[Preventing violence during hospitalisations in psychiatry]. / Prévenir les moments de violence lors des hospitalisations en psychiatrie.

Over recent years, the psychiatric sector has endeavoured to develop community-based care. Paradoxically, the number of compulsory hospitalisations is increasing. At the same time, the legal framework is evolving and measures relating to the deprivation of liberty in the context of psychiatric care have given rise to extensive guidelines. The work of the French National Health Authority represents, in this context, a certain continuity, with regard to the legal, ethical and social discussions around restriction of liberty practices within psychiatric units. The main focus is on the prevention and management of violent outbursts.

Trust-based access control model from sociological approach in dynamic online social network environment.

There has been an explosive increase in the population of the OSN (online social network) in recent years. The OSN provides users with many opportunities to communicate among friends and family. Further, it facilitates developing new relationships with previously unknown people having similar beliefs or interests. However, the OSN can expose users to adverse effects such as privacy breaches, the disclosing of uncontrolled material, and the disseminating of false information. Traditional access control models such as MAC, DAC, and RBAC are applied to the OSN to address these problems. However, these models are not suitable for the dynamic OSN environment because user behavior in the OSN is unpredictable and static access control imposes a burden on the users to change the access control rules individually. We propose a dynamic trust-based access control for the OSN to address the problems of the traditional static access control. Moreover, we provide novel criteria to evaluate trust factors such as sociological approach and evaluate a method to calculate the dynamic trust values. The proposed method can monitor negative behavior and modify access permission levels dynamically to prevent the indiscriminate disclosure of information.

A road map to building ethics capacity in the home and community care and support services sector.

There are unique ethical issues that arise in home and community care because of its locus and range of service. However, the academic literature on ethical issues in the sector of home and community care and support remains minimal. Opportunities for education, collaboration and exchange among professionals and care providers are also severely limited. Although the proposed solution of developing ethics capacity in the home care setting is over 20 years old, only modest progress had been made until recently. This article introduces the Community Ethics Network (CEN), a replicable network of home and community care agencies in the Greater Toronto Area. Its achievements can be attributed to a commitment to work toward a common approach to ethical decision-making and to a focus on education, case reviews and policy development. CEN has produced numerous positive outcomes; key among these is the development and delivery of standardized training on ethics to more than 2,000 front-line staff of diverse backgrounds/professions and representing over 40 different organizations.

Sustainability and the principle of respect for community as a means of enhancing healthcare equality.

Global short-term dental or medical volunteerism has grown significantly in recent years. Dental and medical schools, their faculty, and students, are becoming increasingly interested in the experience of providing care to individuals in low-resource communities around the world. A laudable goal of such care is to provide care to individuals in low-resource communities and to work to achieve equity in health for all people. These goals are consistent with the American Dental Association's ethical principles of justice, beneficence, and nonmaleficence. This paper will discuss ethical guidelines for conducting these volunteer experiences with an emphasis placed on sustainability--the provision of ongoing collaborative care, between the institution overseeing the experience and the local community, after the visiting group has departed. The ultimate goal, global health care equity, requires transforming these shortterm efforts into long-term sustainable solutions. This goal is based on an ethical principle entitled respect for communities. This ethic can be likened to a community-wide application of the ethic of respect for autonomy as routinely applied to individuals such as patients. A tripartite model is proposed as a means for transforming short-term efforts into long-term sustainable solutions.

Priority setting in Ontario's LHINs: ethics and economics in action.

Healthcare organizations the world over are faced with having to set priorities and allocate resources within the constraint of a fixed envelope of funding. Drawing on economic principles of value for money and ethical principles of fair process, a priority setting framework was developed for Ontario's local health integration networks (LHINs) in late 2007 and early 2008. Subsequently, over an 18-month period, the framework was piloted in three LHINs. In this article, the framework and pilot implementations are described, results from a formal evaluation are outlined and recommendations for future use are highlighted.

[Setting up of a community/hospital network providing care for patients and their families]. / Mise en place d'une structure ville/hôpital de prise en charge des patients et de leurs familles.

With the ageing of the population, dementia has become a public healthcare priority. A network designed to help the families of patients suffering from dementia on a medical as well as a social and psychological level has been set up. This structure has been developed in close coordination with community practitioners and physicians and in line with the latest recommendations in particular with regard to ethics. Its first three years of existence confirm the importance of this type of approach which complements the care provided by hospitals.

Lessons in collaboration, four years post-Katrina.

Four action researchers present a case study of a project conducted by members of a national family therapy organization and members of a local family therapy institute, which describes their efforts to collaborate with local disaster recovery workers 2 years after Hurricane Katrina. The aim of the collaboration was to create a local action research team to study best practices that strengthen resilience after disaster. The authors discuss choice points and dilemmas faced in finding collaborative partners and in clarifying what constitutes an invitation to work in a community. The case study illuminates tensions and understandings between outsiders and a community still facing the long-term effects of a disaster.

The evolution of online ideological communities.

Online communities are virtual spaces for users to share interests, support others, and to exchange knowledge and information. Understanding user behavior is valuable to organizations and has applications from marketing to security, for instance, identifying leaders within a community or predicting future behavior. In the present research, we seek to understand the various roles that users adopt in online communities-for instance, who leads the conversation? Who are the supporters? We examine user role changes over time and the pathways that users follow. This allows us to explore the differences between users who progress to leadership positions and users who fail to develop influence. We also reflect on how user role proportions impact the overall health of the community. Here, we examine two online ideological communities, RevLeft and Islamic Awakening (N = 1631; N = 849), and provide a novel approach to identify various types of users. Finally, we study user role trajectories over time and identify community "leaders" from meta-data alone. Study One examined both communities using K-MEANS cluster analysis of behavioral meta-data, which revealed seven user roles. We then mapped these roles against Preece and Schneiderman's (2009) Reader-to-Leader Framework (RtLF). Both communities aligned with the RtLF, where most users were "contributors", many were "collaborators", and few were "leaders". Study Two looked at one community over a two-year period and found that, despite a high churn rate of users, roles were stable over time. We built a model of user role transitions over the two years. This can be used to predict user role changes in the future, which will have implications for community managers and security focused contexts (e.g., analyzing behavioral meta-data from forums and websites known to be associated with illicit activity).

The ethics of Community Empowerment: tensions in health promotion theory and practice.

The concepts of community participation, empowerment and capacity building are central tenets of contemporary health promotion theory. They reflect the view that health and well-being are shaped by a wide range of social, economic, political and organisational forces that are outside the control of individuals.Despite its theoretical appeal, the practice of Community Empowerment is ethically contentious and can produce ethical dilemmas for health promotion practitioners. In this paper we relate these dilemmas to theoretical considerations, and argue that the empowerment of communities should be understood as a means rather than an end . This leads us to argue for the adoption of what we call a Reflective Equilibrium Community Empowerment approach, which draws on both "top-down" and "bottom-up" methods to help resolve the ethical tensions in health promotion programmes.

An "opting in" paradigm for kidney transplantation.

Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, the psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors. An "opting in" paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An "opting in" program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of"organ takers"who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who "opt in" would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive. An "opting in" paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an "opting in" paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an "opting in" policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity.

[Development of health care networks: ethical and political contexts]. / Le développement des réseaux de soins et de santé: contexte éthique et politique.

The operation of our health care system is in the midst of a major crisis. There is a significantly unacceptable level of health inequities and access to care, high premature mortality rates, lack of a coherent health policy, a weakness in the professional demographic projections, increasing financial deficits, quasi-revolt of professionals, complete disregard for the law (Parliament's vote on the National Insurance's budget)--these are just a few of the symptoms of chaos which have embedded themselves right before our very eyes. This article aims to offer a glimmer of light on this gloomy horizon. It is the first outcome of a new working group which was originally referred to as "les Vignerons d'Uzès", a title which could be seen as lacking substance and has therefore become "The Transdisciplinary Working Group on the Organisation of Health and Care". The group's purpose and objective is to reflect upon the values, practices, regulations, evaluation and what is at stake in the context of our health care system.