Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is the (...) contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people’s perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization. (shrink)

A hippocampal patient is described who shows preserved item recognition and simple recognition-based recollection but impaired recall and associative recognition. These data and other evidence suggest that contrary to Aggleton & Brown's target article, Papez circuit damage impairs only complex item-item-context recollection. A patient with perirhinal cortex damage and a delayed global memory deficit, apparently inconsistent with A&B's framework, is also described.

Les décisions politiques sur les risques environnementaux complexes font fréquemment intervenir des éléments scientifiques contestés. Il n’y a généralement pas de « faits » qui conduisent à une politique correcte unique. Les éléments de preuve qui sont intégrés dans les avis scientifiques destinés à une décision politique nécessitent une évaluation de leur qualité. En 2003, l’Agence néerlandaise d’évaluation environnementale a adopté une méthode standardisée, désignée sous le nom de « guide », dans le cadre de laquelle les principaux aspects de (...) la production et de l’utilisation des connaissances sont présentés grâce à une liste de contrôle visant à l’évaluation et à la communication des incertitudes. Dans cet article, nous présentons des résultats de l’application de ce guide à la controverse sur les risques des particules en suspension. La délibération active sur l’incertitude dans un contexte d’expertise entraîne un processus d’apprentissage commun entre les experts et les décideurs politiques, ce qui conduit à une meilleure prise de conscience du phénomène d’incertitude et de ses implications politiques.Policy decisions on complex environmental risks often involve disputed science. Typically, there are no “ facts” to support a single unequivocally correct policy. The evidence provided in scientific studies for policy-making decisions requires high-quality assessment. In 2003, the Netherlands Environmental Assessment Agency adopted a standardized method, referred to as “guidelines”, whereby key quality aspects of knowledge production and use are presented in the form of a checklist for uncertainty assessments and communication. In this article, we present the outcomes of applying the guidelines in controversies on the risks of ambient particulate matter. In the policy–advisory context, active deliberation on uncertainty produces a common learning process for advisors and policy makers, which leads to a deeper understanding and increased awareness of the phenomenon of uncertainty and its policy implications. (shrink)

This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception about the nature of clinical research and the status of research subjects. Second, given that it is not clear who the research subject/s in MFS is/are, if clinical equipoise is to be used as a (...) criterion to test the ethical appropriateness of RCT, its meaning should be unambiguous. Third, because of the multidisciplinary character of MFS, it is not clear who should be in equipoise. As a result, we lack an adequate criterion for the ethical review of MFS protocols. In our account, which is based on Chervenak and McCullough's seminal work in the field of obstetric ethics, equipoise is abandoned. and RCT involving MFS can be ethically initiated when a multidisciplinary ethics review board (ERB), having an evidence-based assessment of the risks involved, is convinced that the value of answering the research hypothesis, for the sake of the health interests of future pregnant women carrying fetuses with certain congenital birth defects, justifies the actual risks research participants might suffer within a set limit of low/manageable. (shrink)

A lot of research has been done on the detection of mental workload using various bio-signals. Recently, deep learning has allowed for novel methods and results. A plethora of measurement modalities have proven to be valuable in this task, yet studies currently often only use a single modality to classify MWL. The goal of this research was to classify perceived mental workload using a deep neural network that flexibly makes use of multiple modalities, in order to allow for feature sharing (...) between modalities. To achieve this goal, an experiment was conducted in which MWL was simulated with the help of verbal logic puzzles. The puzzles came in five levels of difficulty and were presented in a random order. Participants had 1 h to solve as many puzzles as they could. Between puzzles, they gave a difficulty rating between 1 and 7, seven being the highest difficulty. Galvanic skin response, photoplethysmograms, functional near-infrared spectrograms and eye movements were collected simultaneously using LabStreamingLayer. Marker information from the puzzles was also streamed on LSL. We designed and evaluated a novel intermediate fusion multimodal DNN for the classification of PMWL using the aforementioned four modalities. Two main criteria that guided the design and implementation of our DNN are modularity and generalisability. We were able to classify PMWL within-level accurate on a seven-level workload scale using the aforementioned modalities. The model architecture allows for easy addition and removal of modalities without major structural implications because of the modular nature of the design. Furthermore, we showed that our neural network performed better when using multiple modalities, as opposed to a single modality. The dataset and code used in this paper are openly available. (shrink)

In this article the perspective shifts to the “upstream” end of the agricultural knowledge and information system (AKIS). Because knowledge policy and strategic decision-making are not the prerogative of the public sector, organizations such as cooperative unions and multinational companies are included. After considering the influence of the changing environment on the nature of the AKIS, the role of knowledge management and policy in the emerging knowledge and information market is examined. Special attention is given to public and private R&D. (...) The article then looks where information technology (IT) fits in and what considerations determine strategic investment in IT projects and sustained services. Some of the European experiences with this strategic investment are evaluated. (shrink)