Il consenso informato come strumento di esercizio del diritto alla salute per i pazienti stranieri?

L’elaborato propone una riflessione rispetto all’atto giuridico del consenso informato quale strumento garante dell’esercizio del diritto alla salute per i migranti. Attraverso una riflessione antropologica rispetto alla natura, alla costruzione e alla logica dei diritti universali, verranno analizzate le normative nazionali, europee ed internazionali a tutela del diritto alla salute per i migranti; l’obiettivo della ricerca è indagare l’eventuale scarto tra normative e politiche garantiste nei confronti della salute migrante e l’esistenza di barriere strutturali che impediscono un pieno esercizio del diritto alla salute. L’ipotesi di ricerca si basa sulla reale capacità performativa del consenso informato, proposto solitamente sia come strumento volto ad assicurare la piena professionalità dell’operatore sanitario nell’informare il paziente circa i rischi e i benefici di un determinato trattamento sanitario, sia come garante del principio di autonomia. La ricerca, attraverso un’analisi quanti-qualitativa, ha interrogato il proprio campo, rappresentato da un reparto di ginecologia ed ostetrica, rispetto alle modalità pratiche di porre in essere la firma nei moduli del consenso informato, con particolare attenzione alle specificità proprie delle pazienti migranti. Attraverso l’osservazione partecipante è stato quindi possibile riflettere su aspetti rilevanti, quali le dinamiche quotidiane che vengono a crearsi tra personale sanitario e pazienti, le caratteristiche e i limiti del servizio di mediazione sanitaria, le azioni pratiche della medicina difensiva. In questo senso il tema del “consenso informato”, indagato facendo interagire discipline quali l’antropologia, la bioetica, la filosofia e la sociologia, si è posto sia come lente di lettura privilegiata per comprendere le dinamiche relazionali ad oggi esistenti tra professionisti sanitari e popolazione migrante, ancora vittima di diseguaglianze strutturali, ma altresì come “innesco potenziale” di nuove modalità di intendere la relazione medico-paziente.

Design and Control of Robotic Hands

The application of dexterous robotic hands out of research laboratories has been limited by the intrinsic complexity that these devices present. This is directly reflected as an economically unreasonable cost and a low overall reliability. Within the research reported in this thesis it is shown how the problem of complexity in the design of robotic hands can be tackled, taking advantage of modern technologies (i.e. rapid prototyping), leading to innovative concepts for the design of the mechanical structure, the actuation and sensory systems. The solutions adopted drastically reduce the prototyping and production costs and increase the reliability, reducing the number of parts required and averaging their single reliability factors. In order to get guidelines for the design process, the problem of robotic grasp and manipulation by a dual arm/hand system has been reviewed. In this way, the requirements that should be fulfilled at hardware level to guarantee successful execution of the task has been highlighted. The contribution of this research from the manipulation planning side focuses on the redundancy resolution that arise in the execution of the task in a dexterous arm/hand system. In literature the problem of coordination of arm and hand during manipulation of an object has been widely analyzed in theory but often experimentally demonstrated in simplified robotic setup. Our aim is to cover the lack in the study of this topic and experimentally evaluate it in a complex system as a anthropomorphic arm hand system.

Next-state comfort in learning a vertical stick transportation sequence

Over the last decade, the end-state comfort effect (e.g., Rosenbaum et al., 2006) has received a considerable amount of attention. However, some of the underlying mechanisms are still to be investigated, amongst others, how sequential planning affects end-state comfort and how this effect develops over learning. In a two-step sequencing task, e.g., postural comfort can be planned on the intermediate position (next state) or on the actual end position (final state). It might be hypothesized that, in initial acquisition, next state’s comfort is crucial for action planning but that, in the course of learning, final state’s comfort is taken more and more into account. To test this hypothesis, a variant of Rosenbaum’s vertical stick transportation task was used. Participants (N = 16, right-handed) received extensive practice on a two-step transportation task (10,000 trials over 12 sessions). From the initial position on the middle stair of a staircase in front of the participant, the stick had to be transported either 20 cm upwards and then 40 cm downwards or 20 cm downwards and then 40 cm upwards (N = 8 per subgroup). Participants were supposed to produce fluid movements without changing grasp. In the pre- and posttest, participants were tested on both two-step sequencing tasks as well as on 20 cm single-step upwards and downwards movements (10 trials per condition). For the test trials, grasp height was calculated kinematographically. In the pretest, large end/next/final-state comfort effects for single-step transportation tasks and large next-state comfort effects for sequenced tasks were found. However, no change in grasp height from pre- to posttest could be revealed. Results show that, in vertical stick transportation sequences, the final state is not taken into account when planning grasp height. Instead, action planning seems to be solely based on aspects of the next action goal that is to be reached.

Proximal row carpectomy in emergency

Proximal row carpectomy (PRC) is a well-accepted procedure for the treatment of early post-traumatic degenerative disease of the wrist. Much less frequently, PRC has been advocated as an emergency procedure for irreparable fracture-dislocation of the wrist. Our objective was to compare the results of PRC in patients having undergone this procedure in the two contexts. We conducted a retrospective analysis of the clinical and radiographic results of six patients treated by emergency PRC as compared to six patients who underwent elective PRC. The mean follow-up was 36 months. Both the patient's satisfaction and the grasp of the wrist joint were significantly better in patients who underwent PRC emergency as compared to those having undergone elective PRC. Quick DASH score, radiographic results, and return to work were also more favourable in these patients, but the difference between the two groups was not significant. This study confirms that PRC is a valuable salvage technique indicated in early posttraumatic wrist collapse. Moreover, when performed in emergency, the procedure shows even better subjective and objective results, allowing a majority of patients to return to their previous job.

The interface between morphology and action planning: a comparison of two species of New World monkeys

Recent research with several species of nonhuman primates suggests sophisticated motor-planning abilities observed in human adults may be ubiquitous among primates. However, there is considerable variability in the extent to which these abilities are expressed across primate species. In the present experiment, we explore whether the variability in the expression of anticipatory motor-planning abilities may be attributed to cognitive differences (such as tool use abilities) or whether they may be due to the consequences of morphological differences (such as being able to deploy a precision grasp). We compared two species of New World monkeys that differ in their tool use abilities and manual dexterity: squirrel monkeys, Saimiri sciureus (less dexterous with little evidence for tool use) and tufted capuchins, Sapajus apella (more dexterous and known tool users). The monkeys were presented with baited cups in an untrained food extraction task. Consistent with the morphological constraint hypothesis, squirrel monkeys frequently showed second-order motor planning by inverting their grasp when picking up an inverted cup, while capuchins frequently deployed canonical upright grasping postures. Findings suggest that the lack of ability for precision grasping may elicit more consistent second-order motor planning, as the squirrel monkeys (and other species that have shown a high rate of second-order planning) have fewer means of compensating for inefficient initial postures. Thus, the interface between morphology and motor planning likely represents an important factor for understanding both the ontogenetic and phylogenetic origins of sophisticated motor-planning abilities.

The Interface Between Morphology and Action Planning: a Comparison of Two Species of New World Monkeys

Recent research with several species of nonhuman primates suggests sophisticated motor-planning abilities observed in human adults may be ubiquitous among primates. However, there is considerable variability in the extent to which these abilities are expressed across primate species. In the present experiment, we explore whether the variability in the expression of anticipatory motor-planning abilities may be attributed to cognitive differences (such as tool use abilities) or whether they may be due to the consequences of morphological differences (such as being able to deploy a precision grasp). We compared two species of New World monkeys that differ in their tool use abilities and manual dexterity: squirrel monkeys, Saimiri sciureus (less dexterous with little evidence for tool use) and tufted capuchins, Sapajus apella (more dexterous and known tool users). The monkeys were presented with baited cups in an untrained food extraction task. Consistent with the morphological constraint hypothesis, squirrel monkeys frequently showed second-order motor planning by inverting their grasp when picking up an inverted cup, while capuchins frequently deployed canonical upright grasping postures. Findings suggest that the lack of ability for precision grasping may elicit more consistent second-order motor planning, as the squirrel monkeys (and other species that have shown a high rate of second-order planning) have fewer means of compensating for inefficient initial postures. Thus, the interface between morphology and motor planning likely represents an important factor for understanding both the ontogenetic and phylogenetic origins of sophisticated motor-planning abilities. (C) 2013 The Association for the Study of Animal Behaviour. Published by Elsevier Ltd. All rights reserved.

Spinning Song

More than twelve years ago, during the car rides to school, my paternal grandmother, or Obasan as she is known in our family, first began telling me her stories about living in the Philippines during the Japanese Occupation. At the time, I did not know much about World War II, but her stories about being captured by the Japanese soldiersfascinated me. Years have passed, and only recently did I really begin to grasp not only the poignancy of these accounts, but also their importance in a larger context. The absence of first-hand narratives about World War II and the Japanese Occupation of the Philippines from the point of view of a Filipino woman is problematic, and I hope that my grandmother’s story can fill this hole in war literature. There are two main parts to the narrative. The first eight chapters of my thesis are about the early years of the Japanese Occupation. During this time, Obasan and her familylived a relatively peaceful life, with the exception of a few troubling encounters with the Japanese. The last seven chapters recount the Liberation of the Philippines and the days when Obasan and her family were held captive by the Japanese. The primary sources for this thesis are the interviews I have conducted with my grandmother over the course of this year and her own handwritten memoir that she composed in the last two decades. I focus specifically on the three chapters that she wrote about the war. I have also included poems written by women and historical background on the Philippines and World War II. Spinning Song is what I call a hybrid-memoir, as it retells Obasan’s stories about the war and explores the ways in which our experiences as grandmother and granddaughter intersect. More importantly, it is my way of preserving the legacy of my grandmother and paying tribute to the woman who has shaped much of who I am today.

The Expression Of Motor Planning In Squirrel Monkeys (Saimiri sciureus) And Brown Capuchins (Cebus apella)

Multiple recent studies provide evidence that both human and nonhuman primates possess motor planning abilities. I tested for the demonstration of motor planning in two previously untested primate species through two experiments. In the first experiment, I compared the extent to which squirrel monkeys (Saimiri sciureus) and brown capuchins (Cebus apella) plan their movements in a grasping task. Individuals were presented with an inverted cup that required being turned and held upright in order to extract a food reward from the inside of the cup. This task was most efficiently solved by using an initially awkward inverted grasp that affords a comfortable hand and arm orientation at the end of the movement (known as end-state comfort). While certain individuals from both species exhibited end-state comfort, many of the capuchins never demonstrated this type of motor planning. Furthermore, the squirrel monkeys used the efficient grasp significantly more than the capuchins. In the second experiment, I presented the capuchins with another grasping task to test if they would express motor planning abilities in a different context. Here, the capuchins were offered a dowel that was baited on either the left or right end. A radial grasp with the thumb pointing towards the baited end was considered to be the most efficient grasp because it afforded a comfortable final position. The capuchins switched hands and used an overhand radial grasp on the dowel significantly more often than not, thus demonstrating motor planning in this task. The grasps typically utilized by these two closely related species differ considerably in that capuchins are capable of exercising precision grips, whereas squirrel monkeys are limited to whole-handed power grips. Moreover, unlike capuchins, squirrel monkeys are not particularly dexterous nor are they capable of precise manipulative actions. It is therefore more beneficial for squirrel monkeys to plan their movements efficiently because they are less capable of compensating for inappropriate initial grasps. Due to the appreciable variability in the expression of motor planning skills across species, I proposed that morphological constraints might explain the observed discrepancies in movement planning among different primate species.

The Supreme Court Confirmation Process and Its Implications

In recent history, there has been a trend of increasing partisan polarization throughout most of the American political system. Some of the impacts of this polarization are obvious; however, there is reason to believe that we miss some of the indirect effects of polarization. Accompanying the trend of increased polarization has been an increase in the contentiousness of the Supreme Court confirmation process. I believe that these two trends are related. Furthermore, I argue that these trends have an impact on judicial behavior. This is an issue worth exploring, since the Supreme Court is the most isolated branch of the federal government. The Constitution structured the Supreme Court to ensure that it was as isolated as possible from short-term political pressures and interests. This study attempts to show how it may be possible that those goals are no longer being fully achieved. My first hypothesis in this study is that increases in partisan polarization are a direct cause of the increase in the level of contention during the confirmation process. I then hypothesize that the more contention a justice faces during his or her confirmation process, the more ideologically extreme that justice will then vote on the bench. This means that a nominee appointed by a Republican president will tend to vote even more conservatively than was anticipated following a contentious confirmation process, and vice versa for Democratic appointees. In order to test these hypotheses, I developed a data set for every Supreme Court nominee dating back to President Franklin D. Roosevelt¿s appointments (1937). With this data set, I ran a series of regression models to analyze these relationships. Statistically speaking, the results support my first hypothesis in a fairly robust manner. My regression results for my second hypothesis indicate that the trend I am looking for is present for Republican nominees. For Democratic nominees, the impacts are less robust. Nonetheless, as the results will show, contention during the confirmation process does seem to have some impact on judicial behavior. Following my quantitative analysis, I analyze a series of case studies. These case studies serve to provide tangible examples of these statistical trends as well as to explore what else may be going on during the confirmation process and subsequent judicial decision-making. I use Justices Stevens, Rehnquist, and Alito as the subjects for these case studies. These cases will show that the trends described above do seem to be identifiable at the level of an individual case. These studies further help to indicate other potential impacts on judicial behavior. For example, following Justice Rehnquist¿s move from Associate to Chief Justice, we see a marked change in his behavior. Overall, this study serves as a means of analyzing some of the more indirect impacts of partisan polarization in modern politics. Further, the study offers a means of exploring some of the possible constraints (both conscious and subconscious) that Supreme Court justices may feel while they decide how to cast a vote in a particular case. Given the wide-reaching implications of Supreme Court decisions, it is important to try to grasp a full view of how these decisions are made.

Improving sixth grade student knowledge of ecology using fish rearing and release as a real-world context

This research project measured the effects of real-world content in a science classroom by determining change (deep knowledge of life science content, including ecosystems from MDE – Grade Level Content Expectations) in a subset of students (6th Grade Science) that may result from the addition of curriculum (real-world content of rearing trout in the classroom). Data showed large gains from the pre-test to post-test in students from both the experimental and control groups. The ecology unit with the implementation of real-world content [trout] was even more successful, and improved students’ deep knowledge of ecosystem content from Michigan’s Department of Education Grade Level Content Expectations. The gains by the experimental group on the constructed response section of the test, which included higher cognitive level items, were significant. Clinical interviews after the post-test confirmed increases in deep knowledge of ecosystem concepts in the experimental group, by revealing that a sample of experimental group students had a better grasp of important ecology concepts as compared to a sample of control group students.

Movement control of manipulative tasks in patients with Gilles de la Tourette syndrome

When a hand-held object is moved, grip and load force are accurately coordinated for establishing grasp stability. In the present work, the question was raised whether patients with Gilles de la Tourette syndrome (TS), who show tic-like movements, are impaired in grip-load force control when executing a manipulative task. To this end, we assessed force regulation during action patterns that required rhythmical unimanual or bimanual (iso-directional/anti-directional) movements. Results showed that the profile of grip-load force ratio was characterized by maxima and minima that were realized at upward and downward hand positions, respectively. TS patients showed increased force ratios during unimanual and bimanual movements, compared with control subjects, indicative of an inaccurate specification of the precision grip. Functional imaging data complemented the behavioural results and revealed that secondary motor areas showed no (or greatly reduced) activation in TS patients when executing the movement tasks as compared with baseline conditions. This indicates that the metabolic level in the secondary motor areas was equal during rest and task performance. At the neuronal level, this observation suggests that these cortical areas were continuously involved in movement preparation. Based on these data, we conclude that the ongoing activation of secondary motor areas may be explained by the TS patients' involuntary urges to move. Accordingly, interference will prevent an accurate planning of voluntary behaviour. Together, these findings reveal modulations in movement organization in patients with TS and exemplify degrading consequences for manual function.

Critical appraisal of meta-analyses: an introductory guide for the practicing surgeon

ABSTRACT: Meta-analyses are an essential tool of clinical research. Meta-analyses of individual randomized controlled trials frequently constitute the highest possible level of scientific evidence for a given research question and allow surgeons to rapidly gain a comprehensive understanding of an important clinical issue. Moreover, meta-analyses often serve as cornerstones for evidence-based surgery, treatment guidelines, and knowledge transfer. Given the importance of meta-analyses to the medical (and surgical) knowledge base, it is of cardinal importance that surgeons have a basic grasp of the principles that guide a high-quality meta-analysis, and be able to weigh objectively the advantages and potential pitfalls of this clinical research tool. Unfortunately, surgeons are often ill-prepared to successfully conduct, critically appraise, and correctly interpret meta-analyses. The objective of this educational review is to provide surgeons with a brief introductory overview of the knowledge and skills required for understanding and critically appraising surgical meta-analyses as well as assessing their implications for their own surgical practice.

Changing Europe and The Relevance of Care and The Caring Professions

The aim of the paper is to introduce the challenges of the international care debate of the last ten years in order to grasp basic social needs, to analyse their treatment in the public and private sphere and to look at the orientation of professional answers by the care-professions. The concept of care enhances the societal dealing with - or ignoring of - different forms of dependency on informal and formal personal and social services throughout the life-cycle (child-care, nursing sick or handicapped persons, supporting the elderly) and in special life situations (from help to lone mothers and their children, via help to drug-addicts to help for homeless people). All societies have different approaches to deal with these life-situations, they do so by employ-ing various mixtures of: familial support, mostly provided by women, social politics, organized by the state, public and/or private social services. This welfare-mix shows different combinations of private and public obligations, paid and und unpaid work, professional and laymen's tasks based on a specific understanding of mo-rality and justice embedded in the gender structure and intergenerational relationships. The importance of social work as a profession in this context differs according to the historical developments and cultural traditions. Characteristic for the profile of social work is the rele-vance of a care ethics and the existence of social rights, the tension of mothering and profes-sional methods, the relationship between help, denial and punishment and the ways of institu-tionalisation. The actuality of this debate is closely intertwined with the restructuring of societal bonds in the face of globalisation, the political reorganisation of states, the changes in the living to-gether of different generations and both sexes and the consequences for the organisation and contents of welfare. Looking at Germany and Eastern Europe two new phenomena of social relevance for the dis-cussion of care work and care needs can be taken as an example: the extent of cheap illegal women laborers travelling between east and west, especially Polish women working intermit-tendly in private care for old people and the highly organized traffiking of women from Russia to Germany to work in the sex business. The care debate entails a reframing of welfare issues in the light of social justice between classes, ethnicities and gender groups.

A perfect ‘treatment-society’?

The Danish Minister of Social Affairs is a very eager protagonist of quality in treatment, almost searching for the “perfect“ treatment for children, youngsters, disabled, etc. Many expensive research projects dealing with quality management as well as developmental projects have been launched during the latest years in order to improve professional practice. Within that context this article will deal with the relations between paternalism and ignorance and between pro-social behaviour and anti-social treatment in order to grasp “why professions are doing vicious things“. The main focus is concerned with the knowledge field of social pedagogy.

tkCybernetics

tkCybernetics is a simulation software that can be used to create and evaluate simple cybernetic circuits as a combination of lowpass and highpass filters and several nonlinear elements. tkCybernetics has been developed for and successfully applied to introductory courses on biological cybernetics at Bielefeld University. Therefore, it is recommended for students who start learning about cybernetics. Students can quickly grasp the concepts used in the graphical user interface and are able to create their own circuits after a short introduction to the program. Its usefulness for advanced students and researchers is limited to quickly testing circuits. This article provides detailed tutorial information on how to install and work with tkCybernetics for self-learning and for higher education.