Journal articles on the topic 'Degree Discipline: Behavioural Pharmacology'

The COVID 19 pandemic had disrupted the lives of all socio-economic groups of the global population. The lockdowns, social distancing, financial adversities, continuous fear of being a victim to the virus had left every individual desperate with a feeling of vulnerability. Irrespective of all possible efforts at the global level, no ultimate solution to get rid of this virus is available till date except for the preventive measures. Various medicines and formulations are into practice, which may boost one’s immunity to fight against the virus. This catastrophic scenario had resulted in an impact on the human being in all aspects, physical, mental, emotional, social and behavioural. Ayurveda, the science of life has encompassed all these aspects through its preventive and curative principles. Aacharrasayana, code of conduct or behavioural discipline is one such modality that entails perfect mental, physical, social and spiritual health of the human being. The execution of Aacharrasayana in this situation can immensely contribute in restoring mental, spiritual and social health. This review aims to interpret the implementation of various aspects of Aacharrasayanain context of COVID 19 and its utility in combatting the dreadful crisis.

Indiscipline is a major challenge facing schools in Kenya. As a result, the government recommends robust interventions at the school level to rein in on indiscipline. Nevertheless, students continue to exhibit immense behavioural problems. This calls to question the efficacy of the numerous behaviour change interventions put in place. This study assessed the influence of student peer counseling interventions on discipline among public secondary school students in Kiambu County, Kenya. The study was founded on the Ecological Systems Theory (EST). Based on the correlational research design, the study targeted the 227 principals 3,479 guidance and counseling teachers and the 89,065 students in Kiambu County. From these, the study sampled 23 principals, 97 teachers and 398 students using the simple random sampling technique. Data was collected using questionnaires, interview guides, and observation schedules. Piloting was conducted to assist in determining the accuracy, clarity, and suitability of the research instruments. The data was analyzed using descriptive statistics (mean, frequency and percentages) and inferential statistics (Pearson correlation and multivariate regression analysis at a significance level of 0.05). Data from interviews and secondary data sources were subjected to content analysis procedures. The findings show that there was positive and significant correlation between students discipline and student peer counseling (r=0.476, p<0.05). Based on these findings, it is evident that student peer counseling interventions indeed influence students’ discipline in the study area. Interventions around these areas should thus be strengthened to holistically enhance students discipline in the schools studied. The study recommends peer counselors should be frequently recruited and trained by schools to reach more students.

Abstract Background Hospital antimicrobial stewardship strategies, such as ‘Start Smart, Then Focus’ in the UK, balance the need for prompt, effective antibiotic treatment with the need to limit antibiotic overuse using ‘review and revise’. However, only a minority of review decisions are to stop antibiotics. Research suggests that this is due to both behavioural and organizational factors. Objectives To develop and optimize the Antibiotic Review Kit (ARK) intervention. ARK is a complex digital, organizational and behavioural intervention that supports implementation of ‘review and revise’ to help healthcare professionals safely stop unnecessary antibiotics. Methods A theory-, evidence- and person-based approach was used to develop and optimize ARK and its implementation. This was done through iterative stakeholder consultation and in-depth qualitative research with doctors, nurses and pharmacists in UK hospitals. Barriers to and facilitators of the intervention and its implementation, and ways to address them, were identified and then used to inform the intervention’s development. Results A key barrier to stopping antibiotics was reportedly a lack of information about the original prescriber’s rationale for and their degree of certainty about the need for antibiotics. An integral component of ARK was the development and optimization of a Decision Aid and its implementation to increase transparency around initial prescribing decisions. Conclusions The key output of this research is a digital and behavioural intervention targeting important barriers to stopping antibiotics at review (see http://bsac-vle.com/ark-the-antibiotic-review-kit/ and http://antibioticreviewkit.org.uk/). ARK will be evaluated in a feasibility study and, if successful, a stepped-wedge cluster-randomized controlled trial at acute hospitals across the NHS.

This study aimed to explore knowledge, attitude, perceptions, and willingness regarding vaccination among university students in Pakistan. This cross-sectional study was carried out using an open online self-administered survey via Google Forms. The survey data were collected between the 15 to 30 of October 2022. A total of 946 respondents participated in the study, of which the majority were female (514, 54.3%). Most students belonged to a medical background, specifically pharmaceutical sciences. Most of the respondents did not know about monkeypox before 2022 (646, 68.3%). Regarding overall knowledge of monkeypox, most of the respondents had average knowledge (726, 76.7%), with very few having good knowledge (60, 6.3%). Regarding overall attitudes towards monkeypox, most of the respondents had neutral attitudes (648, 68.5%). There was a significant association between knowledge of Monkeypox with the type of academic degree (p < 0.001), type of discipline (p < 0.001), and region of respondents (p < 0.001). The willingness to vaccinate among the population was (67.7%). The current study pointed out that the overall knowledge of monkeypox was average in most respondents, with considerable knowledge gaps in most aspects. The overall attitude towards monkeypox was neutral. Further, the knowledge about monkeypox was strongly associated with academic degree, study discipline, and region of respondents. Our findings emphasize the need to raise public awareness by educating students on the monkeypox virus. This will improve adherence to preventative recommendations.

The recognition that schizophrenia is associated with metabolic comorbidity and a subsequent greater risk of cardiovascular events compared to the general population has led to attempts to reduce this metabolic burden. Increased weight, and smoking rates combined with less exercise and poor dietary choices, have led to a variety of behavioural programmes and pharmacological agents being evaluated with the aim of improving lifestyle and managing weight. Adjunctive pharmacological strategies for weight management have not been shown to be consistently effective and remain contraindicated in many schizophrenia subjects. However some novel compounds with recent promising data suggest that research should not be abandoned. In contrast a variety of behavioural interventions have shown a consistent degree of success not only with weight management but also in achieving lifestyle changes. Many reported data-sets are naturalistic or open-label indicating that there is a difficulty in performing traditional randomized controlled studies in this area. The long-term naturalistic studies and holistic approaches show that weight management and significant lifestyle changes are attainable goals in schizophrenia patients. Weight management and lifestyle advice should be routinely offered to all schizophrenia subjects.

This paper critically examines the recent impact of cognitivism upon the field of clinical psychology, and concludes that certain criteria of scientific adequacy have been compromised. The argument is developed that the introduction of information processing constructs to theoretical models of psychopathology has made a potentially valuable contribution to the discipline; but that the acceptance of mental events as dependent measures has severely undermined the scientific credibility of experimental attempts to evaluate such models. It is proposed that future progress will require the adoption of a particular methodological constraint. Specifically, it is suggested that cognitive explanations of psychopathology can only be tested adequately by evaluating the validity of the behavioural predictions that they generate. Using examples of recent research that has investigated the cognitive characteristics of vulnerability to anxiety and depression, an attempt is made to demonstrate that adherence to this proposed constraint not only is possible, but actually provides a far greater degree of understanding than could be attained through the use of alternative methodologies. It is postulated that the future scientific status of clinical psychology may depend upon our collective response to the issues that are raised in this paper.

The aim of this study was to examine reported changes in children’s behaviour after the children, parents and teachers had participated in the modified early intervention program “STOP 4–7”, which has been developed for children 4 to 7 years old. The aim was also to examine if there are changes in the parents’ parenting behaviour, and if there are differences in the degree of behavioural change ratings between the original and modified “STOP 4–7” groups. For purposes of this study 31 children participated in the first group and 48 children in the second group, as well as at least one of the child’s parents and their teacher. Before and after participation in the program, one of the child’s parents and their teacher completed questionnaires about the child’s behaviour. Parents also completed the Ghent Parental Behaviour Scale. Results show that after participation in the program, in both groups there was a decrease in the child’s externalizing behaviour problems, according to both the parents’ and teachers’ report. After participation in the modified program there was an increase in the parents’ report of discipline strategies and material reward ratings.

Since the 1970s, social psychology has examined real human behaviour to an increasingly smaller degree. This article is an analysis of the reasons why this is so. The author points out that the otherwise valuable phenomenon of cognitive shift, which occurred in social psychology precisely in the 1970s, naturally boosted the interest of psychologists in such phenomena like stereotypes, attitudes, and values; at the same time, it unfortunately decreased interest in others, like aggression, altruism, and social influence. In recent decades, we have also witnessed a growing conviction among psychologists that explaining why people display certain reactions holds greater importance than demonstrating the conditions under which people display these reactions. This assumption has been accompanied by the spread of statistical analysis applied to empirical data, which has led to researchers today generally preferring to employ survey studies (even if they are a component of experiments being conducted) to the analysis of behavioural variables. The author analyses the contents of the most recent volume of “Journal of Personality and Social Psychology”, and argues that it is essentially devoid of presentations of empirical studies in which human behaviours are examined. This gives rise to the question of whether social psychology remains a science of behaviour, and whether such a condition of the discipline is desirable.

Background: The objective of this study was to compare fatigue levels between subjects with and without COPD, and to investigate the relationship between fatigue, demographics, clinical features and disease severity. Methods: A total of 1290 patients with COPD [age 65 ± 9 years, 61% male, forced expiratory volume in 1 s (FEV1) 56 ± 19% predicted] and 199 subjects without COPD (age 63 ± 9 years, 51% male, FEV1 112 ± 21% predicted) were assessed for fatigue (Checklist Individual Strength-Fatigue), demographics, clinical features and disease severity. Results: Patients with COPD had a higher mean fatigue score, and a higher proportion of severe fatigue (CIS-Fatigue score 35 ± 12 versus 21 ± 11 points, p < 0.001; 49 versus 10%, p < 0.001). Fatigue was significantly, but poorly, associated with the degree of airflow limitation [FEV1 (% predicted) Spearman correlation coefficient = −0.08, p = 0.006]. Multiple regression indicated that 30% of the variance in fatigue was explained by the predictor variables. Conclusions: Severe fatigue is prevalent in half of the patients with COPD, and correlates poorly with the degree of airflow limitation. Future studies are needed to better understand the physical, psychological, behavioural, and systemic factors that precipitate or perpetuate fatigue in COPD.

Abstract Although questionnaires are widely used in research impact assessment, their metric properties are not well known. Our aim is to test the internal consistency and content validity of an instrument designed to measure the perceived impacts of a wide range of research projects. To do so, we designed a questionnaire to be completed by principal investigators in a variety of disciplines (arts and humanities, social sciences, health sciences, and information and communication technologies). The impacts perceived and their associated characteristics were also assessed. This easy-to-use questionnaire demonstrated good internal consistency and acceptable content validity. However, its metric properties were more powerful in areas such as knowledge production, capacity building and informing policy and practice, in which the researchers had a degree of control and influence. In general, the research projects represented an stimulus for the production of knowledge and the development of research skills. Behavioural aspects such as engagement with potential users or mission-oriented projects (targeted to practical applications) were associated with higher social benefits. Considering the difficulties in assessing a wide array of research topics, and potential differences in the understanding of the concept of ‘research impact’, an analysis of the context can help to focus on research needs. Analyzing the metric properties of questionnaires can open up new possibilities for validating instruments used to measure research impact. Further to the methodological utility of the current exercise, we see a practical applicability to specific contexts where multiple discipline research impact is requires.

Agricultural law combines two opposing directions of development of law in general. One is connected with the local or regional element and indeed, like no other discipline, is linked to a specific region, culture, tradition and linguistic specificity, being a consequence of the specific nature of agricultural law. On the other hand, at the level of the European Union it is characterised by the greatest degree of integration. The Common Agricultural Policy has made agricultural law locally and regionally rooted but, at the same time, it has created a specific technical language of European agricultural law. Therefore, conducting a comparative legal research into the field of agricultural law faces a particular challenge as it requires combining both local and regional linguistic specificities with the European technical language of agricultural law. This relativism of the technical language of agricultural law does not, however, stand in the way of legal comparativism. However, apart from the linguistic knowledge, it requires the researcher to possess thorough cultural, social and economic knowledge of another country. Professor Budzinowski, unlike many other scholars, embodies these skills in his comparative legal research.

The present research aimed to analyze the effects of an inquiry-based class (investigative class) in a Chemistry Degree class during the discipline of General Didactics. Two investigative classes were developed, one in the experimental methodology and the other in the design thinking project methodology. And at the end of the two classes, the students answered two guiding questions: “What does this class allow you to compose the lesson plans and your own practices as future teachers?” and “What do this knowledge collaborate for your education?” The results demonstrate that the proposed activities contributed in a promising way to the process of understanding graduates on how to develop a teaching lesson plan, besides enabling the use of a teaching methodology by investigation for the development of their future teaching practices.

There are many ways of describing and explaining the properties of living systems; causal, functional, and reductive accounts are necessary but no one account has primacy. The history of biology as a discipline has given excessive authority to reductionism, which collapses higher level accounts, such as social or behavioural ones, into molecular ones. Such reductionism becomes crudely ideological when applied to the human condition, with its claims for genes “for” everything from sexual orientation to compulsive shopping. The current enthusiasm for genetics and ultra-Darwinist accounts, with their selfish-gene metaphors for living processes, misunderstand both the phenomena of development and the interactive role that DNA and the fluid genome play in the cellular orchestra. DNA is not a blueprint, and the four dimensions of life (three of space, one of time) cannot be read off from its one-dimensional strand. Both developmental and evolutionary processes are more than merely instructive or selective; the organism constructs itself, a process known as autopoiesis, through a lifeline trajectory. Because organisms are thermodynamically open systems, living processes are homeodynamic, not homeostatic. The self-organising membrane-bound and energy-utilising metabolic web of the cell must have evolved prior to so-called naked replicators. Evolution is constrained by physics, chemistry, and structure; not all change is powered by natural selection, and not all phenotypes are adaptive. Finally, therefore, living processes are radically indeterminate; like all other living organisms, but to an even greater degree, we make our own future, though in circumstances not of our own choosing.

Background/Aim. Depression is an alcoholism relapse risk factor, but frequently stays underdiagnosed among treated alcoholics. The correlation and characteristics of self-reported and clinically assessed depression in the course of early alcohol abstinence were explored. Methods. A total of 100 inpatient, primary male alcoholics (20-60 years) diagnosed according to Classificaton of Mental and Behavioural Disorders (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were recruited consecutively. The Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI) were scored on admission (T1), after 4 weeks (T2) and after 8 weeks (T3). Student's t-test, repeated measures ANOVA and Pearson's correlation between the scores were done (p < 0.05). Factor analyses of symptoms were performed. Results: On HDRS T1, T2, T3 90,7%, 39.5%, 17.4% alcoholics were depressive, respectively. The mean HDRS vs BDI scores on T1, T2 and T3 were 15.16 ? 6.34, 7.35 ? 4.18, 4.23 ? 2.93 vs 14.20 ? 9.56, 8.14 ? 7.35, 5.30 ? 4.94, respectively. Depression severity significantly lowered in the course of abstinence (ANOVA). The HRDS and BDI correlations on T1, T2 and T3 were significant (r1 = 0.763, r2 = 0.684, r3 = 0.613 respectively). Dysphoric mood, anxious, vegetative and cognitive HDRS subscales on T1, T2 and T3 were detected, but not BDI factors, thus BDI symptoms were analysed. Conclusions. The majority of alcoholics had depression on admission. A predominant mild-degree with a significant lowering of depression severity and positive significant correlations between HRDS and BDI scores in the course of abstinence were detected. The dysphoric mood on the HDRS sub-scale, and self-blame, anhedonia and guilt BDI symptoms were most prominent and persisted. The BDI could be a useful tool not only for routine screening and reassessment of depression, but also for exploring emotional content during early abstinence and planning tailored integrative therapy and relapse prevention for alcoholics.

The cycle of choice “Preclinical experimental research” is an integral component of the compulsory discipline “Pharmacology”. Successful pedagogical training of scientific personnel (graduate students) became possible thanks to the development of the curriculum, which, first of all, became possible thanks to the efforts of the scientific personnel of the Pharmadar Educational and Research Laboratory. They provide not only the functioning of the cycle, but also carry out the scientific and practical burden of fulfilling the tasks of scientific research and economic calculation programs. The composition of the mandatory documentation of pedagogical (educational) work, on which the training of graduate students studying the cycle “Preclinical Experimental Research” is carried out, includes: a practical training program for applicants for the degree of candidate of medical sciences in the specialty 14.03.05 – “pharmacology”; the provision on attaching to the Department of Pharmacology approved by the Academic Council in order to master the mandatory program “222 – medicine, pharmacology”; thematic and calendar plans; independent work; list of additional literature; guidelines The laboratory staff, with the help of graduate students and doctoral students, have developed, improved and patented a number of methods for providing preclinical studies. Thus, the functioning of an educational research laboratory creates an optimal and rational scientific and practical basis for the preparation of a Ph.D. by mastering a post-graduate cycle of choice “Preclinical experimental research”, which was shown by the example of the functioning of the laboratory. In the future, it is appropriate and promising to develop a curriculum for English-speaking students, given the constant increase in their number among university entrants, and as a result — increase in the proportion of foreign citizens, among graduates and entering postgraduate study.

Signalized intersections are nodes in the transportation network where vehicles in different directions meet and are critical points for congestion. Vehicle queue length is one of the performance parameters of a signalized intersection. Long queues of vehicles are at high risk of accidents involving many vehicles. Feedback signal control (actuated signal control) can be used to improve intersection performance. One of the variables that can be used as a feedback input is the length of the vehicle queue. Traffic in Indonesia is mixed traffic where various types of vehicles use the same road lanes and with low lane discipline. This causes the traffic system to become complex and to be stochastic and non-linear. Queue length modeling using a static linear algorithm is unable to capture the phenomenon of this complex traffic system. Therefore, this study aims to build a queue length model based on machine learning, that is, using an artificial neural network (ANN). This model studies traffic systems with historical data so that through the training process it can model queue lengths with a good degree of accuracy. An estimation model was built and applied to a section of the Muara Rapak signalized intersections, Balikpapan. Data on queue length for 10 days, 2 hours/day, obtained using CCTV and direct field surveys. The results of the model test show that ANN has a good level of accuracy with MAE, RMSE and MAPE of 3.8 m, 4.9 m and 6%, respectively.

Addressing the controversies to drug therapy involves talking about and discussing emotional, cognitive, behavioural, and social problems. Also, several pieces of literature and comparative studies have been established to understand the intervention practices of medical staff in patient counselling in terms of improving patient care. But with limited knowledge in counselling-related studies, these issues can be tackled by qualified and knowledgeable pharmacists. The study aims to conduct relevant quantitative data to determine if pharmacists' role in counselling is of high essentiality towards medical care to promote public health and quality care. Also, the research topic revolves in establishing how much pharmacists' obligations are practical towards the patients' counselling. A cross-sectional survey of community pharmacists (n-400) working in the Hail region hospitals in Saudi Arabia was conducted during May 2019. The survey infrastructure comprised of six different sections, gender, age, degree, profession, workplace, and experience. The qualitative data gathered was first explored using frequency distribution and descriptive analysis. The total pharmacist valid response (210) was accepted, and both genders contributed towards such results. Moreover, most of the pharmacists attested to the elements of lack of medical tools and proper training as a significant medical issue towards appropriate counselling approaches. Nonetheless, it was proven that leading problems that undermine the effectiveness of pharmacists towards promoting acute counselling were a lifestyle (mean of 2.96), smoking cessation (mean of 269), time to administer each drug (mean of 3.05), and missed a dose (mean of 2.05). Pharmacists that participated in this study were unanimous, specifically, on understanding the importance of the survey but reflected on considerable variations in their experience in counselling. Moreover, it was clear that the percentage of Saudi Arabia pharmacists are contributing perfectly. However, it is undeniable they might need additional assistance, training, and medical tools to provide enormous quality counselling to patients.

Abstract Background Freshman adaptation has always been one of the important topics in academic research. The purpose of this study is to explore the impact of introductory courses on Freshmen's college adaptation and the related aspects of emotion regulation. Subjects and Methods 404 freshmen in a university in Zhejiang Province were investigated by using the psychological survey based on Student Adaptability Scale (sacq) and the survey method of introduction course quality. The anxiety scale designed by Kim was used as the measurement scale, and the scale was evaluated by Likert scoring method. Pearson correlation, standard deviation and statistical significance are combined to illustrate the correlation. T-test of independent samples was used to verify the difference between high anxiety group and low anxiety group. 397 copies have been returned, of which 384 are valid. SPSS 22.0 and Amos 21.0 were used for statistical analysis. In addition, according to the statistical value of anxiety, Adelmann (1989) regarded the emotional function as a whole according to Hochschild's definition of emotional function, and compiled a one-dimensional emotional labor scale composed of five items, with low internal consistency coefficient. The scale compiled by brotheridge and Lee (1998) is divided into two dimensions: surface play and deep play, which is composed of six items. Surface acting projects, in your daily work, you inhibit the frequency of expressing real emotions every day. Deep acting projects, how often you try to experience the emotions you have to express. The emotional labor scale compiled by brotheridge (2002) consists of 40 items. Through confirmatory factor analysis, the items with low factor load were deleted, and the scale used in the formal test was composed of 15 items. The scale includes six dimensions; The frequency, intensity, diversity, continuity of communication, surface play and deep play of emotional performance. Results “The quality of introduction course” and “research and academic atmosphere” jointly explained the difference of “overall university adaptation” of 61% of freshmen, among which the quality of introduction course had the greatest impact. The most powerful predictor of Freshmen's academic adaptation is the quality of introductory courses (β =0.48). Academic research atmosphere has the greatest impact on interpersonal adaptation (β =0.36). The biggest impact on psychological adjustment is the teaching quality of introductory courses (β =0.26), followed by academic research atmosphere (β =0.19). Academic research atmosphere has the greatest impact on life adaptation (β =0.21). (β =0.19). The most influential factor on life adaptation is the academic research atmosphere (β=0.21). Generally speaking, freshmen have a higher degree of adaptation to interpersonal relationships and campus life, a lower degree of adaptation to psychological adjustment, and the lowest degree of adaptation to university learning. In addition, the study also found that the adaptation problems of college students are mainly anxiety, and anxiety is negatively correlated with achievement. Similarly, there is a significant negative correlation between anxiety and self-efficacy. State anxiety, trait anxiety and learning anxiety are all positively correlated. The “anxiety” component of personality characteristics plays a great role in the generation of anxiety. The correlation coefficient between LCAS and trait anxiety was 0.408, while the correlation coefficient between LCAS and state anxiety was 0.395. Both reached a significant level (P &lt; 0.01). There was a positive correlation between self-efficacy and achievement. Research shows that anxiety, gender and self-efficacy can be used as comprehensive variables to measure academic achievement. Conclusion The following conclusions are drawn: (1) universities should pay attention to improving the quality of introduction course and creating a good academic research environment, because it directly affects the freshmen's University adaptability. Freshmen's college adaptation is not just the responsibility of counselors and logistics personnel. Although these tasks are also important, their impact on Freshmen's university adaptation is far less than that of direct academic services. (2) In order to better adapt to university study and adjust their mentality, universities should pay attention to improving the quality of introductory courses. At the same time, in order to promote freshmen to better adapt to interpersonal relationships and life, universities should pay attention to creating a good academic research atmosphere. (3) We should pay attention to the college adaptation and psychological adaptation of freshmen, the learning adaptation of Engineering Freshmen, and the interpersonal adaptation of Engineering Freshmen and boys. In short, we should give full play to the important influence of Discipline Distribution on students' adaptability, actively pay attention to the changes of their psychology, emotion and behavior, and their impact on positive and active behavior, and strive to become the builder, manager, coordinator and collaborator of the environment. According to the psychological characteristics of this part of the group, flexibly organize rich activities, strive to build a relaxed and harmonious living atmosphere, create a friendly and mutual aid relationship, encourage and guide this part of the group, adjust their psychology to the best state, and promote their good cognition and healthy development of life.

The Pharmacy Education in Europe (PHARMINE) project studies pharmacy practice and education in the European Union (EU) member states. The work was carried out using an electronic survey sent to chosen pharmacy representatives. The surveys of the individual member states are now being published as reference documents for students and staff interested in research on pharmacy education in the EU, and in mobility. This paper presents the results of the PHARMINE survey on pharmacy practice and education in Finland. Pharmacies have a monopoly on the dispensation of medicines. They can also provide diagnostic services. Proviisori act as pharmacy owners and managers. They follow a five-year (M.Sc. Pharm.) degree course with a six-month traineeship. Farmaseutti, who follow a three-year (B.Sc. Pharm.) degree course (also with a six-month traineeship), can dispense medicines and counsel patients in Finland. The B.Sc. and the first three years of the M.Sc. involve the same course. The current pharmacy curriculum (revised in 2014) is based on five strands: (1) pharmacy as a multidisciplinary science with numerous opportunities in the working life, (2) basics of pharmaceutical sciences, (3) patient and medication, (4) optional studies and selected study paths, and (5) drug development and use. The learning outcomes of the pharmacy graduates include (1) basics of natural sciences: chemistry, physics, technology, biosciences required for all the students (B.Sc. and M.Sc.), (2) medicine and medication: compounding of medicines, holism of medication, pharmacology and biopharmaceutics (side-effects and interactions), patient counseling, efficacy and safety of medicines and medication, (3) comprehensive and supportive interactions of the various disciplines of pharmacy education and research: the role and significance of pharmacy as a discipline in society, the necessary skills and knowledge in scientific thinking and pharmaceutical research, and (4) basics of economics and management, multidisciplinarity, hospital pharmacy, scientific writing skills, management skills. In addition, teaching and learning of “general skills”, such as the pharmacist’s professional identity and the role in society as a part of the healthcare system, critical and creative thinking, problem-solving skills, personal learning skills and life-long learning, attitude and sense of responsibility, and communication skills are developed in direct association with subject-specific courses. Professional specialization studies in industrial pharmacy, and community and hospital pharmacy are given at the post-graduate level at the University of Helsinki.

Behavioural economics is a research agenda, which gradually has moved from the periphery to the centre of the discipline of economics. The rise of behavioural economics has fostered a burgeoning number of studies dealing with the past, present and future of the field. In contrast to these studies which focus on predestinated scholars, outlets and key concepts, this article uses exploratory bibliometric approaches to map behavioural economics. Utilising a novel data set, comprising 104,558 references across 1,872 articles published in the period 1956–2016, the article systematically illuminates the historical foundations, development and interdisciplinary nature of behavioural economics. The article shows (a) the overlooked role of several behavioural psychologists in shaping the field; (b) the influence of the Anglo-Saxon universities, such as University of California Berkeley, Harvard University and University of Pennsylvania; and that (c) behavioural economics mainly draws knowledge from five disciplinary clusters: (a) economics and policy, (b) psychology, (c) pharmacology, (d) health and (e) law.

Abstract In the mathematical epidemiology community, there is an increasing interest in shaping the complex interplay between human behaviour and disease spreading. We give a contribution in this direction by illustrating a method to derive behavioural change epidemic models from a stochastic particle description by the means of kinetic equations. We consider an Susceptible–Infected–Removed–like model where contact rates depend on the behavioural patterns adopted across the population. The selection of the social behaviour happens during the interactions between individuals adopting alternative strategies and it is driven by an imitation game dynamics. Agents have a double microscopic state: a discrete label, that denotes the epidemiological compartment to which they belong, and the degree of flexibility of opinion, that is a measure of the personal attitude to change opinion and, hence, to switch between the alternative social contact patterns. We derive kinetic evolution equations for the distribution functions of the degree of flexibility of opinion of the individuals for each compartment, whence we obtain macroscopic equations for the densities and average flexibilities of opinion. After providing the basic properties of the macroscopic model, we numerically investigate it by focusing on the impact of the flexibility of opinion on the epidemic course and on the consequent behavioural responses.

The main objectives that arise while teaching future chemists currently include formation of knowledge, abilities and skills of pharmacological support of treatment of diseases that enable effective work aimed at implementation of professional tasks and degree of mastery over labor functions. While teaching clinical pharmacology at the pharmaceutical department, we follow the path of an increased scope of new topics on private matters of the discipline including assessment of effectiveness and safety of medicinal preparations taking into account adverse reactions, issues of pharmacoeconomics, pharmacoepidemiology and provisions of evidence-based medicine. In Russian medicine, it is common to adhere to the principle that moral standards are interwoven into clinical practice. This principle is followed during teaching. Proper management of the educational process will enable students to independently work with literature, critically assess new data and continuously improve their professionalism in future.

Abstract Introduction In the Indian subcontinent, Master’s-level Public Health (MlPH) programmes attract graduates of diverse academic disciplines from health and non-health sciences alike. Considering the current and futuristic importance of the public health cadre, we described them and reviewed their transdisciplinarity status based on MlPH admissibility criteria 1995 to 2021. Methods Using a search strategy, we abstracted information available in the public domain on MlPH programmes and their admissibility criteria. We categorized the admission criteria based on specified disciplines into Health science, Non-health science and Non-health non-science categories. We described the MlPH programmes by location, type of institution, course duration, curriculum, pedagogical methods, specializations offered, and nature of admission criteria statements. We calculated descriptive statistics for eligible educational qualifications for MlPH admission. Results Overall, 76 Indian institutions (Medical colleges—21 and Non-medical coleges—55) offered 92 MlPH programmes (Private—58 and Public—34). We included 89 for review. These programmes represent a 51% increase (n = 47) from 2016 to 2021. They are mostly concentrated in 21 Indian provinces. These programmes stated that they admit candidates of but not limited to “graduation in any life sciences”, “3-year bachelor’s degree in any discipline”, “graduation from any Indian universities”, and “graduation in any discipline”. Among the health science disciplines, Modern medicine (n = 89; 100%), Occupational therapy (n = 57; 64%) is the least eligible. Among the non-health science disciplines, life sciences and behavioural sciences (n = 53; 59%) and non-health non-science disciplines, humanities and social sciences (n = 62; 72%) are the topmost eligible disciplines for admission in the MPH programmes. Conclusion Our review suggests that India’s MlPH programmes are less transdisciplinary. Relatively, non-medical institutions offer admission to various academic disciplines than the medical institutions in their MlPH programmes. India’s Master’s level public health programmes could be more inclusive by opening to graduates from trans-disciplinary backgrounds.

Abstract: Neurorestorative treatments have been able to improve the quality of life for patients suffering from neurological diseases and damages since the concept of Neurorestoratology was proposed. The discipline of Neurorestoratology focuses to restore impaired neurological functions and/or structures through the varying neurorestorative mechanisms including neurostimulation or neuromodulation, neuroprotection, neuroplasticity, neuroreplacement, loop reconstruction, remyelination, immunoregulation, angiogenesis or revascularization, and others. The neurorestorative strategies of Neurorestoratology include all therapeutic methods which can restore dysfunctions for patients with neurological diseases and improve their quality of life. The Neurorestoratology is different from the regenerative medicine in nervous system, which mainly focuses the neuroregeneration. It also is different from Neurorehabilitation. Neurorestoratology and Neurorehabilitation shares some functional recovering mechanisms, such as neuroplasticity, especially in the early phase of neurological diseases; but generally Neurorehabilitation mainly focuses to recover neurological functions through making the best use of residual neurological functions, replacing lost neurological functions in the largest degree, and preventing and treating varying complications. Recently, there have been more advances in restoring damaged nerves by cell therapy, neurostimulation/ neuromodulation and brain–computer interface (BCI), neurorestorative surgery, neurorestorative pharmaceutics, and other clinic strategies. Simultaneously related therapeutic guidelines and standards are set up in succession. Based on those advances, clinicians should consider injured and degenerated nervous disorders or diseases in the central nervous system as treatable or neurorestorative disorders. Extending and encouraging further neurorestorative explorations and achieving better clinical efficacy with stronger evidence regarding neurorestoratology will shed new light and discover superior benefits for patients with neurological disorders.

Abstract Background Internet-based Cognitive Behavioural Therapy (iCBT) is found effective in treating common mental disorders. However, the use of these interventions in routine care is limited. The international ImpleMentAll study is funded by the European Union’s Horizon 2020 programme. It is concerned with studying and improving methods for implementing evidence-based iCBT services for common mental disorders in routine mental health care. A digitally accessible implementation toolkit (ItFits-toolkit) will be introduced to mental health care organizations with the aim to facilitate the ongoing implementation of iCBT services within local contexts. This study investigates the effectiveness of the ItFits-toolkit by comparing it to implementation-as-usual activities. Methods A stepped wedge cluster randomized controlled trial (SWT) design will be applied. Over a trial period of 30 months, the ItFits-toolkit will be introduced sequentially in twelve routine mental health care organizations in primary and specialist care across nine countries in Europe and Australia. Repeated measures are applied to assess change over time in the outcome variables. The effectiveness of the ItFits-toolkit will be assessed in terms of the degree of normalization of the use of the iCBT services. Several exploratory outcomes including uptake of the iCBT services will be measured to feed the interpretation of the primary outcome. Data will be collected via a centralized data collection system and analysed using generalized linear mixed modelling. A qualitative process evaluation of routine implementation activities and the use of the ItFits-toolkit will be conducted within this study. Discussion The ImpleMentAll study is a large-scale international research project designed to study the effectiveness of tailored implementation. Using a SWT design that allows to examine change over time, this study will investigate the effect of tailored implementation on the normalization of the use of iCBT services and their uptake. It will provide a better understanding of the process and methods of tailoring implementation strategies. If found effective, the ItFits-toolkit will be made accessible for mental health care service providers, to help them overcome their context-specific implementation challenges. Trial registration ClinicalTrials.gov NCT03652883. Retrospectively registered on 29 August 2018

SOMMARIO: 1. Premessa: l’Islam tra religione ed economia - 2. Dalla finanza al contratto islamico, tra vincolo e libertà: alla ricerca di una teoria generale dei contratti - 3. L’etica islamica dei contratti: divieto di ribà e divieto di ghàrar - 4. Operatività delle attività della banca islamica e contrattualistica commerciale Shari’ah Compliant - 5. I contratti di tipo partecipativo: “mudàraba” e “mushàraka” - 6. (segue) Tipologie di mudàraba - 7. Cenni conclusivi e prospettive future. The Prophet's Economy: Islamic Finance and the Religious Foundations of Islamic Law of Shari'ah Compliant Contracts ABSTRACT: The growing presence of Muslim believers in Europe has increasingly led to heated debates also at the doctrinal level. Legal and economic literature, particularly, has recently emphasised the importance that inclusive, effective and efficient financial regulation can have on the degree of integration of the Islamic communities present in non-Muslim contexts. Since the Shari'ah dictates a series of behavioural rules in different sectors of the believer’s life, the Koran and the narratives of the Prophet (hadith) offer a series of prescriptions also in economic matters. With the aim of outlining the religious and juridical reasoning of the so-called halal economic dimension, this paper first examines the economic principles of Islamic finance: the prohibition of ribà (interest), the prohibition of ghàrar (uncertainty) and that of maysìr (speculation). It then provides a recognition aimed at finding a general theory of Islamic contracts. Finally, it reconstructs the discipline of the mudàraba and musharàka participatory contracts. These two forms of contracts represent a product of Islamic finance widely used in banking-financial practice and considered by Islamic legal schools to be totally in conformity with the Word of Allah. They are therefore instruments of comparison particularly interesting as well as useful for the Italian legal system. They can represent a flywheel for the integration of Muslims in the social fabric, and at the same time, an antidote to the unstable European economic panorama.

Abstract Background Self-management support is increasingly viewed as an integral part of chronic condition management in adolescence. It is well recognized that markers of chronic illness control deteriorate during adolescence. Due to the increasing prevalence of long-term chronic health conditions in childhood and improved survival rates of previously life-limiting conditions in children and adolescents, significant numbers of adolescents are having to manage their chronic condition effectively as they transition to adult health care. Therapy adherence has been identified as a major challenge for young people living with a chronic condition such as cystic fibrosis, diabetes, or asthma requiring long-term pharmacological therapy and/or lifestyle modifications. Most systematic reviews on self-management interventions address adult populations. Very few intervention studies are directed at adolescents with a chronic condition who are transitioning to adult health services. This protocol describes a prospective randomized controlled trial of a standardized self-management intervention program delivered to adolescents aged 15–18 years prior to their transfer to adult care. This study has been designed to provide evidence regarding self-management programs for adolescents and is the first study to use the Flinders Program with this important, under-researched age group. Methods A randomized controlled trial is used to investigate the effectiveness of a modified adolescent-friendly version of an adult self-management program. This program is directed at improving self-management in an adolescent cohort 15–18 years of age with a chronic condition being treated in a specialist pediatric hospital. Participants will be randomized to either usual care or the modified Flinders Program plus usual care. Data collection will include measures of specific illness control, unscheduled hospital admissions, and questionnaires to record self-management competencies, quality of life, self-efficacy, and outcome measures specific to the chronic condition at baseline, 3 months, 6 months, and 12 months after delivery. Discussion This study will provide a better understanding of the elements required for effective self-management programs in adolescents with a chronic condition and address some important knowledge gaps in current literature. The study will be carried out in collaboration with the Discipline of Behavioural Health at Flinders University, Adelaide, Australia, in order to inform the development of an adolescent version of the successful and validated Flinders Program™. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12621000390886). Registered on April 8, 2021.

Objectives: Many colleges and schools of Pharmacy combine interdisciplinary topics such as pathophysiology, pharmacology, medicinal chemistry and therapeutics into one integrated course. Our main aim for this study is to determine if students pass integrated courses and yet fail to pass interdisciplinary sections of those courses. Methods: Two representative integrated sequence courses were evaluated without any study-imposed intervention. Individual student examination scores (~140 students) were evaluated for overall performance as well as for performance on the interdisciplinary topics of pathophysiology/pharmacology, medicinal chemistry, and therapeutics. The degree of difficulty of the examination questions, as well as the test item discrimination, were also measured. Results: There were students that passed the course but failed one, or more, of the interdisciplinary topics. Combining data from both courses, medicinal chemistry was the most frequently failed discipline (29 students), followed closely by pharmacology (22 students), and distantly by therapeutics (1 student). The examination questions for medicinal chemistry were not more difficult nor more discriminatory than the questions for the other disciplines. Conclusions: These data indicate that students pass integrated courses, but fail to pass interdisciplinary sections of those courses, especially the pharmaceutical sciences. It is not known if these results are consistent, nor what long-term adverse consequences may result. These results inform curricular and assessment aspects of the pharmacy academy as pertains to establishing the scientific foundation required by the CAPE 2013 Educational Outcomes. Type: Original Research

PurposeThe study aims to examine the factors that determine the success of graduates in the labour market. This success is measured in several ways, namely, above-average wages in the economy, employment in accordance with the field of study and job satisfaction. The research explores the employment outcomes of graduates from Jagiellonian University, which is the oldest and one of the best in Poland. Not only does the analysis focus on degree-related predictors such as discipline or faculty, but it is also extended to include activities undertaken during studies and family background.Design/methodology/approachThe analysis is based on data collected in the graduates' career survey, which is conducted six months after graduation. For this article, a database of over 6,000 graduates from four subsequent editions of the survey was compiled. In order to identify the predictors of graduates' success, a logistic regression model was applied.FindingsThe study reveals that graduates' success in the labour market is influenced not only by their discipline, but also by the activities undertaken during their studies, the type of studies and demographic features. Studies in natural sciences give chance for higher earnings, job matching and satisfaction. The humanities and social sciences increase only graduates’ group satisfaction. The impact of activities during studies is diversified – those matched to studies increase the job matching and those unmatched lower the earnings, job matching and satisfaction. Parents' level of education resulted in salary increase. The results also confirm the premises of behavioural theory.Research limitations/implicationsFirstly, the main research limitation is that data of one particular university's graduates are used, so the results should be interpreted in the context of Poland only. Secondly, the authors propose a precise concept of success; however, it could be refined in any future study. This limitation could be mitigated by the flexibility of the model, which guarantees that other predictors of success could be involved. Furthermore, the article was based on data collected before the COVID-19 pandemic, when the labour market was completely different, so it also could be revised now.Practical implicationsThe results of the analysis can be used when preparing the University’s educational offer. Since various predictors are implemented in the model, the information could be useful not only for future students, but also for current students, so they can make a more data-driven decision about their future careers. Additionally, University careers’ advisors are provided with knowledge on the determinants of graduates' success. Taking a broader view, the research findings are also informative for labour market institutions.Originality/valueThe paper offers an advanced analysis in a field that is under-researched in many transition countries, including Poland, i.e. graduates' entry into the workplace. Although the study provides insight into the factors that determine the labour market success of one particular university's graduates, this modelling can be applied to the empirical data of another higher education institution’s (HEI's) graduates.

Abstract Background MYRIAD (My Resilience in Adolescence) is a superiority, parallel group, cluster randomised controlled trial designed to examine the effectiveness and cost-effectiveness of a mindfulness training (MT) programme, compared with normal social and emotional learning (SEL) school provision to enhance mental health, social-emotional-behavioural functioning and well-being in adolescence. The original trial protocol was published in Trials (accessible at 10.1186/s13063-017-1917-4). This included recruitment in two cohorts, enabling the learning from the smaller first cohort to be incorporated in the second cohort. Here we describe final amendments to the study protocol and discuss their underlying rationale. Methods Four major changes were introduced into the study protocol: (1) there were changes in eligibility criteria, including a clearer operational definition to assess the degree of SEL implementation in schools, and also new criteria to avoid experimental contamination; (2) the number of schools and pupils that had to be recruited was increased based on what we learned in the first cohort; (3) some changes were made to the secondary outcome measures to improve their validity and ability to measure constructs of interest and to reduce the burden on school staff; and (4) the current Coronavirus Disease 2019 (SARS-CoV-2 or COVID-19) pandemic both influences and makes it difficult to interpret the 2-year follow-up primary endpoint results, so we changed our primary endpoint to 1-year follow-up. Discussion These changes to the study protocol were approved by the Trial Management Group, Trial Steering Committee and Data and Ethics Monitoring Committees and improved the enrolment of participants and quality of measures. Furthermore, the change in the primary endpoint will give a more reliable answer to our primary question because it was collected prior to the COVID-19 pandemic in both cohort 1 and cohort 2. Nevertheless, the longer 2-year follow-up data will still be acquired, although this time-point will be now framed as a second major investigation to answer some new important questions presented by the combination of the pandemic and our study design. Trial registration International Standard Randomised Controlled Trials ISRCTN86619085. Registered on 3 June 2016.

Since the presence of the Internet, it has been immensely used globally and has become an essential tool for learning, therefore creating a positive and negative impact on students as avid users. The positive aspect of the Internet is that it assists in teaching and learning by making instantaneous access for information to be available at their fingertips. Despite its benefits, internet addiction may negatively impact students' life, causing them to be emotionally unstable, depressive, exhibiting poor time management, and poor academic performance. Students who do not have self-discipline and proper guidelines may be exposed to internet addiction. The aim of this study is to determine the effect of internet addiction to students' and the correlation to their emotional stability. This study was conducted among 236-degree students in UniKL RCMP. A survey form has been distributed using the Internet Addiction Test (IAT) and Depression, Anxiety, and Stress Scales (DASS21). A Statistical Package for the Social Sciences (SPSS) was used to analyze the data. The results showed that all hypotheses formulated were considerably related. There are 37 percent of students facing problems with internet addiction, creating a significant impact to their life. The remaining 63 percent describes the average online user who are able to have self-control for internet usage. Using the Pearson Correlation, the relationship between internet addiction and anxiety were compared and correlated. A significant level of 0.05 was used to test the significance of the results. This study also found that internet addiction will lead students to develop anxiety problems, but not towards depression and stress. Anxiety appears to be a persistent predictor with internet addiction in both genders. The results indicated that internet addiction has a significant association to anxiety problems. In the future, the university must focus more on developing a holistic student intellectually, emotionally, and spiritually. This holistic and balanced development is crucial for the computer-savvy generation due to the challenging era that lies ahead. Proper knowledge should be imparted for them to choose the right tools and control their resources on the Internet. With the right awareness, students will know how to fully utilize the Internet without being dominated by it.

Data are generated and employed for many ends, including governing societies, managing organisations, leveraging profit, and regulating places. In all these cases, data are key inputs into systems that paradoxically are implemented in the name of making societies more secure, safe, competitive, productive, efficient, transparent and accountable, yet do so through processes that monitor, discipline, repress, coerce, and exploit people. (Kitchin, 165) Introduction Provenance refers to the place of origin or earliest known history of a thing. It refers to the custodial history of objects. It is a term that is commonly used in the art-world but also has come into the language of other disciplines such as computer science. It has also been applied in reference to the transactional nature of objects in supply chains and circular economies. In an interview with Scotland’s Institute for Public Policy Research, Adam Greenfield suggests that provenance has a role to play in the “establishment of reliability” given that a “transaction or artifact has a specified provenance, then that assertion can be tested and verified to the satisfaction of all parities” (Lawrence). Recent debates on the unrecognised effects of digital media have convincingly argued that data is fully embroiled within capitalism, but it is necessary to remember that data is more than just a transactable commodity. One challenge in bringing processes of datafication into critical light is how we understand what happens to data from its point of acquisition to the point where it becomes instrumental in the production of outcomes that are of ethical concern. All data gather their meaning through relationality; whether acting as a representation of an exterior world or representing relations between other data points. Data objectifies relations, and despite any higher-order complexities, at its core, data is involved in factualising a relation into a binary. Assumptions like these about data shape reasoning, decision-making and evidence-based practice in private, personal and economic contexts. If processes of datafication are to be better understood, then we need to seek out conceptual frameworks that are adequate to the way that data is used and understood by its users. Deborah Lupton suggests that often we give data “other vital capacities because they are about human life itself, have implications for human life opportunities and livelihoods, [and] can have recursive effects on human lives (shaping action and concepts of embodiment ... selfhood [and subjectivity]) and generate economic value”. But when data are afforded such capacities, the analysis of its politics also calls for us to “consider context” and “making the labour [of datafication] visible” (D’Ignazio and Klein). For Jenny L. Davis, getting beyond simply thinking about what data affords involves bringing to light how continually and dynamically to requests, demands, encourages, discourages, and refuses certain operations and interpretations. It is in this re-orientation of the question from what to how where “practical analytical tool[s]” (Davis) can be found. Davis writes: requests and demands are bids placed by technological objects, on user-subjects. Encourage, discourage and refuse are the ways technologies respond to bids user-subjects place upon them. Allow pertains equally to bids from technological objects and the object’s response to user-subjects. (Davis) Building on Lupton, Davis, and D’Ignazio and Klein, we see three principles that we consider crucial for work on data, darkness and light: data is not simply a technological object that exists within sociotechnical systems without having undergone any priming or processing, so as a consequence the data collecting entity imposes standards and way of imagining data before it comes into contact with user-subjects; data is not neutral and does not possess qualities that make it equivalent to the things that it comes to represent; data is partial, situated, and contingent on technical processes, but the outcomes of its use afford it properties beyond those that are purely informational. This article builds from these principles and traces a framework for investigating the complications arising when data moves from one context to another. We draw from the “data provenance” as it is applied in the computing and informational sciences where it is used to query the location and accuracy of data in databases. In developing “data provenance”, we adapt provenance from an approach that solely focuses on technical infrastructures and material processes that move data from one place to another and turn to sociotechnical, institutional, and discursive forces that bring about data acquisition, sharing, interpretation, and re-use. As data passes through open, opaque, and darkened spaces within sociotechnical systems, we argue that provenance can shed light on gaps and overlaps in technical, legal, ethical, and ideological forms of data governance. Whether data becomes exclusive by moving from light to dark (as has happened with the removal of many pages and links from Facebook around the Australian news revenue-sharing bill), or is publicised by shifting from dark to light (such as the Australian government releasing investigative journalist Andie Fox’s welfare history to the press), or even recontextualised from one dark space to another (as with genetic data shifting from medical to legal contexts, or the theft of personal financial data), there is still a process of transmission here that we can assess and critique through provenance. These different modalities, which guide data acquisition, sharing, interpretation, and re-use, cascade and influence different elements and apparatuses within data-driven sociotechnical systems to different extents depending on context. Attempts to illuminate and make sense of these complex forces, we argue, exposes data-driven practices as inherently political in terms of whose interests they serve. Provenance in Darkness and in Light When processes of data capture, sharing, interpretation, and re-use are obscured, it impacts on the extent to which we might retrospectively examine cases where malpractice in responsible data custodianship and stewardship has occurred, because it makes it difficult to see how things have been rendered real and knowable, changed over time, had causality ascribed to them, and to what degree of confidence a decision has been made based on a given dataset. To borrow from this issue’s concerns, the paradigm of dark spaces covers a range of different kinds of valences on the idea of private, secret, or exclusive contexts. We can parallel it with the idea of ‘light’ spaces, which equally holds a range of different concepts about what is open, public, or accessible. For instance, in the use of social data garnered from online platforms, the practices of academic researchers and analysts working in the private sector often fall within a grey zone when it comes to consent and transparency. Here the binary notion of public and private is complicated by the passage of data from light to dark (and back to light). Writing in a different context, Michael Warner complicates the notion of publicness. He observes that the idea of something being public is in and of itself always sectioned off, divorced from being fully generalisable, and it is “just whatever people in a given context think it is” (11). Michael Hardt and Antonio Negri argue that publicness is already shadowed by an idea of state ownership, leaving us in a situation where public and private already both sit on the same side of the propertied/commons divide as if the “only alternative to the private is the public, that is, what is managed and regulated by states and other governmental authorities” (vii). The same can be said about the way data is conceived as a public good or common asset. These ideas of light and dark are useful categorisations for deliberately moving past the tensions that arise when trying to qualify different subspecies of privacy and openness. The problem with specific linguistic dyads of private vs. public, or open vs. closed, and so on, is that they are embedded within legal, moral, technical, economic, or rhetorical distinctions that already involve normative judgements on whether such categories are appropriate or valid. Data may be located in a dark space for legal reasons that fall under the legal domain of ‘private’ or it may be dark because it has been stolen. It may simply be inaccessible, encrypted away behind a lost password on a forgotten external drive. Equally, there are distinctions around lightness that can be glossed – the openness of Open Data (see: theodi.org) is of an entirely separate category to the AACS encryption key, which was illegally but enthusiastically shared across the internet in 2007 to the point where it is now accessible on Wikipedia. The language of light and dark spaces allows us to cut across these distinctions and discuss in deliberately loose terms the degree to which something is accessed, with any normative judgments reserved for the cases themselves. Data provenance, in this sense, can be used as a methodology to critique the way that data is recontextualised from light to dark, dark to light, and even within these distinctions. Data provenance critiques the way that data is presented as if it were “there for the taking”. This also suggests that when data is used for some or another secondary purpose – generally for value creation – some form of closure or darkening is to be expected. Data in the public domain is more than simply a specific informational thing: there is always context, and this contextual specificity, we argue, extends far beyond anything that can be captured in a metadata schema or a licensing model. Even the transfer of data from one open, public, or light context to another will evoke new degrees of openness and luminosity that should not be assumed to be straightforward. And with this a new set of relations between data-user-subjects and stewards emerges. The movement of data between public and private contexts by virtue of the growing amount of personal information that is generated through the traces left behind as people make use of increasingly digitised services going about their everyday lives means that data-motile processes are constantly occurring behind the scenes – in darkness – where it comes into the view, or possession, of third parties without obvious mechanisms of consent, disclosure, or justification. Given that there are “many hands” (D’Iganzio and Klein) involved in making data portable between light and dark spaces, equally there can be diversity in the approaches taken to generate critical literacies of these relations. There are two complexities that we argue are important for considering the ethics of data motility from light to dark, and this differs from the concerns that we might have when we think about other illuminating tactics such as open data publishing, freedom-of-information requests, or when data is anonymously leaked in the public interest. The first is that the terms of ethics must be communicable to individuals and groups whose data literacy may be low, effectively non-existent, or not oriented around the objective of upholding or generating data-luminosity as an element of a wider, more general form of responsible data stewardship. Historically, a productive approach to data literacy has been finding appropriate metaphors from adjacent fields that can help add depth – by way of analogy – to understanding data motility. Here we return to our earlier assertion that data is more than simply a transactable commodity. Consider the notion of “giving” and “taking” in the context of darkness and light. The analogy of giving and taking is deeply embedded into the notion of data acquisition and sharing by virtue of the etymology of the word data itself: in Latin, “things having been given”, whereby in French données, a natural gift, perhaps one that is given to those that attempt capture for the purposes of empiricism – representation in quantitative form is a quality that is given to phenomena being brought into the light. However, in the contemporary parlance of “analytics” data is “taken” in the form of recording, measuring, and tracking. Data is considered to be something valuable enough to give or take because of its capacity to stand in for real things. The empiricist’s preferred method is to take rather than to accept what is given (Kitchin, 2); the data-capitalist’s is to incentivise the act of giving or to take what is already given (or yet to be taken). Because data-motile processes are not simply passive forms of reading what is contained within a dataset, the materiality and subjectivity of data extraction and interpretation is something that should not be ignored. These processes represent the recontextualisation of data from one space to another and are expressed in the landmark case of Cambridge Analytica, where a private research company extracted data from Facebook and used it to engage in psychometric analysis of unknowing users. Data Capture Mechanism Characteristics and Approach to Data Stewardship Historical Information created, recorded, or gathered about people of things directly from the source or a delegate but accessed for secondary purposes. Observational Represents patterns and realities of everyday life, collected by subjects by their own choice and with some degree of discretion over the methods. Third parties access this data through reciprocal arrangement with the subject (e.g., in exchange for providing a digital service such as online shopping, banking, healthcare, or social networking). Purposeful Data gathered with a specific purpose in mind and collected with the objective to manipulate its analysis to achieve certain ends. Integrative Places less emphasis on specific data types but rather looks towards social and cultural factors that afford access to and facilitate the integration and linkage of disparate datasets Table 1: Mechanisms of Data Capture There are ethical challenges associated with data that has been sourced from pre-existing sets or that has been extracted from websites and online platforms through scraping data and then enriching it through cleaning, annotation, de-identification, aggregation, or linking to other data sources (tab. 1). As a way to address this challenge, our suggestion of “data provenance” can be defined as where a data point comes from, how it came into being, and how it became valuable for some or another purpose. In developing this idea, we borrow from both the computational and biological sciences (Buneman et al.) where provenance, as a form of qualitative inquiry into data-motile processes, centres around understanding the origin of a data point as part of a broader almost forensic analysis of quality and error-potential in datasets. Provenance is an evaluation of a priori computational inputs and outputs from the results of database queries and audits. Provenance can also be applied to other contexts where data passes through sociotechnical systems, such as behavioural analytics, targeted advertising, machine learning, and algorithmic decision-making. Conventionally, data provenance is based on understanding where data has come from and why it was collected. Both these questions are concerned with the evaluation of the nature of a data point within the wider context of a database that is itself situated within a larger sociotechnical system where the data is made available for use. In its conventional sense, provenance is a means of ensuring that a data point is maintained as a single source of truth (Buneman, 89), and by way of a reproducible mechanism which allows for its path through a set of technical processes, it affords the assessment of a how reliable a system’s output might be by sheer virtue of the ability for one to retrace the steps from point A to B. “Where” and “why” questions are illuminating because they offer an ends-and-means view of the relation between the origins and ultimate uses of a given data point or set. Provenance is interesting when studying data luminosity because means and ends have much to tell us about the origins and uses of data in ways that gesture towards a more accurate and structured research agenda for data ethics that takes the emphasis away from individual moral patients and reorients it towards practices that occur within information management environments. Provenance offers researchers seeking to study data-driven practices a similar heuristic to a journalist’s line of questioning who, what, when, where, why, and how? This last question of how is something that can be incorporated into conventional models of provenance that make it useful in data ethics. The question of how data comes into being extends questions of power, legality, literacy, permission-seeking, and harm in an entangled way and notes how these factors shape the nature of personal data as it moves between contexts. Forms of provenance accumulate from transaction to transaction, cascading along, as a dataset ‘picks up’ the types of provenance that have led to its creation. This may involve multiple forms of overlapping provenance – methodological and epistemological, legal and illegal – which modulate different elements and apparatuses. Provenance, we argue is an important methodological consideration for workers in the humanities and social sciences. Provenance provides a set of shared questions on which models of transparency, accountability, and trust may be established. It points us towards tactics that might help data-subjects understand privacy in a contextual manner (Nissenbaum) and even establish practices of obfuscation and “informational self-defence” against regimes of datafication (Brunton and Nissenbaum). Here provenance is not just a declaration of what means and ends of data capture, sharing, linkage, and analysis are. We sketch the outlines of a provenance model in table 2 below. Type Metaphorical frame Dark Light What? The epistemological structure of a database determines the accuracy of subsequent decisions. Data must be consistent. What data is asked of a person beyond what is strictly needed for service delivery. Data that is collected for a specific stated purpose with informed consent from the data-subject. How does the decision about what to collect disrupt existing polities and communities? What demands for conformity does the database make of its subjects? Where? The contents of a database is important for making informed decisions. Data must be represented. The parameters of inclusion/exclusion that create unjust risks or costs to people because of their inclusion or exclusion in a dataset. The parameters of inclusion or exclusion that afford individuals representation or acknowledgement by being included or excluded from a dataset. How are populations recruited into a dataset? What divides exist that systematically exclude individuals? Who? Who has access to data, and how privacy is framed is important for the security of data-subjects. Data access is political. Access to the data by parties not disclosed to the data-subject. Who has collected the data and who has or will access it? How is the data made available to those beyond the data subjects? How? Data is created with a purpose and is never neutral. Data is instrumental. How the data is used, to what ends, discursively, practically, instrumentally. Is it a private record, a source of value creation, the subject of extortion or blackmail? How the data was intended to be used at the time that it was collected. Why? Data is created by people who are shaped by ideological factors. Data has potential. The political rationality that shapes data governance with regard to technological innovation. The trade-offs that are made known to individuals when they contribute data into sociotechnical systems over which they have limited control. Table 2: Forms of Data Provenance Conclusion As an illuminating methodology, provenance offers a specific line of questioning practices that take information through darkness and light. The emphasis that it places on a narrative for data assets themselves (asking what when, who, how, and why) offers a mechanism for traceability and has potential for application across contexts and cases that allows us to see data malpractice as something that can be productively generalised and understood as a series of ideologically driven technical events with social and political consequences without being marred by perceptions of exceptionality of individual, localised cases of data harm or data violence. References Brunton, Finn, and Helen Nissenbaum. "Political and Ethical Perspectives on Data Obfuscation." Privacy, Due Process and the Computational Turn: The Philosophy of Law Meets the Philosophy of Technology. Eds. Mireille Hildebrandt and Katja de Vries. New York: Routledge, 2013. 171-195. Buneman, Peter, Sanjeev Khanna, and Wang-Chiew Tan. "Data Provenance: Some Basic Issues." International Conference on Foundations of Software Technology and Theoretical Computer Science. Berlin: Springer, 2000. Davis, Jenny L. How Artifacts Afford: The Power and Politics of Everyday Things. Cambridge: MIT Press, 2020. D'Ignazio, Catherine, and Lauren F. Klein. Data Feminism. Cambridge: MIT Press, 2020. Hardt, Michael, and Antonio Negri. Commonwealth. Cambridge: Harvard UP, 2009. Kitchin, Rob. "Big Data, New Epistemologies and Paradigm Shifts." Big Data & Society 1.1 (2014). Lawrence, Matthew. “Emerging Technology: An Interview with Adam Greenfield. ‘God Forbid That Anyone Stopped to Ask What Harm This Might Do to Us’. Institute for Public Policy Research, 13 Oct. 2017. <https://www.ippr.org/juncture-item/emerging-technology-an-interview-with-adam-greenfield-god-forbid-that-anyone-stopped-to-ask-what-harm-this-might-do-us>. Lupton, Deborah. "Vital Materialism and the Thing-Power of Lively Digital Data." Social Theory, Health and Education. Eds. Deana Leahy, Katie Fitzpatrick, and Jan Wright. London: Routledge, 2018. Nissenbaum, Helen F. Privacy in Context: Technology, Policy, and the Integrity of Social Life. Stanford: Stanford Law Books, 2020. Warner, Michael. "Publics and Counterpublics." Public Culture 14.1 (2002): 49-90.

From an interview with “Mr A”, executive producer and co-creator of the Getaway in Stockholm (GiS) films: Mr A: Yeah, when I tell my girlfriend, ‘You should watch this, it’s good, it’s a classic, it’s an old movie’ and she thinks it’s, like, the worst. And when I actually look at it and it is the worst, it is just a car chase … [Laughs] But you have to look a lot harder, to how it is filmed, you have to learn … Because, you can’t watch car racing for instance, because they are lousy at filming; you get no sensation of speed. If you watch the World Rally Championship it looks like they go two miles an hour. The hardest thing [of the whole thing] is capturing the speed … I want to engage with the notion of “speed” in terms of the necessary affects of automobility, but first I will give some brief background information on the Getaway in Stockholm series of films. Most of the information on the films is derived from the interview with Mr A carried out over dinner in Stockholm, October 2004. Contact was made via e-mail and I organised with the editors of Autosalon Magazine for an edited transcription to be published as an incentive to participate in the interview. Mr A’s “Tarantino-style” name is necessary because the films he makes with Mr X (co-creator) and a small unnamed group of others involve filming highly illegal acts: one or two cars racing through the streets of Stockholm evading police at sustained speeds well over 200 km/h. Due to a quirk in Swedish traffic law, unless they are caught within a certain time frame of committing driving offences or they actually admit to the driving offences, then they cannot be charged. The Swedish police are so keen to capture these renegade film makers that when they appeared on Efterlyst (pron: ef-de-list; the equivalent of “Sweden’s Most Wanted”) instead of the normal toll-free 1-800 number that viewers could phone to give tips, the number on the screen was the direct line to the chief of Stockholm’s traffic unit. The original GiS film (2000) was made as a dare. Mr A and some friends had just watched Claude Lelouch’s 1976 film C’était un Rendez-vous. Rumour has it that Lelouch had a ten-minute film cartridge and had seen how a gyro stabilised camera worked on a recent film. He decided to make use of it with his Ferrari. He mounted the camera to the bonnet and raced through the streets of Paris. In typical Parisian style at the end of the short nine minute film the driver parks and jumps from the Ferrari to embrace a waiting woman for their “rendezvous”. Shortly after watching the film someone said to Mr A, “you don’t do that sort of thing in Stockholm”. Mr A and Mr X set out to prove him wrong. Nearly all the equipment used in the filming of the first GiS film was either borrowed or stolen. The Porsche used in the film (like all the cars in the films) was lent to them. The film equipment consisted of, in Mr A’s words, a “big ass” television broadcast camera and a smaller “lipstick” camera stolen from the set of the world’s first “interactive” reality TV show called The Bar. (The Bar followed a group of people who all lived together in an apartment and also worked together in a bar. The bar was a “real” bar and served actual customers.) The first film was made for fun, but after Mr A and his associates received several requests for copies they decided to ramp up production to commercial levels. Mr A has a “real job” working in advertising; making the GiS films once a year is his main job with his advertising job being on a self-employed, casual basis. As a production team it is a good example of amateurs becoming semi-professionals within the culture industries. The GiS production team distributes one film per year under the guise of being a “documentary” which allows them to escape the wrath of Swedish authorities due to further legal quirks. Although they still sell DVDs from their Website, the main source of income comes from the sale of the worldwide distribution rights to British “powersports” specialist media company Duke Video. Duke also sells a digitally remastered DVD version of Rendezvous on their Website. As well as these legitimate distribution methods, copies of all six GiS films and Rendezvous are available on the internet through various peer-to-peer file-sharing networks. Mr A says there isn’t much he can do about online file sharing besides asking people to support the franchise if they like the films by buying the DVDs. There are a number of groups making films for car enthusiast using similar guerilla film production methods. However, most of the films are one-offs or do not involve cars driven at such radical speeds. An exception was another Swedish film maker who called himself “Ghostrider” and who produced similar films using a motorbike. Police apprehended a man who they alleged is “Ghostrider” in mid-2004 within the requisite timeframe of an offence that had been allegedly committed. The GiS films alongside these others exist within the automotive cultural industry. The automotive cultural industry is a term I am using to describe the overlap between the automotive industry and the cultural industries of popular culture. The films tap in to a niche market of car enthusiasts. There are many different types of car enthusiasts, everything from petite-bourgeois vintage-car restorers to moral panic-inducing street racers. Obviously the GiS films are targeted more towards the street racing end of the spectrum, which is not surprising because Sweden has a very developed underground street racing scene. A good example is the Stockholm-based “Birka Cup”: a quasi-professional multi-round underground street-racing tournament with 60,000 SEK (approx. AUD$11,000) prize money. The rules and rankings for the tournament are found on the tournament Website. To give some indication of what goes on at these events a short teaser video clip for the 2003 Birka Cup DVD is also available for download from the Website. The GiS films have an element of the exotic European-Other about them, not only because of the street-racing pedigree exemplified by the Birka Cup and similar underground social institutions (such as another event for “import” street racers called the “Stockholm Open”), but because they capture an excess within European car culture normally associated with exotic supercars or the extravagant speeds of cars driven on German autobahns or Italian autostradas. For example, the phrase “European Styling” is often used in Australia to sell European designed “inner-city” cars, such as the GM Holden Barina, a.k.a. the Vauxhall Corsa or the Opel Corsa. Cars from other regional manufacturing zones often do not receive such a specific regional identification; for example, cars built in Asian countries are described as “fully imported” rather than “Asian styling”. Tom O’Dell has noted that dominant conception of automobility in Sweden is different to that of the US. That is, “automobility” needs to be qualified with a national or local context and I assume that other national contexts in Europe would equally be just as different. However, in non-European, mainly post-colonial contexts, such as Australia, the term “European” is an affectation signaling something special. On a different axis, “excess” is directly expressed in the way the police are “captured” in the GiS films. Throughout the GiS series there is a strongly antagonist relation to the police. The initial pre-commercial version of the first GiS film had NWA’s “Fuck the Police” playing over the opening credits. Subsequent commercially-released versions of the film had to change the opening title music due to copyright infringement issues. The “bonus footage” material of subsequent DVDs in the series represents the police as impotent and foolish. Mr A describes it as a kind of “prank” played on police. His rationale is that they live out the fantasy that “everyone” wishes they could do to the police when they are pulled over for speeding and the like; as he puts it, “flipping the bird and driving off”. The police are rendered foolish and captured on film, which is an inversion of the normative traffic-cop-versus-traffic-infringer power relation. Mr A specifies the excess of European modernity to something specific to automobility, which is the near-universal condition of urbanity in most developed nations. The antagonism between the GiS drivers and the police is figured as a duel. The speed of the car(s) obviously exceeds what is socially and legally acceptable and therefore places the drivers in direct conflict with police. The speed captured on film is in part a product of this tension and gives speed a qualitative cultural dimension beyond a simple notion from rectilinear physics of speed as a rate of motion. The qualitative dimension of speed as been noted by Peter Wollen: Speed is not simply thrilling in itself, once sufficiently accelerated, but also enables us to enter exposed and unfamiliar situations, far removed from the zones of safety and normality – to travel into space, for instance, beyond the frontiers of the known. (106) Knowledge is subsumed by the dialect of road safety: “safety” versus “speed”. Knowledge takes on many forms and it is here that speed gains its complexity. In the high-school physics of rectilinear motion speed refers to a rate. Mr A discusses speed as a sensation (“thrill” in the language of Wollen) in the quote at the beginning of the essay. If the body develops sensations from affects and percepts (Deleuze and Guattari 179-83), then what are the affects and percepts that are developed by the body into the sensation of speed? The catchphrase for the GiS films is “Reality Beats Fiction By Far!” The “reality” at stake here is not only the actuality of cars traveling at high speeds within urban spaces, which in the vernacular of automotive popular culture is more “real” than Hollywood representations, but the “reality” of automobilised bodies engaging with and “getting away” from the police. Important here is that the police serve as the symbolic representatives of the governmental institutions and authorities that regulate and discipline populations to be automobilised road users. The police are principally symbolic because one’s road-user body is policed, to a large degree, by one’s self; that is, by the perceptual apparatus that enables us to judge traffic’s rates of movement and gestures of negotiation that are indoctrinated into habit. We do this unthinkingly as part of everyday life. What I want to suggest is that the GiS films tap into the part of our respective bodily perceptual and affective configurations that allow us to exist as road users. To explain this I need to go on a brief detour through “traffic” and its relation to “speed”. Speed serves a functional role within automobilised societies. Contrary to the dominant line from the road safety industry, the “speed limit” we encounter everyday on the road is not so much a limit, but a guide for the self-organisation of traffic. To think the “speed limit” as a limit allows authorities to imagine a particular movement-based threshold of perception and action that bestows upon drivers the ability to negotiate the various everyday hazard-events that constitute the road environment. This is a negative way to look at traffic and is typical of the (post)modernist preoccupation with incorporating contingency (“the accident”) into behavioural protocol and technical design (Lyotard 65-8). It is not surprising that the road safety industry is an exemplary institution of what Gilles Deleuze called the “control society”. The business of the road safety industry is the perpetual modulation of road user populations in a paradoxical attempt to both capture (forecast and study) the social mechanics of the accident-event while postponing its actualisation. Another way to look at traffic is to understand it as a self-organising system. Ilya Prigogine and Robert Herman modeled vehicle traffic as two flows – collective and individual – as a function of the concentration and speed of vehicles. At a certain tipping point the concentration of traffic is such that individual mobility is subsumed by the collective. Speed plays an important role both in the abstract sense of a legislated “speed limit” and as the emergent consistency of mobile road users distributed in traffic. That is, automotive traffic does not move at a constant speed, but nominally moves at a consistent speed. The rate and rhythms of traffic have a consistency that we all must become familiar with to successfully negotiate the everyday system of automobility. For example, someone simply walking becomes a “pedestrian” in the duration of automobilised time-space. Pedestrians must embody a similar sense of the rate of traffic as that perceived by drivers in the cars that constitute traffic. The pedestrian uses this sense of speed when negotiating traffic so as to cross the road, while the driver uses it to maintain a safe distance from the car in front and so on. The shared sense of speed demands an affective complicity of road-user bodies to allow them to seamlessly incorporate themselves into the larger body of traffic on a number of different registers. When road users do not comply with this shared sense of speed that underpins traffic they are met with horn blasts, rude figure gestures, abuse, violence and so on. The affects of traffic are accelerated in the body and developed by the body into the sensations and emotions of “road rage”. Road users must performatively incorporate the necessary dispositions for participating with other road users in traffic otherwise they disrupt the affective script (“habits”) for the production of traffic. When I screened the first GiS film in a seminar in Sweden the room was filled with the sound of horrified gasps. Afterwards someone suggested to me that they (the Swedes) were more shocked than I (an Australian) about the film. Why? Is it because I am a “hoon”? We had all watched the same images heard the same sounds, yet, the “speeds” were not equal. They had experienced the streets in the film as a part of traffic. Their bodies knew just how slow the car was meant to be going. The film captured and transmitted the affects of a different automobilised body. Audiences follow the driver “getting away” from those universally entrusted (at least on a symbolic level) with the governance of traffic – the police – while, for a short period, becoming a new body that gets away from the “practiced perception” (Massumi 189) of habits that normatively enable the production of traffic. What is captured in the film – the event of the getaway – has the potential to develop in the body of the spectator as the sensation of “speed” and trigger a getaway of the body. Acknowledgement I would like to acknowledge the generous funding from the Centre for Cultural Research and the College of Arts, Education and Social Sciences, University of Western Sydney, in awarding me the 2004 CCR CAESS Postgraduate International Scholarship, and the support from my colleagues at the Advanced Cultural Studies Institute of Sweden where I carried out this research as a doctoral exchange student. References Deleuze, Gilles. “Postscript on Control Societies”. Negotiations. Trans. Martin Joughin. New York: Columbia UP, 1995. Deleuze, Gilles, and Felix Guattari. What Is Philosophy? Trans. Graham Burchill and Hugh Tomlinson. London: Verso, 1994. Getaway in Stockholm series. 21 Oct. 2005 http://www.getawayinstockholm.com>. Lyotard, Jean François. The Inhuman: Reflections on Time. Trans. Geoffrey Bennington and Rachel Bowlby. Stanford, California: Stanford UP, 1991. Massumi, Brian. “Parables for the Virtual: Movement, Affect, Sensation”. Post-Contemporary Interventions. Eds. Stanley Fish and Fredric Jameson. Durham, London: Duke UP, 2002. O’Dell, Tom. “Raggare and the Panic of Mobility: Modernity and Everyday Life in Sweden.” Car Culture. Ed. Daniel Miller. Oxford: Berg, 2001. 105-32. Prigogine, Ilya, and Robert Herman. “A Two-Fluid Approach to Town Traffic.” Science 204 (1979): 148-51. Wollen, Peter. “Speed and the Cinema.” New Left Review 16 (2002): 105–14. Citation reference for this article MLA Style Fuller, Glen. "The Getaway." M/C Journal 8.6 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0512/07-fuller.php>. APA Style Fuller, G. (Dec. 2005) "The Getaway," M/C Journal, 8(6). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0512/07-fuller.php>.

Photo by Diana Polekhina on Unsplash ABSTRACT With the increasing legalization of MAiD across the world, the question of whether psychiatric patients with refractory mental illness should have access to this health service is a topic of ethical debate. Even so, with present-day autonomy encouragement, and the right to die, a psychiatric diagnosis should never automatically preclude a patient from making decisions about their treatment, including the use of MAiD. INTRODUCTION Likely, no matter where we live in the world, we have similar wants: to be healthy, to be happy, to be in a community, to make our own decisions about our lives. The first and last of these wants are the primary concerns of medicine. Diseases are treated, suffering is alleviated, chronic illnesses are managed – to the extent possible. Along the way, patient autonomy is encouraged. Perhaps the greatest manifestation of this autonomy is evidenced in the increasing availability of Physician-Assisted Suicide or Medical Aid-in-Dying (MAiD). With important nuances, the criteria that patients must meet to participate in MAiD are generally similar: a patient must be over the age of 18, able to state a voluntary desire to end their own life, and two independent physicians must verify their decision-making capacity. Yet, clinical criteria for accessing this option differ. In U.S. jurisdictions where MAiD is legal, patients must have a terminal illness with a 6-month prognosis.[1] In Holland and Belgium, the presence of “intractable pain” is sufficient.[2] With the increasing legalization of MAiD across the world, the question of whether psychiatric patients suffering from refractory mental illness should have access to this means of relieving suffering is under continual debate. The ethical implications of denying autonomous decision-making to psychiatric patients at the end of life will be discussed – along with suggestions for clinical practice. l. Medical Aid-in-Dying and the Psychiatric Patient There are three main arguments against allowing a patient with psychiatric suffering to pursue MAiD. The first is that patients with severe mental illness may have impaired decision-making capacity. This impaired capacity generally encompasses the following four criteria: the ability to express a choice, the ability to understand the information presented, the ability to appreciate the “medical consequences of the situation,” and the ability to engage with different choices of treatment.[3] These criteria are impaired to varying degrees across the spectrum of mental illnesses. For instance, about 50 percent of patients with schizophrenia hospitalized for an acute episode displayed at least one element of impaired capacity, compared with 20-25 percent of those admitted with an acute depressive episode. In contrast, depression treated on an outpatient basis may not be associated with any impairment in capacity.[4] The second argument against allowing a patient with psychiatric suffering to pursue MAiD is that suicidality itself can manifest as a common symptom of psychiatric disorders (including major depressive disorder). In this context, a patient with severe mental illness who has requested MAiD, following appropriate treatment, may in fact no longer wish to die. The fear of wrongly fulfilling a MAiD request in this context alienates the notion of liberally applying MAiD to the psychiatric population. A literature review found that between 8 percent and 47 percent of patients in the Netherlands and Oregon who requested MAiD presented with depression, while 2-17 percent of those who pursued MAiD to completion had “depressive symptoms.” In the Netherlands, patients with depression were significantly less likely to be granted euthanasia/MAiD requests.[5] Providers are rightfully afraid of making a mistake that will cost a life. Kious and Battin phrase the dilemma simply: “When is it worse that someone die, whether from suicide or with physician assistance, who could have been helped, and when is it worse that someone whose suffering could only be alleviated by death continue to suffer?”[6] It is doubtful that this question will ever have a sufficient answer. The third argument, that Calkins and Swetz fervently pose, claims that “allowing the psychiatrically ill to participate in [MAiD] will compromise the patient-clinician relationship and the relationship of medicine with the public as a whole… fundamentally alter[ing] the clinician’s role as healer and trusted advisor.”[7] This argument stems from western medicine’s bias of preserving life at whatever cost, the idea being that any deviation from this goal constitutes an abandonment of the patient. Calkins and Swetz’s suggestion that all patients with severe, persistent mental illness who might request MAiD do so inappropriately vastly overestimate the capacity of current psychotropic pharmacology to alleviate pain and suffering. There remain patients who have diligently run the gamut of available treatment options and remain debilitated by their disease. Allowing for participation in MAiD can instead be a testament to the strength of a patient-clinician relationship: that this patient, after presenting the topic of MAiD to their “healer and trusted advisor,” is met with a provider who willingly and carefully listens to their reasons for requesting this option, rather than rejecting the notion out of hand. If deemed appropriate, and after careful fulfillment of the remaining MAiD criteria, the relationship can then shift towards an end-of-life alliance – therapeutic in and of itself, one in which the goal is not further treatment but a peaceful end. However, attitudes about the appropriateness of MAiD for patients with severe mental illness differ, even among psychiatrists. In a survey of 457 psychiatrists in Switzerland – one of the few countries in which MAiD can be granted “on the basis of a primary psychiatric diagnosis,” 29.3 percent of respondents indicated some degree of support for the availability of MAiD to patients with severe and persistent mental illness – an acceptance rate that parallels that of medical providers.[8] Among a profession dedicated to preserving life, there remains much (reasonable) caution about hastening its end. ll. The Psychiatric Advance Directive The ambiguity over whether patients with psychiatric illnesses should be allowed to make their own treatment decisions is not limited to the end of life. For patients with predominantly medical conditions who no longer have the capacity to make decisions about their care (for instance, patients with advanced dementia), clinicians can defer to previously stated wishes as expressed in an advance directive or per the discretion of a healthcare proxy. This deferred decision-making is sometimes referred to as substituted judgment.[9] As a correlate, patients suffering from mental illness can complete a Psychiatric Advance Directive (PAD) to indicate what treatments they would or would not want should they lose decisional capacity. These are often informed by prior, traumatic hospitalizations (for instance, a patient may request not to undergo involuntary electroconvulsive shock therapy, or receive specific antipsychotics, or may decline all psychiatric management). Yet, in contrast to advance directives guiding medical treatment, PADs are frequently (and legally) overridden if they violate “accepted clinical standards.”[10] At their discretion, physicians can override any part or all of a patient’s PAD if it violates what they deem to be acceptable care. Rather than a “let-the-patient-decide” law, the actual influence of PADs on clinical management is often minimal – shrinking its effect to a “let the doctor decide whether the patient gets to decide” law.[11] For example, Pennsylvania’s PAD statute (Act 194) specifies three instances in which physicians can override a patient’s directive. First, a physician maintains the right to involuntarily admit a patient under civil commitment law. Second, a physician may override any part of a patient’s PAD so long as they make “every reasonable effort” to have the patient transferred to a provider willing to adhere to the patient’s request. Third, the act protects any physician who violates a patient’s PAD request from “criminal or civil liability or discipline[e] for unprofessional conduct” who is deemed to have acted in “good faith” based on accepted clinical guidelines.[12] In Pennsylvania’s fairly standard PAD legislation, the physician is virtually untouchable. North Carolina’s “Advance Instruction for Mental Health Treatment” documentation explicitly communicates its limitations to the patient: the opening paragraph states, “Your instructions may be overridden if you are being held in accordance with civil commitment law.”[13] Of course, neither is it sustainable to adhere to all PAD requests. Consider the case of Hargrave v. Vermont. The Second Circuit Court of Appeals upheld the durable power of attorney (DPOA) of Nancy Hargrave (a patient with schizophrenia who was civilly committed) to refuse treatment. As Applebaum notes, “If large numbers of patients were to complete advance directives such as Nancy Hargrave’s, declining all medication, hospitals might well begin to fill with patients whom they could neither treat nor discharge.”[14] Notably, this case is an exception rather than the rule. Broad legislation emulating Hargrave will not act towards the betterment of all patients with severe mental illness. But, in the conversation on the applicability of MAiD for psychiatric patients, it is worth noting how frequently and readily these patients’ wishes are overlooked, even when they have been expressed and properly documented in a state of decisional capacity (as must be the case when completing a Psychiatric Advance Directive). lll. The Way Forward While those with mental illness deserve both fierce protection and robust mental health treatment, they also have a right to define what quality of life is acceptable. When determining the point at which treatment of a psychiatric illness becomes futile – and thus the option of pursuing MAiD more readily permissible – the concept of “qualitative futility” is particularly generative. Focus turns towards a patient’s first-person experience of illness and an understanding of their “subjective view about the quality of an outcome.”[15] This perspective shifts away from the statistical probability that a certain treatment will succeed and instead incorporates the lived reality of a patient’s illness narrative. For example, in the World Health Organization’s published report on the treatment of cancer pain, the phrase “total pain” identifies the physical and non-physical components of suffering, including “the noxious physical stimulus and also psychological, spiritual, social, and financial factors.”[16] For severely ill patients with treatment-refractory mental illness, an understanding of “qualitative futility” and “total pain” could be the most humane way to approach who should and should not qualify for MAiD. In one take on how patients with mental illness have the right to define what consists of an acceptable quality of life, Kious and Battin posit that if a patient’s decision to pursue MAiD is voluntary and if the patient possesses decision-making capacity, their request should be granted “irrespective of whether their underlying medical diagnosis is physical or mental, terminal or nonterminal.”[17] While this option should, of course, be withheld from patients suffering from an acute exacerbation in which the patient may not achieve decisional capacity, it is nevertheless true that psychiatric illness, even in severe cases, is often episodic, undergoing periods of remission when a patient may be symptom-free.[18] During these periods of lucidity, the patient’s perception of quality of life should be examined with great care. Another option offered by Kious and Battin to identify psychiatric patients who may be appropriately pursuing MAiD is to create two “metric[s] for suffering” – one for physical and one for mental illnesses. For psychiatric patients who wish to end their lives, this establishes a threshold above which suffering becomes “unbearable,” opening the door for a legitimate conversation about MAiD between patient and physician (should the patient request it). Suffering below this threshold would remain grounds for involuntary admission to an inpatient facility.[19] The question remains: how do we gauge severe enough suffering to die and suffering that is not? In exploring this question, Zhong et al.’s understanding that a person with mental illness pursuing MAiD must be evaluated differently proves valuable. The authors suggest that rather than focusing on “point capacity” (the ability to make a specific decision), an evaluation of “global capacity” should instead be conducted - a style of evaluation that is interested in “fully contextualiz[ing]” the patient’s choice to pursue MAiD. This requires asking not only about medical and psychiatric history but also family and relationship history, trauma history, education and employment history, and includes a rigorous collection of collateral information from family and friends who can confirm the patient’s wishes.[20] An additional benefit of evaluating for “global capacity” should the choice of MAiD be followed to completion is the illumination, no matter how slight, that might be provided to relatives and friends. This prior justification for, and understanding of, the patient’s decision might dull the sharpness of loss for family and friends – healing insight that may be inaccessible in the case of unassisted suicide. While Kious and Battin express concern that it is “deeply unclear” how to measure the dimensions of suffering given that “we cannot wholly trust first-person reports,” these narratives nonetheless form the substrate of psychiatry and serve as the diagnostic tool of most gravitas available to providers of mental illness.[21] They must be trusted. Or, as the old medical adage goes, they can be trusted and confirmed. It is no accident that in the WHO’s “Cancer Pain Relief” manual, the first step of pain assessment is to “believe the patient’s complaint of pain.”[22] The lived experience of a patient with severe, refractory mental illness can challenge physician hesitation about the appropriateness of MAiD. In the previously cited study in which 29.3 percent of Swiss psychiatrists reported general support for the availability of MAiD in cases of refractory mental illness, the percentage curiously swelled when presented with three clinical vignettes (in each, the patient is stated to have decision-making capacity to “refuse further treatment”). In the case of a 37-year old female with a 26-year history of anorexia nervosa, ten prior hospitalizations, a weight of 52 pounds, general muscle weakness, and low bone density, who no longer wishes to undergo force-feeds, 35.4 percent of respondents indicated that they would support her choice of MAiD.[23] In the case of a 33-year old male with a 16-year history of schizophrenia, who has failed numerous trials of anti-psychotic regiments and electroconvulsive shock therapy, who has “never been free from positive or negative symptoms,” and whose persisting illness has left him severely isolated, 32.1 percent indicated that they would support his choice of MAiD. And in the case of a 40-year-old male with persistent suicidal ideation for 20 years, whose symptoms have been refractory to numerous trials of anti-depressants, anti-psychotics, mood stabilizers, combination therapy, psychotherapy, and electroconvulsive shock therapy, who plans to commit suicide “in the near future,” 31.4 percent of respondents indicated that they would support his choice of MAiD. With generous and nuanced attention to a patient’s “total pain,” following careful evaluation of their “global capacity,” and after a thorough review of all treatment trials and any available therapeutic options yet un-tried (assessing “psychiatric futility”), those who are suffering from severe, refractory mental illness should be granted similar access to MAiD as patients suffering from cancer, ALS, and other organic causes of disease. We cannot adequately police the “badness of suffering.”[24] CONCLUSION In summary, a psychiatric diagnosis should never automatically preclude a patient from making decisions about their treatment, including deciding to end one’s own life with the help of a licensed provider. Medical Aid-in-Dying is associated with a safe, certain, and painless death. In the circumstances where it would be applicable, it serves as a less fraught option than unassisted suicide. We owe anyone who is ceaselessly suffering that much. Or, at the very least, we owe this equally fraught topic an honest conversation. [1] Calkins, Bethany C., and Keith M. Swetz. “Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Imperative Over a Crisis.” The American Journal of Bioethics, vol. 19, no. 10, 2019, pp. 68–70, doi:10.1080/15265161.2019.1653398. [2] Montanari Vergallo, Gianluca et al. “Euthanasia and physician-assisted suicide for patients with depression: thought-provoking remarks.” Rivista di psichiatria vol. 55,2 (2020): 119-128. doi:10.1708/3333.33027 [3] Appelbaum, Paul S. “Assessment of Patients’ Competence to Consent to Treatment.” New England Journal of Medicine, vol. 357, no. 18, 2007, pp. 1834–40, doi:10.1056/nejmcp074045. [4] Appelbaum, Paul S. “Assessment of Patients’ Competence to Consent to Treatment,” 1834–40. [5] Levene, Ilana, and Michael Parker. “Prevalence of Depression in Granted and Refused Requests for Euthanasia and Assisted Suicide: A Systematic Review.” Journal of Medical Ethics vol. 37,4 (2011): 205-11. doi:10.1136/jme.2010.039057 [6] Levene, Ilana, and Michael Parker. “Prevalence of Depression in Granted and Refused Requests for Euthanasia ...” 205-11. [7] Calkins, Bethany C., and Keith M. Swetz. “Physician Aid-in-Dying and Suicide Prevention in Psychiatry,” 68–70. [8] Hodel, Martina A et al. “Attitudes Toward Assisted Suicide Requests in the Context of Severe and Persistent Mental Illness: A Survey of Psychiatrists in Switzerland.” Palliative & Supportive Care vol. 17,6 (2019): 621-627. doi:10.1017/S1478951519000233 [9] Appel, Jacob M. “Trial by Triad: Substituted Judgment, Mental Illness and the Right to Die.” Journal of Medical Ethics, 2021, pp. 1–4. doi:10.1136/medethics-2020-107154. [10] Swanson, Jeffrey W et al. “Superseding Psychiatric Advance Directives: Ethical and Legal Considerations.” The Journal of the American Academy of Psychiatry and the Law vol. 34,3 (2006): 385-94. [11] Swanson, Jeffrey W et al. “Superseding Psychiatric Advance Directives,” 385-94. [12] Ibid [13] “Advance Directive for Mental Health Treatment." NC Secretary of State. Web. 13 July 2021. <https://www.sosnc.gov/forms/by_title/_advance_healthcare_directives>. [14] Appelbaum, Paul S. “Law & Psychiatry: Psychiatric Advance Directives and the Treatment of Committed Patients.” Psychiatric Services (Washington, D.C.) vol. 55, no. 7, 2004, pp. 751–763. doi:10.1176/appi.ps.55.7.751 [15] Zhong, Rocksheng, et al. “Physician Aid-in-Dying for Individuals with Serious Mental Illness: Clarifying Decision-Making Capacity and Psychiatric Futility.” The American Journal of Bioethics, vol. 19, no. 10, 2019, pp. 61–63, doi:10.1080/15265161.2019.1654018. [16] World Health Organization. (‎1986)‎. Cancer Pain Relief. World Health Organization. https://apps.who.int/iris/handle/10665/43944 [17] Kious, Brent M., and Margaret (Peggy) Battin. “Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Crisis?” The American Journal of Bioethics, vol. 19, no. 10, 2019, pp. 29–39, doi:10.1080/15265161.2019.1653397. [18] Kious, Brent M., and Margaret (Peggy) Battin. “Physician Aid-in-Dying,” 29–39. [19] Ibid [20] Appelbaum, Paul S. “Law & Psychiatry,” 751–763. [21] Kious, Brent M., and Margaret (Peggy) Battin. “Physician Aid-in-Dying,” 29–39. [22] World Health Organization, Cancer Pain Relief. [23] Hodel, Martina A et al. “Attitudes Toward Assisted Suicide Requests,” 621-627. [24] Kious, Brent M., and Margaret (Peggy) Battin. “Physician Aid-in-Dying,” 29–39.