Relationship between brand and dealer loyalty in the agricultural equipment market

Agricultural equipment companies intend to understand agriculture producers’ buying behavior by answering questions such as how loyal producers are to brands and dealers, which have an important impact on their profitability. This paper addresses the problem of how loyal agricultural producers are to equipment brands and dealers. Using a combination of cluster analysis and probit models, we identified producers’ behavioral and attitudinal loyalty to brands and dealers and analyzed the factors that explain such loyalty. We also found a strong interdependence between brand and dealer loyalty and the significant value that dealer loyalty adds to the brands. Additionally, we present some management implications of developing brand recognition, understanding producers purchasing behavior, and segmenting producers. This paper’s contributions are the establishment and measurement of an ‘empirical’ definition of brand and dealer loyalty, the identification and quantification of the impact of the explanatory factors of brand and dealer loyalty, and the determination of a dual loyalty relationship between brand and dealer loyalty.

Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study

Background French military doctors are currently deployed in the Sahel to support the armed forces of Operation Barkhane, in medical or surgical units. As well as supporting French soldiers, their other missions are diverse and complex: medical assistance to civilians and persons under control (PUC), advice to commanding officers. These tasks can create ethical dilemmas when decisions are forced upon doctors that may be in conflict with medical values or fundamental principles. Little is known about the specific dilemmas experienced by French military doctors in overseas operations. We therefore conducted a qualitative study among doctors and surgeons recently deployed to the Sahel to explore and better understand this question. Method Semi-structured, face-to-face interviews were conducted with 20 French military doctors or surgeons deployed since January 2016 in medical or surgical facilities in Mali and Chad. Results All interviewed doctors reported having faced several ethical dilemmas during missions. All reported dilemmas involved the treatment of civilians (while delivering community medical assistance) or of PUC. The dilemmas involved choices as to which patients to treat, the use of care as a means to an end by military authorities, and the level of care attainable in the absence of any possible hospital follow-up. Questions of delivering care at the risk of their own safety or the mission’s and of treating openly hostile patients were also brought up. Several dilemmas stemmed from the dual loyalty problem, namely the conflict between military doctors’ duty of care to patients and to the military institution, but this was not the only factor involved. Contextual factors (restricted resources and security constraints) and psychological factors (especially hostility towards the enemy) were also associated with many of the reported dilemmas. Conclusion This is the first reported study focusing on the ethical dilemmas encountered by French military doctors in overseas operations. It provides unique insights into their ethical experiences and should prove useful in improving operational training for healthcare personnel deployed on overseas missions.

Medical Ethics for the Military Profession

This paper summarizes medical ethics in the military profession to raise military leaders’ awareness of Military Medical Ethics (MME) and the ethical issues that may impact their medical services and personnel. First, it summarizes core concepts, including the four principles of medical ethics (autonomy, beneficence, non-maleficence, and justice), the two legal frameworks for the use of military force in war, jus ad bellum and jus in bello, and the concept of dual loyalty. It then examines MME issues during conflict, in garrison healthcare, and during the COVID-19 epidemic. Finally, it concludes by arguing that MME is an important domain of military ethics that should be taught to military leaders to complement the detailed education of MME for military medical professionals.

Forensic mental health professionals’ perceptions of their dual loyalty conflict: findings from a qualitative study

Background Mental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient’s well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs’ decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice. Methods 31 MHPs working in court-mandated treatment settings were interviewed. The interviews were semi-structured and our in-depth analysis followed the thematic analysis approach. Results We first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved. Conclusions Even though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system.

Thematic Analysis of Military Medical Ethics Publications From 2000 to 2020—A Bibliometric Approach

ABSTRACT Introduction There has been external criticism of the compliance of military health personnel with internationally agreed principles in military medical ethics (MME). In response, a number of authors have called for clarity on the principles and topics within the domain of MME. This complements an increased acknowledgment of the need for education in MME for military health personnel. Our paper utilizes bibliometric techniques to identify key themes in MME to inform the development of a curriculum for this subject. Materials and Methods We designed a search strategy to find publications over the period January 1, 2000-December 31, 2020 in the domain of MME from the three databases, PubMed, Web of Science, and Scopus, using the search string (ethic* OR bioethics* OR moral*) AND military AND (medic* OR health*). We obtained a total of 1,115 publications after duplication removal. After exclusion based on topic, year, and study design, we analyzed a total of 633 publications using Scopus’s embedded analysis tool and the software VOSViewer. We generated a co-occurrence word map from the abstracts of each of the publications. We deduced themes of MME based on the clusters shown in the word map, and we categorized each publication into one of these themes to analyze the change of themes over time. Results We observed a 10-fold increase in annual publications on MME between 2000 and 2020. The majority of papers were written by U.S. (72%) and UK (13%) authors, although a total of 15 countries were represented. After using VOSViewer to identify co-occurring keywords in titles and abstracts from these publications, nine themes were identified: biomedical research, care to detained populations, disaster/triage, mental health, patient-focused foundations, technology, dual loyalty, education/training, and frameworks. The relative proportion of each of these themes changed over the study period, with mental health being dominant by the end. Conclusions This study has identified key themes that might inform the development of a curriculum for teaching MME. It is noticeable that the majority of themes cover MME from the perspective of professional practice on military operations; noting, the research and technology themes also pertain to the generation of knowledge for military operations. There were a limited number of publications covering practice in the non-deployed or garrison settings, and these were codified under the themes of “framework” and “dual loyalty”. The results are skewed toward English-speaking countries and exclude non-academic publications. Further work will search for other open-source information and non-English publications. To our knowledge, this exploratory bibliometric analysis on MME in the academic literature is the first of its kind. This article has demonstrated the use of bibliometric techniques to evaluate the evolution of knowledge in MME, including the identification of key themes. These will be used to support further work to develop a curriculum for the teaching of MME to military medical audiences.

Patient Rights and Practitioner Duties

In military medicine, the goals of war transform patient rights and practitioner duties. Attention to conserving mission readiness and maintaining one’s fitness for duty limits soldiers’ rights to refuse standard medical care, initiate DNR (Do Not Resuscitate) orders, maintain privacy, and demand confidentiality. At the same time, however, military medical practitioners are expected to maintain impartiality and neutrality. In wartime, both are problematic. The imperative of military necessity may override impartiality while medical staff members tending compatriot warfighters are not neutral. Special, associative duties of care, moreover, may demand preferential treatment for compatriots at the expense of the medical needs of others. Citing dual loyalty, some observers call on military medical personnel to choose between their medical and military obligations. Dual loyalty, however, is a false dichotomy that obscures the moral tension between collective and individual interests coloring all aspects of political and military ethics.

Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study.

Background French military doctors are currently deployed in the Sahel to support the armed forces of Operation Barkhane, in medical or surgical units. As well as supporting French soldiers, their other missions are diverse and complex: medical assistance to civilians and persons under control (PUC), advice to commanding officers. These tasks can create ethical dilemmas when decisions are forced upon doctors that may be in conflict with medical values or fundamental principles. Little is known about the specific dilemmas experienced by French military doctors in overseas operations. We therefore conducted a qualitative study among doctors and surgeons recently deployed to the Sahel to explore and better understand this question.Method Semi-structured, face-to-face interviews were conducted with 20 French military doctors or surgeons deployed since January 2016 in medical or surgical facilities in Mali and Chad. Results All interviewed doctors reported having faced several ethical dilemmas during missions. All reported dilemmas involved the treatment of civilians (while delivering community medical assistance) or of PUC. The dilemmas involved choices as to which patients to treat, the use of care as a means to an end by military authorities, and the level of care attainable in the absence of any possible hospital follow-up. Questions of delivering care at the risk of their own safety or the mission’s and of treating openly hostile patients were also brought up. Most dilemmas stemmed from the dual loyalty problem, namely the conflict between military doctors’ duty of care to patients and to the military institution. Contextual factors (restricted resources and security constraints) were also associated with many of the reported dilemmas. Conclusion This is the first reported study focusing on the ethical dilemmas encountered by French military doctors in overseas operations. It provides unique insights into their ethical experiences and should prove useful in improving operational training for healthcare personnel deployed on overseas missions.

Health Effects of Incarceration

Since 1976, incarcerated individuals in the United States have an established right to healthcare. This has created a national system charged with addressing the unique challenges of healthcare delivery in jails and prisons. As incarcerated populations are often excluded from large research studies, evidence-based practices must often be extrapolated from community data. There is a wide variation in care delivery across institutions nationwide. Challenges in correctional settings include a “dual loyalty” to patients’ health and facility security and the toxic effects of disciplinary practices including solitary confinement, violence, communicable disease control, an aging population, discharge planning for community reentry, and a high prevalence of substance use disorder and mental health disease. Although incarceration may offer a unique opportunity to address chronic health issues of a difficult-to-reach population, the net health effects in the United States seem to be mostly negative. Mass incarceration in the United States has led to significant health consequences at the individual, family, and community levels and has exacerbated health, socioeconomic, and racial disparities. As most incarcerated individuals return to the community, healthcare delivery during incarceration plays a substantial role in the health of communities at all levels.

Court-Mandated Patients’ Perspectives on the Psychotherapist’s Dual Loyalty Conflict – Between Ally and Enemy

BackgroundMental health professionals working in correctional contexts engage a double role to care and control. This dual loyalty conflict has repeatedly been criticized to impede the development of a high-quality alliance. As therapeutic alliance is a robust predictor of outcome measures of psychotherapy, it is essential to investigate the effects of this ethical dilemma.MethodsThis qualitative interview study investigates patients’ perceptions of their therapists’ dual role conflict in court-mandated treatment settings. We interviewed 41 older incarcerated persons using a semi-structured interview guide, the interviews were subsequently analyzed following thematic analysis.ResultsWe first present the patients’ perceptions of their treating psychotherapist’s dual loyalty conflict, which was linked to their overall treatment experience. In a second step, we outline the study participants’ reasons for this judgment, which were most commonly linked to feelings of trust or betrayal. More specifically, they named certain therapist characteristics and activities that enabled them to develop a trustful therapeutic alliance, which we grouped into four topics: (1) respecting the patient’s pace and perceived coercion; (2) patient health needs to be first priority; (3) clarity in roles and responsibilities; and (4) the art of communication – between transparency and unchecked information sharing.DiscussionDeveloping a high quality alliance in mandatory offender treatment is central due to its relationship with recovery and desistance. Our findings show that some therapists’ characteristics and activities attenuate the negative impact of their double role on the development and maintenance of the alliance. To increase the effectiveness of court-mandated treatments, we need to support clinicians in dealing with their dual role to allow the formation of a high quality therapeutic alliance. Our qualitative interview study contributed to this much-needed empirical research on therapist’ characteristics promoting a trustful relationship in correctional settings.