"We're back in control of the story and we're not letting anyone take that away from us": patient teacher programs as means for patient emancipation.

While patient engagement in healthcare professions education (HPE) has significantly increased in the past decades, a theoretical gap remains. What are the varied reasons as to why patients get involved with HPE programs? With a focus on understanding what drives patient involvement with HPE programs, this study examined how a patient as teacher (PAT) program was experienced by medical students, patient teachers, and faculty within a medical school. Through a phenomenographic approach, this study captures and describes the different ways our study participants experienced a PAT program (the 'phenomenon'). 24 semi-structured interviews were conducted in total, comprised of interviews with patient teachers (N = 10), medical students (N = 10) and program facilitators (N = 4) who participated in a PAT program. Our focus was on participants' description of the program and was grounded in their experiences of as well as their beliefs about it. Our findings captured 4 layers representing the qualitatively different (yet interrelated) ways in which participants experienced/perceived and conceptualized the various aspects of their experience with the PAT program: (1) A productive disruption of the learning space (2) A re-humanization within healthcare (3) A means of empowerment and agency (4) A catalyst for change and emancipation. Our outcome space results can be visually illustrated by a nesting "Matryoshka" doll, representing the four layers and depicting the process of uncovering the less conscious layers of sense-making within this phenomenon. HPE programs that are co-produced with patients and actively involve patients as teachers have the potential, but not guarantee, to be emancipatory. To engage in PAT programs that exhibit an emancipatory potential, we need to consider transformative paradigms of education, which are aligned with social change, and disrupt the traditional teacher-learner hierarchy.

An integrative literature review and critical reflection on nurses' agency.

The idea of agency has long been used in the nursing literature in the study of nurses' roles regarding the patients they take care of, but it has not often been used to study its relationship with nurses themselves and their status in the healthcare system. The purpose of this article is to analyze how the idea of agency is used in nursing research to better understand how we might advance our thinking around nurses' agency to shape nursing and healthcare with an emancipatory intent. Based on the results of a literature review focused on the study of conceptions, treatments, and applications of the concept of agency in nursing, we present a critical discussion to reflect on the need to consistently define the idea of nurses' agency, to guide research concerned with this topic in theoretical frameworks with emancipatory and social change tenets, and to make a call to develop the idea of agency as a central one to rework nurses' relationship with themselves. The idea of agency provides a valuable analytical framework for the study of a wide range of issues around nurses' status in healthcare organizations and in the healthcare system while offering a means for nurses' emancipation.

Shared Decision Making in Psychiatry: Dissolving the Responsibility Problem.

Person centered care (PCC) invites ideas of shared responsibility as a direct result of its shared decision making (SDM) process. The intersection of PCC and psychiatric contexts brings about what I refer to as the responsibility problem, which seemingly arises when SDM is applied in psychiatric settings due to (1) patients' potentially diminished capacities for responsibility, (2) tension prompted by professional reasons for and against sharing responsibility with patients, as well as (3) the responsibility/blame dilemma. This paper aims to do away with the responsibility problem through arguing for a functional approach to mental illness, a blameless responsibility ascription to the person with mental illness, as well as a nuanced understanding of SDM as part of an emancipation-oriented PCC model.

Oocyte vitrification for elective fertility preservation: a SWOT analysis.

Oocyte vitrification, also known as egg freezing, is increasingly being used by women as a precautionary measure against the anticipated decline in fertility. In countries where this procedure is allowed, elective oocyte vitrification has become an integral part of the treatment portfolio of fertility clinics. The widespread tendency towards the postponement of motherhood and the advances in laboratory technologies are encouraging women to consider oocyte vitrification and, by doing so, increase their reproductive autonomy. However, elective oocyte vitrification, or elective egg freezing (EEF), still elicits controversy, not only when EEF is appraised from a cost-efficiency point of view, but also in terms of medical and ethical concerns. In general, although the laboratory tool of vitrification has revolutionized the treatment of infertility, the pros and cons need to be clarified when considering EEF.

Leading women in respiratory medicine: Letter from Indonesia.

Special Series: Leading Women in Respiratory Medicine Series Editors: Natasha Smallwood and Fanny Wai San Ko.

Realist evaluation in times of decolonising global health.

Realist evaluation (RE) is a theory-driven evaluation approach inspired by scientific realism. It has become increasingly popular in the field of global health where it is often applied in low- and middle-income countries. This makes it timely to discuss RE's relationship to the emerging decolonisation of global health movement. In this short perspective, we argue that the principles and practices that underpin RE have great potential to contribute to the decolonisation endeavour. Both the focus on the inclusion of local stakeholders and the openness to the rival theories these stakeholders bring to the fore, are promising. However, in practice, we see that a lack of acknowledgement of power imbalances and different ontologies and an overreliance on Western-based theories thwart this potential. We therefore suggest that realist evaluations performed by external researchers, especially in the field of global health, should actively engage with issues of (power) inequities. This is not only the just thing to do, but will also contribute to a better understanding of the intervention and may facilitate the emancipation of the disenfranchised. One way of doing this is through the adoption of participatory (action) research methods, currently underused in realist evaluations. We finally give a short example of an evaluation that combines emancipatory and participatory practice development with a realist approach. The Afya-Tek project in Tanzania has an innovative bottom-up approach throughout the full evaluation cycle and shows the possible strength of the proposed combination to create better interventions, more empowered stakeholders, and more illuminating programme theories.

Communal Labor in Ecovillages: Contradictions, Impasses, and Possibilities within the Notion of Self-sufficiency.

Our goal is to outline the concept of communal labor in ecovillages of Brazil. To do that, we considered three elements: (1) political orientation for self-sufficiency; (2) technical-productive orientation in self-managed work and in plural economic practices; and (3) socio-environmental orientation centered on the recovery of biodiversity. We collected data in four ecovillages for 49 days, through a methodological path of inspiration ethnography with fieldnote and participant observation, followed by remote monitoring for 22 months. Our option was for flexible procedure to collect complex dynamics of management and routines of life by dialogues between researchers and informants. The results show that communal labor emerged in ecovillages as a resistance to market-centric society, although dependent on it incidentally. If, on the one hand, there are tensions and contradictions, on the other they reveal a strong organizational practice that shows possibilities and ways of redefining the relationships among human beings, and between collective organizations and ecosystems, by mitigating elements of alienation on values that inspire human emancipation.

Elective egg freezing and women's emancipation.

All studies show that the primary reason for women to consider elective egg freezing (EEF) is the lack of a partner. The first question then is where this shortage comes from and how it can be remedied. The main cause of the 'lack of partner' issue for highly educated women (the group most involved in elective egg freezing) is the reversed gender gap in education. It is concluded that EEF may increase individual reproductive autonomy but does not increase reproductive freedom for the group of highly educated women. Regardless of how many women freeze their eggs, a large number of educated women will eventually have to choose between going it alone as a single mother or looking for another life goal. Finally, some possible policy measures are proposed to reduce the gender gap and thus remove the real cause of the problem.

"Starting from a higher place": linking Habermas to teaching and learning clinical reasoning in the emergency medicine context.

Teaching clinical reasoning in emergency medicine requires educators to foster diagnostic accuracy and judicious decision-making amidst chaotic ambient factors including clinician fatigue, high cognitive load, and diverse patient expectations. The current study applies the early work of Jurgen Habermas and his knowledge-constitutive interests as a lens to explore an educational approach where physician-educators were asked to make their expert reasoning visible to emergency medicine trainees, to more deliberately make visible and accessible the context-specific thinking that emergency physicians routinely use. An action research methodology was used. The 'making thinking visible' teaching approach was introduced to five emergency medicine educators working in large public hospital emergency departments. Participants were asked to trial this teaching method and document its impact on student learning over two reporting cycles. Based on written reports of trialing the teaching approach, participants identified a need to change from: (1) introducing thinking structures to cultivating enquiry; and, (2) providing explanations based on cognitive thinking routines towards encouraging the learner to see the relevance of the clinical context. Educators described how they developed a more diagnostic and reflexive approach to learners, recognized the need to cultivate independent thinking, and valued the opportunity to reflect on their usual teaching. Teaching clinical reasoning using the 'making thinking visible' approach prompted educators to decrease the emphasis on providing technical information to assisting learners to understand the purposes and meanings behind clinical reasoning in emergency medicine. The knowledge-constitutive interests work of Jurgen Habermas was found to provide a robust framework supporting this emancipatory teaching approach.

THE BLOOD CRISIS: A CHOICE BETWEEN DYING AND REARRANGING?

I began my Ferenczi studies in the fall of 1987, a year before the English translation of his Clinical Diary was published. Since then, I have demonstrated in writing, teaching, working, and living that there is scarcely a passage in this "laboratory notebook of psychoanalysis" that fails to illuminate the clinical and the personal. And above all is Ferenczi's late awareness that his personality had been constructed upon false assumptions. This is a reckoning of thirty years' conscious and unconscious usage of Ferenczi's experience to illustrate, to interpret, and to expose the clinical and personal dimensions of my own life lived as "the will of another person." What constitutes, what allows, a choice between dying and rearranging? Now that I am long past Ferenczi's fifty-nine years, I take the risk every day, and I know it.

Between exclusion and emancipation: Foucault's ethics and disability.

The aim of the study was to demonstrate how Foucault's ethics, which we understand as a tension between exclusion and emancipation, helps both critically reassess two disability models that prevail in the contemporary literature concerning disability, that is the medical model and the social one, and support and inspire an ethical project of including people with disabilities in spheres of life from which they have been excluded by various power/knowledge regimes. We claim, following Foucault, that such a project should be informed by critical reflection on exclusion-generating forms of knowledge about people with disabilities and focused on individual ethical actions fostering self-realization and emancipation of people with disability.

ADVERSE CHILDHOOD EXPERIENCES AMONG YOUTH AGING OUT OF FOSTER CARE: A LATENT CLASS ANALYSIS.

Research has demonstrated that youth who age out, or emancipate, from foster care face deleterious outcomes across a variety of domains in early adulthood. This article builds on this knowledge base by investigating the role of adverse childhood experience accumulation and composition on these outcomes. A latent class analysis was performed to identify three subgroups: Complex Adversity, Environmental Adversity, and Lower Adversity. Differences are found amongst the classes in terms of young adult outcomes in terms of socio-economic outcomes, psychosocial problems, and criminal behaviors. The results indicate that not only does the accumulation of adversity matter, but so does the composition of the adversity. These results have implications for policymakers, the numerous service providers and systems that interact with foster youth, and for future research.

At the threshold of retirement: From all-absorbing relations to self-actualization.

To investigate the complexities of the retirement process, the present article draws on a case study of Eva, a Swedish woman who "awakened" from all-absorbing relations. It considers the ways in which retirement can enable liberation from patriarchal kinship structures and embodied values of respectability. The aim is to illuminate how deep, embodied values can become conscious and explicit during precarious life situations and transitional phases. The relation between the Swedish welfare state, an I-we balance, and gender equity values are illuminated. These analytical dimensions support the analysis by providing insights into the ways in which individuals embody and use cultural and social structures when they aim to manage unpredictability and to create change toward self-actualization.

Working against many grains: Rethinking difference, emancipation and agency in the counter-discourse of an ethnic minority women's organisation in Belgium.

In this article, we aim to contribute to feminist academic debates about multiculturalism and secularism/religion by drawing upon an analysis of an ethnic minority women's organisation in Belgium that has been active since 1999: ella. The analysis focuses upon the way in which ella constructs notions of empowerment and emancipation by discussing structural inequalities, cultural-ethnic values and religious authority and identity. First, we look at how ella formulates its ideas about the emancipation trajectories of minoritised women and the potential role of religious belonging. Second, we look at ella's discussion of religious interpretation and gender/sexual diversity. Here, we explore assumptions about the relationship between religious authority and minoritised women's and LGBTQs' desires and pursuit for knowledge. We conclude by considering ella as an affirmative-critical actor of multiculturalism, and an implicit agent of religious reform.

Cet article vise à contribuer aux débats académiques féministes relatifs à la diversité culturelle et au rapport laïcité/religion par l'analyse d'une organisation de femmes de minorité ethnique en Belgique, connue sous le nom d'ella. Cette analyse se concentre sur la manière dont ella développe des notions de responsabilisation et d'émancipation en discutant des inégalités structurelles, des valeurs ethniques et culturelles ainsi que de l'autorité et de l'identité religieuse. Dans un premier temps, nous examinons comment ella formule ses idées sur les trajectoires d'émancipation des femmes mises en minorité et du rôle potentiel de leur appartenance religieuse. Dans un deuxième temps, nous analysons la manière dont ella envisage l'interprétation religieuse et la diversité des genres/diversité sexuelle. Nous concluons en considérant ella comme un acteur critique et affirmé du multiculturalisme et un agent implicite de la réforme religieuse.

Enslaved ants: not as helpless as they were thought to be.

Slavery in ants involves robbing of brood of host ant species and rearing captured individuals in the enslaver's nest. Whereas slaves of facultative slave-makers increase the workforce of the colony, in obligate slave-makers presence of slaves is vital for colony survival. Until recently, it was generally believed that enslaved workers act solely for the benefit of their social parasite and are wholly lost for their own colony and population. However, evidence that slaves may act also in favour of their own maternal population by engaging in various forms of the so-called slave rebellions is already quite extensive and may be found in both old and recent myrmecological literature, although, unfortunately, these data are often neglected or overlooked. They may be classified into four categories: (1) acts of physical aggression directed by slaves to slave-makers, (2) attempts of slaves to reproduce within a slave-maker colony, (3) 'sabotage', i.e. activities of slaves leading to weakening of the slave-maker colony and population, and (4) slave emancipation, i.e. partial or complete self-liberation of slaves from slave-maker colonies. In this review, we present and discuss all these diverse (often interrelated) expressions of slave opposition to their enslavers, focussing our discussion on both proximate and evolutionary causation of the discussed phenomena. We also indicate some open questions which remain to be answered by future research.

Emancipation in the Gold Coast: The Abolitionist Views of James Hutton Brew.

This article deals with the abolitionist views of James Hutton Brew who argued against the British emancipation model in the Gold Coast. Brew was the proprietor and editor of the Gold Coast Times and discussed the British abolition process in its editorial pages. These articles revealed his thinking on abolition. Brew not only opposed the emancipation process set out by the British, which he felt was contradictory and disconnected from the Gold Coast context, but also argued for an alternative model that involved paying compensation to slave owners and creating a program to accommodate freed slaves. The British Governor portrayed some of the arguments of African abolitionists like Brew as those of slave owners trying to retain their positions. In discussing the ideas of James Hutton Brew, this article contributes to the literature on the historiography of slavery and abolition in Africa.

Prevalence and Predictors of Intimate Partner Violence Among Youth With Foster Care Histories.

A small but growing body of research suggests that adolescents and young adults involved with the child welfare system and those transitioning out of foster care are at heightened risk of experiencing intimate partner violence (IPV). Understanding the factors that place youth at risk of IPV is central to prevention and treatment of this public health problem. However, questions remain about the prevalence and correlates of IPV among youth in foster care. Additionally, emotional abuse, a particular form of IPV in intimate partnerships, remains an understudied area in this population. This study aimed to address these gaps in research by exploring factors associated with IPV using longitudinal data from a representative sample of older youth in California Foster Care who participated in the California Youth Transitions to Adulthood Study (CalYOUTH). Our IPV outcome measures included victimization, perpetration, bidirectional IPV, and emotional abuse. Findings suggest that approximately one-fifth (20.4%) of CalYOUTH respondents had experienced some form of IPV at age 23, with emotional abuse and bidirectional violence being the most commonly reported types of IPV. Females reported emotional abuse, as well as bidirectional violence, at nearly double the rates of their male counterparts. Self-identified sexual minority youth (SMY; lesbian, gay, bisexual, transgender, queer, or questioning) were more likely to report IPV victimization, IPV perpetration, and bidirectional violence than their non-SMY peers. Youth with histories of emotional abuse, caregiver IPV victimization, sexual abuse in foster care, placement instability, substance use, anxiety, and incarceration were also at heightened risk of IPV involvement. Emotional abuse was most prevalent with SMY. The findings contribute to the growing research on IPV among transition-age foster youth with important implications for future research, practice, and policy.

Does emancipation devour its children? Beyond a stalled dialectic of emancipation.

Emancipation serves not only as a midwife for progressive agendas such as greater equality and sustainability but also as their gravedigger. This diagnosis underpins Ingolfur Blühdorn's 'dialectic of emancipation', which depicts a dilemma but offers no perspective on how to deal with it. By drawing on Foucault, this article suggests conceiving of emancipation as a task moderns are confronted with even if a given emancipatory project has come to devour its children. Claiming autonomy from given social constellations is key to this task; key also is judging between legitimate and illegitimate claims to autonomy. In late modernity, the criteria for such judgement are no longer universally given. Instead of regarding the latter as entry into mere subjectivism (Blühdorn), this article presents judgement as a key political, 'world building'-activity (Arendt), a critical social theory may join in, by not only observing the world but by also taking sides in it.

Khaled Hosseini's women as modern archetypes: A study of obedient, resistant and empowered Afghan women.

This article focuses on Khaled Hosseini's use of the analogy of women as obedient, resistant, and empowered as modern archetypes who learn of the gendered oppression that works through their bodies. Khaled Hosseini, through his writings, lends voice and offers moral encouragement to women by crafting resistant, rebellious, empowered, and strong female characters. With theoretical support from Johnson's Patriarchal Terrorism and Spivak's Can the subaltern speak, this article traces how Hosseini interrogates the patriarchal hierarchies that encompass women's identity in Afghanistan. Women's sufferings correlate with the country's overall circumstances, particularly during and after the war, on the terror regime. Therefore, women's endurance and Afghanistan's endurance amid hostile and oppressive circumstances become equally imperative for Hosseini's works. This article finds that Hosseini correlates Afghan women's issues like tradition and modernity, women and Islam, mother and daughter relationship, resistance and rebellion, and their quest for change and empowerment with the war on terror, foreign invasions, and the rule of the Taliban in Afghanistan.

Modeling changes in adolescent health risk behaviors approaching and just after the time of emancipation from foster care.

BACKGROUND: Emancipated foster youth frequently engage in behaviors that contribute to poor health. Whether health risk behaviors increase following emancipation or are established while in foster care remains unclear. OBJECTIVE: This secondary data analysis examined substance use and attitudes toward sexual risk behaviors to understand continuity in risk behaviors among foster youth before emancipation and following emancipation. PARTICIPANTS AND SETTING: Youth ages 16-20 (N = 151) who had been in foster care for at least 12 months and were expected to emancipate were recruited. The urban county where the study was conducted allowed youth to remain in foster care until 21 years of age. METHODS: Participants completed surveys assessing substance use and attitudes toward sexual risk behaviors at baseline, 6 and 12 months. Multilevel models estimated trajectories of health behaviors and attitudes, with emancipation timing as the primary predictor. Individual and child welfare characteristics were included as covariates. RESULTS: Substance use did not change with emancipation (Bs = 0.01, p = 0.81) and positive attitudes about risky sexual behavior significantly decreased as youth approached emancipation (Bs = 1.67, p < 0.01). Placement instability and adversity were not associated with either outcome (ps > 0.08). Females reported more positive attitudes about higher-risk sexual behavior than males (B = 3.09, p < 0.01) and less substance use (B = -1.15, p = 0.03). CONCLUSIONS: Substance use and attitudes about sexual risk behaviors are established before emancipation; interventions prior to emancipation are necessary to improve health outcomes.