Long-Term Maintenance Strategies after Pulmonary Rehabilitation: Perspectives of People with Chronic Respiratory Diseases, Informal Carers, and Healthcare Professionals

Pulmonary rehabilitation (PR) is an effective intervention for people with chronic respiratory diseases (CRD); however, its effects fade after 6–12 months. Community-based strategies might be valuable to sustain PR benefits, but this has been little explored. People with CRD, informal carers, and healthcare professionals (HCPs) were recruited from pulmonology appointments of two local hospitals, two primary care centres, and one community institutional practice and through snowballing technique. Focus groups were conducted using a semi-structured guide. Data were thematically analysed. Twenty-nine people with CRD (24% female, median 69 years), 5 informal carers (100% female, median 69 years), and 16 HCPs (75% female, median 36 years) were included. Three themes were identified: “Maintaining an independent and active lifestyle” which revealed common strategies adopted by people with “intrinsic motivation and professional and peer support” as key elements to maintain benefits, and that “access to information and partnerships with city councils’ physical activities” were necessary future steps to sustain active lifestyles. This study suggests that motivation, and professional and peer support are key elements to maintaining the benefits of PR in people with CRD, and that different physical activity options (independent or group activities) considering peoples’ preferences, should be available through partnerships with the community, namely city councils.

The Chilling Effects of Digital Dataveillance: A Theoretical Model and an Empirical Research Agenda

People's sense of being subject to digital dataveillance can cause them to restrict their digital communication behavior. Such a chilling effect is essentially a form of self-censorship in everyday digital media use with the attendant risks of undermining individual autonomy and well-being. This article combines the existing theoretical and limited empirical work on surveillance and chilling effects across fields with an analysis of novel data toward a research agenda. The institutional practice of dataveillance—the automated, continuous, and unspecific collection, retention, and analysis of digital traces—affects individual behavior. A mechanism-based causal model based on the theory of planned behavior is proposed for the micro level: An individual's increased sense of dataveillance causes their subjective probability assigned to negative outcomes of digital communication behavior to increase and attitudes toward this communication to become less favorable, ultimately decreasing the intention to engage in it. In aggregate and triggered through successive salience shocks such as data scandals, dataveillance is accordingly hypothesized to lower the baseline of free digital communication in a society through the chilling effects mechanism. From the developed theoretical model, a set of methodological consequences and questions for future studies are derived.

What Should the Right to Higher Education Look Like?

This chapter addresses some key objections to the right to higher education and provides a fuller picture of what this right can look like at the level of public policy and institutional practice. First, the chapter revisits the broader rationale for the argument in order to show how a rights-based conception of can better inform public debate about the justice, fairness, and purposes of higher education. Second, it applies this account to Martin Trow’s famous conceptualization of higher education systems into “elite,” “mass,” and “universal” stages of growth and development in order to demonstrate how the right to higher education can inform higher education policy. Finally, it addresses the worry that the right to higher education overstates the importance of post-compulsory education for a liberal society. Here the chapter engages with issues about the role of higher education in the promotion of human welfare and the level of “idealization” built into the argument.

“Transformative agency” as an object of sociological analysis: Contemporary discussions and the role of education

Negative trends of the global social-economic development enhanced by the covid-19 pandemic explain the theoretical and practical relevance of the study of perspectives for structural transformations and their possible sources. In education, this means the need to improve the existing models of institutional practice and to contribute to the development of agency that would support positive transformations in all domains of social life. The scientific attention to agency and its transformative potential in relation to structures is still limited compared to the issues of structures reproduction. The so-called new institutionalists in sociology (including primarily J.W. Meyer and his followers) provide a promising basis for new theoretical models and empirical studies of the content, factors and effects of transformative agency. Meyers core idea is that social structures can both suppress and support the initiative formation of new social entities and the corresponding new values and modes of action. Further research in education should refer to the concepts of institutional entrepreneurship, institutional work and expanded actorhood, when using the proposed theoretical framework to empirically study (1) globally and nationally promoted initiatives in entrepreneurship education in universities, and (2) processes of transformation of institutional contexts in education under the continuing global pandemic with an emphasis on the proactive role of students.

The Challenge of Biography: Reading Theologians in Light of their Breached Sexual Ethics

Though their biographies vastly differ, Karl Barth's long-term extra-marital relationship with Charlotte von Kirschbaum and John H. Yoder's sexual crimes have been the focus of a range of reactions and proposed approaches on how to read the theology of the two theologians given their biographies. This article will examine those critical responses using an analytical framework appropriated from Sameer Yadav's work on cognate conversations about locating and remedying the causes of white supremacy in the church: are the problems due to problematic theology, problematic institutional practice, or both? A correct diagnosis helps the theologian to then propose the right remedy. This adapted framework will be applied to the cases of Barth and Yoder to critically examine how Steven Plant and Rachel Muers respond to Barth's biography and how Stanley Hauerwas and Hilary Scarsella respond to Yoder's biography. After demonstrating how the different respondents address the issue as one primarily of problematic theology or problematic institutional practices, I will argue that it is both theology and practice that must be addressed in order to satisfactorily deal with the reality and scale of infection when it comes to influential theologians. Sample treatments will be offered for responding to Barth's and Yoder's biographies.

Use of percutaneous cholecystostomy for complicated acute lithiasic cholecystitis: solving or deferring the problem?

Objective: Percutaneous cholecystostomies are not infrequently used as an adjunct in the treatment of severe lithiasic cholecystitis, particularly in unstable and comorbid patients. However, their out of proportion liberal use tends to substitute the performance of emergency cholecystectomy, which the definitive treatment. Our aim was to assess the short and long-term outcomes of patients who had percutaneous cholecystostomy insertion due to severe lithiasic cholecystitis, aiming to define areas for improvement of our institutional practice. Materials and Methods: Retrospective review of our institutional practice including all patients who had a percutaneous cholecystostomy for complex lithiasic cholecystitis, over a 5-year period, allowing for an additional 1-year follow up. Results: A total of 34 patients were included in our final analysis. Percutaneous cholecystostomy insertion enabled quick and efficient control of the source of biliary sepsis without major procedural complications in all cases. In 14 (41.2%) patients, cholecystostomy alone served as definitive treatment, while in 20 (58.9%) cases it was used as bridging strategy for delayed elective cholecystectomy. In the delayed cholecystectomy group of patients, we noted a high conversion rate from laparoscopic to open surgery rate of 70%, with an overall subtotal cholecystectomy rate of 60%. Conclusion: Percutaneous cholecystostomies should be reserved only for complex lithiasic cholecystitis patients who are unwilling and/or unfit for surgery. We advocate the performance of upfront emergency cholecystectomy in any other case with liberal use of operative bail-out strategies, as a delayed elective operation is anyway likely to be converted to open and/or subtotal cholecystectomy.

Climate Change Inaction and Post-Reality

Blame for climate change inaction is rarely directed at a fundamental cause, the excessive complexity of society. It has given rise to post-truth, which has been largely reduced to unflattering stereotypes of the public, and post-trust, by which the public see their national institutions as increasingly distant and ineffectual. The two comprise post-reality, by which confidence in the truth is weakened by distance from its source, a pervasive remoteness leads to a lack of accountability and indifference, and much scholarship and institutional practice is similarly prejudiced. A gross lack of proportion goes unnoticed in discourse that is innumerate, the more readily accepted by those (including many of those in public life) with a higher education that closes the mind to technical matters and thus to the seriousness of climate change. Regarding climate change inaction as an applied problem suggests a renewed emphasis on authentic public education and on activism outside the traditional ambit of scholarship.