of their life and, also, as a non pharmacological and complementary therapy in an integral and holistic medicine. What we report here comes from the direct experience, nourished after many years of interventions and reflections in oncology and palliative care units. We’re talking about silence, music, therapy, models and techniques. We will read and feel therapeutic sessions… but above all, we’re talking about life, conscience and love.

De la metafísica a la anarquía. El pensamiento político de Reiner Schürmann

El artículo pretende abordar el modo en el que la obra de Reiner Schürmann, a través de un original interpretación del pensamiento de Martin Heidegger, consigue desarrollar un tipo de filosofía política anárquica. Se intentará analizar, en la dispersa obra del filósofo holandés, la idea de anarquía como condición existencial, prestando especial atención al nexo entre el concepto de muerte de la metafísica y la posibilidad de una praxis política anárquica. El artículo se compone de tres partes: en la primera se examinará la noción de Ser y de “a priori práctico” en el trabajo de Schürmann. En la segunda se verá la diferencia entre el nihilismo del autor y el de Vattimo, y en la tercera, se profundizará en las consecuencias más propiamente políticas del pensamiento de Schürmann.

La tercera persona: una propuesta antropológico-filosófica delimitada frente al planteamiento sociológico

Frente al paradigma diádico preponderante en la teoría social, recientes propuestas reivindican la función del tercero. En estas teorías, el tercero personaliza el orden social normativo –surgido en la relación diádica– y atribuye empíricamente el reconocimiento como persona. Frente a este planteamiento empírico, proponemos un enfoque trascendental antropológico-filosófico, según el cual la estructura tri-posicional de las relaciones sociales constituye la condición de posibilidad de la cultura normativa y del modo de ser propio del hombre en cuanto que persona.

Hegel’s Non-Metaphysical Idea of Freedom

the article explores the putatively non-metaphysical – non-voluntarist, and even non-causal – concept of freedom outlined in Hegel’s work and discusses its influential interpretation by robert Pippin as an ‘essentially practical’ concept. I argue that Hegel’s affirmation of freedom must be distinguished from that of Kant and Fichte, since it does not rely on a prior understanding of self-consciousness as an originally teleological relation and it has not the nature of a claim ‘from a practical point of view’.

‘I don’t think I’d be frightened if the statins went’: a phenomenological qualitative study exploring medicines use in palliative care patients, carers and healthcare professionals

Background

Non-pharmacological interventions for cognitive impairment due to systemic cancer treatment (Review)

Background

It is estimated that up to 75% of cancer survivors may experience cognitive impairment as a result of cancer treatment and given the increasing size of the cancer survivor population, the number of affected people is set to rise considerably in coming years. There is a need, therefore, to identify effective, non-pharmacological interventions for maintaining cognitive function or ameliorating cognitive impairment among people with a previous cancer diagnosis.
Objectives

To evaluate the cognitive effects, non-cognitive effects, duration and safety of non-pharmacological interventions among cancer patients targeted at maintaining cognitive function or ameliorating cognitive impairment as a result of cancer or receipt of systemic cancer treatment (i.e. chemotherapy or hormonal therapies in isolation or combination with other treatments).
Search methods

We searched the Cochrane Centre Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PUBMED, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PsycINFO databases. We also searched registries of ongoing trials and grey literature including theses, dissertations and conference proceedings. Searches were conducted for articles published from 1980 to 29 September 2015.
Selection criteria

Randomised controlled trials (RCTs) of non-pharmacological interventions to improve cognitive impairment or to maintain cognitive functioning among survivors of adult-onset cancers who have completed systemic cancer therapy (in isolation or combination with other treatments) were eligible. Studies among individuals continuing to receive hormonal therapy were included. We excluded interventions targeted at cancer survivors with central nervous system (CNS) tumours or metastases, non-melanoma skin cancer or those who had received cranial radiation or, were from nursing or care home settings. Language restrictions were not applied.
Data collection and analysis

Author pairs independently screened, selected, extracted data and rated the risk of bias of studies. We were unable to conduct planned meta-analyses due to heterogeneity in the type of interventions and outcomes, with the exception of compensatory strategy training interventions for which we pooled data for mental and physical well-being outcomes. We report a narrative synthesis of intervention effectiveness for other outcomes.
Main results

Five RCTs describing six interventions (comprising a total of 235 participants) met the eligibility criteria for the review. Two trials of computer-assisted cognitive training interventions (n = 100), two of compensatory strategy training interventions (n = 95), one of meditation (n = 47) and one of physical activity intervention (n = 19) were identified. Each study focused on breast cancer survivors. All five studies were rated as having a high risk of bias. Data for our primary outcome of interest, cognitive function were not amenable to being pooled statistically. Cognitive training demonstrated beneficial effects on objectively assessed cognitive function (including processing speed, executive functions, cognitive flexibility, language, delayed- and immediate- memory), subjectively reported cognitive function and mental well-being. Compensatory strategy training demonstrated improvements on objectively assessed delayed-, immediate- and verbal-memory, self-reported cognitive function and spiritual quality of life (QoL). The meta-analyses of two RCTs (95 participants) did not show a beneficial effect from compensatory strategy training on physical well-being immediately (standardised mean difference (SMD) 0.12, 95% confidence interval (CI) -0.59 to 0.83; I2= 67%) or two months post-intervention (SMD - 0.21, 95% CI -0.89 to 0.47; I2 = 63%) or on mental well-being two months post-intervention (SMD -0.38, 95% CI -1.10 to 0.34; I2 = 67%). Lower mental well-being immediately post-intervention appeared to be observed in patients who received compensatory strategy training compared to wait-list controls (SMD -0.57, 95% CI -0.98 to -0.16; I2 = 0%). We assessed the assembled studies using GRADE for physical and mental health outcomes and this evidence was rated to be low quality and, therefore findings should be interpreted with caution. Evidence for physical activity and meditation interventions on cognitive outcomes is unclear.
Authors' conclusions

Overall, the, albeit low-quality evidence may be interpreted to suggest that non-pharmacological interventions may have the potential to reduce the risk of, or ameliorate, cognitive impairment following systemic cancer treatment. Larger, multi-site studies including an appropriate, active attentional control group, as well as consideration of functional outcomes (e.g. activities of daily living) are required in order to come to firmer conclusions about the benefits or otherwise of this intervention approach. There is also a need to conduct research into cognitive impairment among cancer patient groups other than women with breast cancer.

A Relação entre Mindfulness, Auto-Compaixão, Vergonha e Psicopatologia em Praticantes e Não Praticantes de Meditação/Yoga

O estudo do mindfulness tem sido alvo de um crescente interesse no domínio da Psicologia, pela sua importância no aumento de bem-estar e redução de sintomatologia psicopatológica. Os estudos realizados acerca da forma como o mindfulness assume um papel preponderante no bem-estar psicológico dos indivíduos, tendo por base um conjunto de competências ou aptidões que podem ser aprendidas e praticadas, favorece uma melhoria da saúde e do bem-estar dos indivíduos. Deste modo, com o objectivo de contribuir para o conhecimento da relação entre mindfulness, auto-compaixão, vergonha e psicopatologia em praticantes e não praticantes de meditação/yoga, realizou-se um conjunto de estudos numa amostra constituída por 121 sujeitos, em que 53 integram uma população praticante de meditação/yoga e 68 pertencem à população geral não praticante de meditação/yoga. Os resultados revelam que indivíduos praticantes de meditação/yoga registam valores significativamente mais elevados nas facetas observar e não reagir da escala de mindfulness. Por sua vez, sujeitos com maiores índices de traço de mindfulness apresentam níveis mais baixos de vergonha externa e interna. Para além disto, indivíduos com elevado traço de mindfulness distinguem-se significativamente dos indivíduos com baixo traço de mindfulness ao apresentarem níveis mais elevados de auto-compaixão e níveis mais baixos de depressão, ansiedade e stress. / The study of mindfulness has been the target of a growing interest in the field of psychology because of its importance in increasing welfare and lessening of psychopathological symptoms. Studies on how mindfulness plays a central role in psychological well-being of individuals, based on a set of competencies or skills that can be learned and practiced, promotes improved health and well-being of individuals. Thus, in order to contribute to the knowledge of the relationship between mindfulness, self-pity, shame and psychopathology in non-practitioners and practitioners of meditation / yoga, it was held a series of studies on a sample of 121 subjects, in which 53 were part of a population practicing meditation / yoga and 68 belong to the general population not practicing meditation / yoga. The results show that individuals who practice meditation / yoga recorded significantly higher values in the watch and not react aspects of mindfulness scale. In turn, subjects with higher trait mindfulness have lower levels of external and internal shame. In addition, individuals with higher trait mindfulness differ significantly from individuals with low trait mindfulness of the present higher levels of self-pity and lower levels of depression, anxiety and stress.

A Influência de um Curso de Meditação nos Níveis de Mindfulness, Satisfação com a Vida e Optimismo

O mindfulness tem sido alvo de um crescente interesse no domínio da Psicologia e a sua importância ao nível do funcionamento psicológico tem vindo a ser empiricamente verificada. Os estudos sobre mindfulness têm demonstrado que este constructo está positivamente relacionado com a saúde psicológica e negativamente com a psicopatologia. Deste modo, a presente investigação teve como objectivo compreender a relação entre mindfulness, satisfação com a vida e optimismo, bem como explicar a influência de um curso de meditação nestas variáveis. Neste sentido, os participantes completaram uma bateria de questionários de auto-resposta avaliando o mindfulness, satisfação com a vida e optimismo num primeiro momento de avaliação, antes do curso de meditação (N = 104), num segundo momento, depois do curso de meditação (N = 30). Os resultados revelam um aumento significativo nos níveis de mindfulness, satisfação com a vida e optimismo após a frequência do curso de meditação e indicam que a prática do curso de meditação fortalece a relação entre estes constructos. Apesar de algumas limitações metodológicas que futura investigação deverá tentar colmatar, este estudo reforça a importância da prática de meditação para um funcionamento psicológico positivo e adaptativo. / Mindfulness has been target of a growing interest to Psychology in terms of the verified importance to psychological function. Studies show that mindfulness has demonstrated an important correlation with psychological health and negatively to psychopathology. The objective of the present research is to understand the relation between mindfulness, satisfaction with life and optimism as well as to explain the influence of a course of meditation in the study of these variables. The participants of this research completed several different types of auto-response questionnaires regarding mindfulness, satisfaction with life, and optimism; prior to the meditation course (N = 104), and then, after the meditation course (N = 30). Therefore, the results of the research demonstrated that the level of mindfulness, satisfaction with life and optimism significantly increased as the participants undergone in the meditation course as well as indicated that the practice such course strengthens the relation between the variables. Despite some methodological limitations that a future research should relieve, this study reinforces the practice of meditation for a positive and adaptive psychological function.

Learning at the Interstices; Locating Practical Philosophies for Understanding Physical/virtual Inter-spaces

Virtual worlds are relatively recent developments, and so it is tempting to believe that they need to be understood through newly developed theories and philosophies. However, humans have long thought about the nature of reality and what it means to be “real.” This paper examines the three persistent philosophical concepts of Metaxis, Liminality and Space that have evolved across more than 2000 years of meditation, contemplation and reflection. Our particular focus here is on the nature of the interface between the virtual and the physical: at the interstices, and how the nature of transactions and transitions across those interfaces may impact upon learning. This may, at first, appear to be an esoteric pursuit, but we ground our arguments in primary and secondary data from research studies in higher education.

Understanding the Patient Experience Through the Power of Film: a Mixed Method Qualitative Research Study

Background For decades film has proved to be a powerful form of communication. Whether produced as entertainment, art or documentary, films have the capacity to inform and move us. Films are a highly attractive teaching instrument and an appropriate teaching method in health education. It is a valuable tool for studying situations most transcendental to human beings such as pain, disease and death. Objectives The objectives were to determine how this helps students engage with their role as health care professionals; to determine how they view the personal experience of illness, disease, disability or death; and to determine how this may impact upon their provision of patient care. Design, Setting and Participants The project was underpinned by the film selection determined by considerate review, intensive scrutiny, contemplation and discourse by the research team. 7 films were selected, ranging from animation; foreign, documentary, biopic and Hollywood drama. Each film was shown discretely, in an acoustic lecture theatre projected onto a large screen to pre-registration student nurses (adult, child and mental health) across each year of study from different cohorts (n = 49). Method A mixed qualitative method approach consisted of audio-recorded 5-minute reactions post film screening; coded questionnaires; and focus group. Findings were drawn from the impact of the films through thematic analysis of data sets and subjective text condensation categorised as: new insights looking through patient eyes; evoking emotion in student nurses; spiritual care; going to the moves to learn about the patient experience; self discovery through films; using films to link theory to practice. Results Deeper learning through film as a powerful medium was identified in meeting the objectives of the study. Integration of film into pre registration curriculum, pedagogy, teaching and learning is recommended. Conclusion The teaching potential of film stems from the visual process linked to human emotion and experience. Its impact has the power to not only help in learning the values that underpin nursing, but also for respecting the patient experience of disease, disability, death and its reality.

Compassion and its role in the clinical encounter – An argument for compassion training

Empathic communication, (i.e. emotionally engaging with a patient), is an important part of the therapeutic relationship. It has been shown to improve the health and therapeutic outcomes for patients by improving diagnosis and compliance. In the West, front-line medical professionals, including herbal medicine practitioners, put themselves at risk of burnout and compassion fatigue by giving emotionally intensive care. While treatments for compassion fatigue and burnout are available, another way forward is needed to ensure healthcare professionals do not become ill; one that will enable both patients and healthcare professionals to receive the care needed. In this paper it is argued that compassion, which is defined in this paper, involves different neural circuitry to empathy and can protect healthcare professionals from the effects of stress that can, if not addressed, lead to burnout. Traditional Buddhist meditation techniques such as loving-kindness meditation have been shown to increase compassion in non-meditative states. Short daily sessions of such mediation practices have been shown to improve compassion in a way that protects healthcare professionals from burnout.

Theatrical Latency: Walking Katrina Palmer’s The Loss Adjusters

In this article I introduce the term ‘theatrical latency’ as a pleasurable effect experienced when listening to sound in relation to visual perception. Latency refers to both the phenomena of audio delay (in feedback from analogue to digital conversion and the momentary lapses experienced when playing live with recorded music) and a theatrical sensation that comes from the reanimation of visual environments through aural framing. In this configuration, the notion of latency takes on a double meaning as both a recorded phenomenon and the retrieval of something dormant within physical objects, sites or materials. These ideas will be introduced through my experience of walking Katrina Palmer’s site-specific audio work The Loss Adjusters (2015) on the island of Portland (UK). The audio tracks create an extended meditation on Portland, interweaving specific locations and histories with fictional characters and ghosts of the island.

The impact of mindfulness on the wellbeing and performance of educators: A systematic review of the empirical literature

Given the potentially demanding nature of teaching, efforts are underway to develop practices that can improve the wellbeing of educators, including interventions based on mindfulness meditation. We performed systematic review of empirical studies featuring analyses of mindfulness in teaching contexts. Databases were reviewed from the start of records to January 2016. Eligibility criteria included empirical analyses of mindfulness and wellbeing outcomes acquired in relation to practice. A total of 19 papers met the eligibility criteria and were included in the systematic review, consisting of a total 1,981 participants. Studies were principally examined for outcomes such as burnout, anxiety, depression and stress, as well as more positive wellbeing measures (e.g., life satisfaction). The systematic review revealed that mindfulness was generally associated with positive outcomes in relation to most measures. However, the quality of the studies was inconsistent, and so further research is needed, particularly involving high-quality randomised control trials.