Background Protecting a person’s right to privacy and confidentiality is important in healthcare services. As future health professionals, nursing students should bear the same responsibility as qualified health professionals in protecting patient privacy. Objectives To investigate nursing students’ practices of patient privacy protection and to identify factors associated with their practices. Research design A cross-sectional study design was adopted. A two-part survey was used to collect two types of data on nursing students: (1) personal characteristics, including demographics, clinical experience and (...) use of information and communication technology and social media and (2) practice of patient privacy protection, collected using the Patient Privacy Scale. Participants and research context: A total of 319 nursing students aged 18 or above, studying pre-registration nursing programmes and who had attended at least one block of clinical placement, were recruited from a university in Hong Kong. Ethical considerations The study received ethical approval from the Survey and Behavioural Research Ethics Committee of the Chinese University of Hong Kong. The participants were informed of the study aim and written consent was obtained before completing the survey. Findings: The mean total score on the Patient Privacy Scale was 119.7 out of 135. Nursing students who were regular users of Instagram and those who had never taken photographs with patients and hence did not need to obtain patient consent were associated with better practices of patient privacy protection (higher total scores on the Patient Privacy Scale). Conclusions The findings improve our understanding of nursing students’ practice of patient privacy protection and the associated factors. This will inform the development and revision of current strategies to enhance nursing students’ practice of patient privacy protection, especially their use of social media. (shrink)

Cheating is a serious issue among business students worldwide. However, research investigating the social factors that may help prevent cheating in Chinese higher education is rare. The present study examined two key social relationship factors of perceived teacher-student relationships and peer relationships by the students. It attempted to build a model which addressed the effects of two variables on Chinese business students’ cheating behaviour: the teacher’s approachability and the relationship goal of the students. Two important social influence factors were also (...) tested as mediators: neutralizing attitudes and perceived cheating norms of the students. A student survey was conducted with 1329 questionnaires collected. The results showed the negative effects of both social relationship variables on cheating, and that their effects were fully mediated by neutralizing attitudes. Moreover, perceived cheating norms fully mediated the effect of the teacher’s approachability, but not so for the relationship goal of the students. This study provided novel insights and recommendations for promoting academic integrity in Chinese business schools and universities. (shrink)

Little attention has been given in medical ethics literature to issues relating to the truthfulness of patients. Beginning with an actual medical case, this paper first explores truth-telling by doctors and patients as related to two prominent models of the physician-patient relationship. Utilizing this discussion and the literature on the truthfulness and accuracy of the information patients convey to doctors, these models are then critically assessed. It is argued that the patient agency (patient autonomy or contractual) model is inherently and (...) seriously flawed in numerous circumstances, even those involving informed and competent adult patients. (shrink)

This paper discusses the stability and Hopf bifurcation analysis of the diffusive Kaldor–Kalecki model with a delay included in both gross product and capital stock functions. The reaction-diffusion domain is considered, and the Galerkin analytical method is used to derive the system of ordinary differential equations. The methodology used to determine the Hopf bifurcation points is discussed in detail. Furthermore, full diagrams of the Hopf bifurcation regions considered in the stability analysis are shown, and some numerical simulations of the limit (...) cycle are used to confirm the theoretical outcomes. The delay investment parameter and diffusion coefficient can have great impacts on the Hopf bifurcations and stability of the business cycle model. The investment parameters for the gross product and capital stock as well as the adjustment coefficient of the production market are also studied. These parameters can cause instability in, and the stabilization of, the business cycle model. In addition, we point out that, as the delay investment parameter increases, the Hopf bifurcation points for the diffusion coefficient values decrease considerably. When the delay investment parameter has a very small value, the solution of the business cycle model tends to become steady. (shrink)

The 25th of January, 2011 witnessed a wave of political unrest all over Egypt, with repercussions that have re-shaped the future of contemporary Egypt. For the first time in the modern history of Egypt since the 1952 Nasserite revolution, grass-root protestors went to streets chanting slogans against the military regime headed by the (since then ex-) President of Egypt, Hosni Mubarak. This placed the then regime, as well as its mainstay, the National Democratic Party (NDP), in a political crisis on (...) both local and international scales. It is this critical moment that led Mubarak to give his unprecedented speech on February 1st, 2011. The speech has brought about epoch-making political changes in the history of contemporary Egypt. Under public pressure, two seminal declarations were made in this speech: (1) Mubarak’s intention not to nominate himself for a new presidential term; (2) a call on the Houses of Parliament to amend articles 76 and 77 of the constitution concerning the conditions on running for presidency and the period for the presidential term in Egypt. The present paper seeks to answer the following overarching question: what are the discursive strategies used for saving the political face of Mubarak in his speech on February 1st, 2011? I follow a text-analytic framework based on the socio-semantic theory of social actors and the pragmatic models of speech acts and face-threatening acts. The analysis reveals Mubarak’s attempt to save his positive political face as a legitimate President who regarded himself as the official ruler invested with absolute power over Egypt. (shrink)

The present study investigates the collocation-induced semiosis of the linguistic sign AFRICA as being used in the academic section of the Corpus of Contemporary American English (known as COCA) (Davies, Mark. 2008. The Corpus of Contemporary American English (COCA): one billion words, 1990-present. Available online at https://corpus.byu.edu/coca/). Drawing on a hybrid theoretical framework, the study utilizes Charles Peirce’s (1931–58) semiotic model of the sign and Roman Jakobson’s theory of “markedness” (Jakobson, Roman. 1972. Verbal communication. Scientific American (Special Issue, September 1). (...) 73–80) as well as Stuart Hall’s treatment of “code” (Hall, Stuart. 1980. Encoding/decoding. In Stuart Hall, Doothy Hobson, Andrew Lowe, & Paul Willis (eds.), Culture, media, language: Working papers in cultural studies, 1972–79, 117–127. New York: Routledge) and John Swales’ notion of “discourse community” (Swales, John M. 1990. Genre analysis: English in academic and research settings. Cambridge: Cambridge University Press). The study empirically tests the hypothesis that, in a given discourse domain, the relevant interpretant can decode a linguistic sign (representamen) in the co-text of its marked collocates in a way that is collocationally used via the two modes of iconic and indexical signification. The concordance-based analysis conducted in the present study offers two findings, theoretical and practical. First, the study proposes the theoretical concept of collocational semiosis as one way of methodologically integrating the study of collocation into a structural-linguistic analytic framework that richly intersects with the genre-based notion of “discourse community.” Second, in the academic discourse community of the COCA, to the expert interpretant, the representamen AFRICA has been decoded due to its marked collocates which have been technically used in two modes of signification, viz. iconic and indexical. (shrink)

Thought experiments play an important cognitive role in many fields of inquiry, especially in physics and philosophy. Do they also matter in revealed theology? In addressing this question, I will argue first why it is important to do so, then elaborate on the characteristic features of such thought experiments in revealed theology, and finally discuss two instances of thought experimenting in Augustine.

The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents’ dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in (...) this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: ‘A feeling of being abandoned’. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life. (shrink)

Based on a survey of 237 managers in Singapore, three measures of organizational ethics (namely, top management support for ethical behavior, the organization''s ethical climate, and the association between ethical behavior and career success) are found to be associated with job satisfaction. The link between organizational ethics and job satisfaction is argued from Viswesvaran et al.''s (1998) organizational justice and cognitive dissonance theories. The findings imply that organizational leaders can favorably influence organizational outcomes by engaging in, supporting and rewarding ethical (...) behavior. (shrink)

Introduction: Expressions of dignity as a clinical phenomenon in nursing homes as expressed by caregivers were investigated. A coherence could be detected between the concepts and phenomena of existence and dignity in relationships and caring culture as a context. A caring culture is interpreted by caregivers as the meaning-making of what is accepted or not in the ward culture. Background: The rationale for the connection between existence and dignity in relationships and caring culture is that suffering is a part of (...) existence, as well as compassion in relieving suffering, and ontological interdependency. Aim: To describe different expressions of dignity in relationships and existence in context of caring cultures from the perspective of the caregivers. Research design: The methodology and method are hermeneutic. The method used was to merge the theoretical preunderstanding as one horizon of understanding with empirical data. Participants and research context: Focus group interviews with caregivers in nursing homes. Ethical considerations: The principles of the Helsinki Declaration have been followed to, for example, preserve self-determination, integrity, dignity, confidentiality and privacy of the research persons. Findings: Data interpretation resulted in four themes: Encountering existential needs that promote dignity in a caring culture; To amplify dignity in relationships by the creative art of caring in a caring culture; Violation of dignity by ignorance or neglect in a non-caring culture and The ethic of words and appropriated ground values in a caring culture. Discussion: Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are adequate to see from the perspective of dignity in relationships and existence and the caring culture. Conclusions: Dignity in relationships seems to touch the innermost existential life, as the existential life is dependent on confirmation from others. (shrink)

Social technology can improve the quality of older adults' social lives and mitigate negative mental and physical health outcomes associated with loneliness, but it should be designed collaboratively with this population. In this paper, we used participatory design methods to investigate how robots might be used as social facilitators for middle-aged and older adults in both the US and Japan. We conducted PD workshops in the US and Japan because both countries are concerned about the social isolation of these older (...) adults due to their rapidly aging populations. We developed a novel approach to participatory design of future technologies that spends 2/3 of the PD session asking participants about their own life experiences as a foundation. This grounds the conversation in reality, creates rapport among the participants, and engages them in creative critical thinking. Then, we build upon this foundation, pose an abstract topic, and ask participants to brainstorm on the topic based on their previous discussion. In both countries, participants were eager to actively discuss design ideas for socially facilitative robots and imagine how they might improve their social lives. US participants suggested design ideas for telepresence robots, social distancing robots, and social skills artificial intelligence programs, while Japanese participants suggested ideas for pet robots, robots for sharing experiences, and easy-to-operate instructor robots. Comparing these two countries, we found that US participants saw robots as tools to help facilitate their social connections, while Japanese participants envisioned robots to function as surrogate companions for their parents and distract them from loneliness when they were unavailable. With this paper, we contribute to the literature in two main ways, presenting: A novel approach to participatory design of future technologies that grounds participants in their everyday experience, and Results of the study indicating how middle-aged and older adults from the US and Japan wanted technologies to improve their social lives. Although we conducted the workshops during the COVID-19 pandemic, many findings generalized to other situations related to social isolation, such as older adults living alone. (shrink)

There is a need for person-centred approaches and empowerment of staff within the residential care for older people; a movement called ‘culture change’. There is however no single path for achieving culture change. With the aim of increasing understandings about cultural change processes and the promotion of cultural values and norms associated with person-centred practices, this article presents an action research project set on a unit in the Netherlands providing care for older people with dementia. The project is presented as (...) a case study. This study examines what has contributed to the improvement of participation of older people with dementia in daily occupational and leisure activities according to practitioners. Data was collected by participant observation, interviews and focus groups. The results show that simultaneous to the improvement of the older people’s involvement in daily activities a cultural transformation took place and that the care became more person-centred. Spontaneous interactions and responses rather than planned interventions, analysis and reflection contributed to this. Furthermore, it proved to be beneficial that the process of change and the facilitation of that process reflected the same values as those underlying the cultural change. It is concluded that changes arise from dynamic, interactive and non-linear processes which are complex in nature and difficult to predict and to control. Nevertheless, managers and facilitators can facilitate such change by generating movement through the introduction of small focused projects that meet the stakeholders’ needs, by creating conditions for interaction and sense making, and by promoting the new desired cultural values. (shrink)

The purpose of this research is to investigate the effectiveness of Digital Content Marketing on a Mixed Reality training platform environment with the consideration of online purchase intention through social media. E-commerce today encounters several common issues that cause customers to have reservations to purchase online. With the absence of physical contact points, customers often perceive more risks when making purchase decisions. Furthermore, online retailers often find it hard to engage customers and develop long-term relationships. In this research, a Structural (...) Equation Model is proposed to examine the efficacy of DCM from both immediate and long-term OPI. The results examine whether adopting DCM on an MR training platform environment through social media brings positive results in OPI. Empirical research was carried out through online questionnaires collected in 2021 and 2022. A total of 374 questionnaires were qualified for data analysis in this study, conducted with IBM SPSS and AMOS. The results imply that DCM is critical to stimulating both immediate and long-term OPI. The immediate OPI is positively affected by increasing perceived value through MR in DCM. Regarding the long-term OPI, increased customer engagement with DCM under MR environment can cultivate brand trust and significantly affect the long-term OPI. (shrink)

The counseling process involves attention, emotional perception, cognitive appraisal, and decision-making. This study aimed to investigate cognitive appraisal and the associated emotional processes when reading short therapists' statements of motivational interviewing (MI). Thirty participants with work injuries were classified into the pre-contemplation (PC,n= 15) or readiness stage of the change group (RD,n= 15). The participants viewed MI congruent (MI-C), MI incongruent (MI-INC), or control phrases during which their electroencephalograms were captured. The results indicated significant Group × Condition effects in the (...) frontally oriented late positive complex (P600/LPC). The P600/LPC's amplitudes were more positive-going in the PC than in the RD group for the MI congruent statements. Within the PC group, the amplitudes of the N400 were significantly correlated (r= 0.607–0.649) with the participants' level of negative affect. Our findings suggest that the brief contents of MI statements alone can elicit late cognitive and emotional appraisal processes beyond semantic processing. (shrink)

While experience often affords important knowledge and insight that is difficult to garner through observation or testimony alone, it also has the potential to generate conflicts of interest and unrepresentative perspectives. We call this tension the paradox of experience. In this paper, we first outline appeals to experience made in debates about access to unproven medical products and disability bioethics, as examples of how experience claims arise in bioethics and some of the challenges raised by these claims. We then motivate (...) the idea that experience can be an asset by appealing to themes in feminist and moral epistemology, distinguishing between epistemic and justice-based appeals. Next, we explain the concern that experience may be a liability by appealing to empirical work on cognitive biases and theoretical work about the problem of partial representation. We conclude with preliminary recommendations for addressing the paradox and offer several questions for future discussion. (shrink)

Cheating is a serious issue among business students worldwide. However, research investigating the social factors that may help prevent cheating in Chinese higher education is rare. The present study examined two key social relationship factors of perceived teacher-student relationships and peer relationships by the students. It attempted to build a model which addressed the effects of two variables on Chinese business students’ cheating behaviour: the teacher’s approachability and the relationship goal of the students. Two important social influence factors were also (...) tested as mediators: neutralizing attitudes and perceived cheating norms of the students. A student survey was conducted with 1329 questionnaires collected. The results showed the negative effects of both social relationship variables on cheating, and that their effects were fully mediated by neutralizing attitudes. Moreover, perceived cheating norms fully mediated the effect of the teacher’s approachability, but not so for the relationship goal of the students. This study provided novel insights and recommendations for promoting academic integrity in Chinese business schools and universities. (shrink)

If a hereditary predisposition to colorectal cancer or breast cancer is diagnosed, most guidelines state that clinical geneticists should request index patients to inform their at-risk relatives about the existence of this condition in their family, thus enabling them to consider presymptomatic genetic testing. Those identified as mutation carriers can undertake strategies to reduce their risk of developing the disease or to facilitate early diagnosis. This procedure of informing relatives through the index patient has been criticised, as it results in (...) relatively few requests for genetic testing, conceivably because a certain number of relatives remain uninformed. This pilot study explored attitudes toward informing family members and relevant practices among clinical geneticists. In general, clinical geneticists consider it to be in the interests of family members to be informed and acknowledge that this goal is not accomplished by current procedures. The reasons given for maintaining present practices despite this include clinical ‘mores’, uncertainty about the legal right of doctors to inform family members themselves, and, importantly, a lack of resources. We discuss these reasons from an ethical point of view and conclude that they are partly uninformed and inconsistent. If informing relatives is considered to be in their best interests, clinical geneticists should consider informing relatives themselves. In the common situation in which index patients do not object to informing relatives, no legal obstacles prevent geneticists from doing so. An evaluation of these findings among professionals may lead to a more active approach in clinical practice. (shrink)

Cyclin-dependent kinase 5 has been implicated in Alzheimer's disease pathogenesis. Here, we demonstrate that overexpression of p25, an activator of cdk5, led to increased levels of BACE1 mRNA and protein in vitro and in vivo. A p25/cdk5 responsive region containing multiple sites for signal transducer and activator of transcription was identified in the BACE1 promoter. STAT3 interacts with the BACE1 promoter, and p25-overexpressing mice had elevated levels of pSTAT3 and BACE1, whereas cdk5-deficient mice had reduced levels. Furthermore, mice with a (...) targeted mutation in the STAT3 cdk5 responsive site had lower levels of BACE1. Increased BACE levels in p25 overexpressing mice correlated with enhanced amyloidogenic processing that could be reversed by a cdk5 inhibitor. These data demonstrate a pathway by which p25/cdk5 increases the amyloidogenic processing of APP through STAT3-mediated transcriptional control of BACE1 that could have implications for AD pathogenesis. (shrink)

ABSTRACTThe rapid expansion of primary education in Ethiopia has enabled most children to attend primary education—or at least to start schooling. This expansion, however, is largely “symbolic” rat...

Causal independence of the simultaneous positions and momenta of two distinguishable particles in nonrelativistic physics and causal independence of events in two relatively spacelike regions of space-time in relativity are analyzed and discussed. This review paper formulates causal independence in a general and operational way and summarizes the inferences drawn from it in non-relativistic quantum mechanics, classical relativistic point mechanics, quantum field theory, and classical field theory. Special attention is given to the open question of the relationship between local independence (...) and commutativity in quantum field theory. (shrink)

The image of nature as causality has been a major theme of science and poetry. It has been a symbol of hope and fear, of progress and futility. Yet its meaning has seldom been clear. Prior to any statement about the relation of causality to physical nature, life, and mind, its meaning should be established. I shall therefore first define causality, and I shall then discuss its applicability to nature.

Upshot: In the model simulation and the human experiment, we observed that attention shifted from a tool to a task. This was accompanied by bodily extension. However, our experiments lack a sense of bodily incorporation (the sense of ownership. Based on the valuable commentaries, we would like to discuss the necessary conditions for possible bodily incorporation in terms of redundant degrees of freedom, synchronous visual tactile stimulation, and 1/f noise.

One of the hot research topics today is relationship marketing. However, little research has been carried out in understanding the complex concepts of Guanxi (relationship) in a Chinese society. This research describes a study to operate the constructs of guanxi and explores the importance of guanxi in relationship development in order to present a new Guanxi framework. A study of both Western and Chinese literature provides foundations of the Guanxi perspectives. The constructs of adaptation, trust, opportunism and favour are identified. (...) Adaptation and trust are found to be positively correlated with sales stability and quality. Whilst, adaptation is negatively correlated with relationship termination costs. Both theoretical framework (a new perceptual map) and managerial implications are given. In addition, recommendations for future research are made. (shrink)

Faced with the threat of pandemic influenza, several countries have made the decision to put a number of measures in place which have been incorporated into national plans. In view of the magnitude of the powers and responsibilities that States assume in the event of a pandemic, a review of the various national preparedness and response plans for pandemic influenza brought to light a series of extremely important ethical concerns. Nevertheless, in spite of the recent emergence of literature focusing specifically (...) on the ethical aspects of pandemics, too few studies explicitly examine public participation as one means of ethical contribution to public health policies. Thus this article seeks, in the first place, to present an analysis of the various national preparedness and response plans for pandemic influenza, and secondly, to outline the role that the plans envisage for ethics and more importantly for public participation. (shrink)

All these activities of living beings, and the functioning of their organs, and the functioning of instruments demand a teleological explanation. Why do human beings toil? Why do living beings try to maintain the activities of the organism? What are the functions of specific organs or instruments? Intelligible answers can be given in teleological terms. Of course, one could ask many questions about these situations that would not require the teleological explanation; for example, questions concerning the mechanical structure of living (...) beings or of instruments. Yet this fact would not eliminate the legitimacy nor the utility of the teleological category. (shrink)

All these activities of living beings, and the functioning of their organs, and the functioning of instruments demand a teleological explanation. Why do human beings toil? Why do living beings try to maintain the activities of the organism? What are the functions of specific organs or instruments? Intelligible answers can be given in teleological terms. Of course, one could ask many questions about these situations that would not require the teleological explanation; for example, questions concerning the mechanical structure of living (...) beings or of instruments. Yet this fact would not eliminate the legitimacy nor the utility of the teleological category. (shrink)

Subjects enrolled in studies testing high risk interventions for incurable or progressive brain diseases may be vulnerable to deficiencies in informed consent, such as the therapeutic misconception. However, the definition and measurement of the therapeutic misconception is a subject of continuing debate. Our qualitative pilot study of persons enrolled in a phase I trial of gene transfer for Parkinson disease suggests potential avenues for both measuring and preventing the therapeutic misconception. Building on earlier literature on the topic, we developed and (...) tested an interview guide that focuses on how the subjects decided to participate, emphasizing the integration of subjects’ various statements that are relevant to assessing the therapeutic misconception, rather than evaluating them as isolated statements. The results indicate that a subject’s understanding of the purpose of research is best explored in juxtaposition to the subject’s motivation for participating. (shrink)

Context: Our body schema is not restricted to biological body boundaries (such as the skin), as can be seen in the use of a cane by a person who is visually impaired or the “rubber hands” experiment. The tool becomes a part of the body schema when the focus of our attention is shifted from the tool to the task to be performed. Problem: A body schema is formed through interactions among brain, body, tool, and environment. Nevertheless, the dynamic mechanisms (...) underlying changes in the body schema are still not fully understood. Method: To study the changing conditions of the body schema (e.g., a shift of attention), a simulation model of object discrimination was extended to differentiate between two kinds of sensitivities – sensitivity to an object being directly manipulated and sensitivity to another object being manipulated by the first. The proposed model consisted of windmills with different numbers of vanes. A model agent was required to determine the number of vanes on a windmill by touching the vanes blindly with an arm controlled by a neural network. Placing a second windmill beside the first and gearing the two windmills to move associatively resulted in the agent using the first windmill as a tool with which to discern the number of vanes on the second windmill. In other words, an agent’s body schema can shift from its arm tip to the boundary between the first and second windmills. We then introduced an experiment with a real windmill model to test the hypothesis demonstrated by the theoretical model. Results: We demonstrated that even simple computational agents can have two different sensitivities to the windmills. One agent becomes sensitive to the first windmill and insensitive to the second one. Another agent becomes insensitive to the first windmill and sensitive to the second one by using the first one as a tool. Therefore, we concluded that the boundary of the body schema was extended to the first windmill in the case of the latter agent because paying attention to the task to be performed instead of the tool itself is essential for the tool to be considered as part of the body schema. Analysis of the experiments using a computational model and human experimentation revealed that a shift from an irregular to a regular movement of a windmill is an indication of extension of the body schema. Constructivist content: Our insights are beneficial for enactive cognitive science. This is because an extended body schema questions the Cartesian separation between subject and object, and the self and the environment. (shrink)

The paper surveys the problem of language and translation in Antoine Berman’s pioneering achievements. This French philosopher of translation was deeply influenced not only by Schleiermacher, who affirmed the unity of thought and expression, but also by Benjamin, who drew attention to the formalism of language. In Berman’s view the essence of language lies in signifiers and letters. He criticized the Platonic view of language and translation which endows non-sensual, mental, and universal elements, with a higher ontological status. Thus Berman (...) proposed a modern theory of translation without Platonism. Meanings can be realized through and within letters not only in the source language, but also in the target language. In this sense, Berman’s philosophy of translation clearly reflects “the achievements of modern semiotics” . The paper criticizes the conception of translation as trapped within the logic of identity, which ignores the differences between, and the multiplicity of, languages as a result of a deep-rooted drive to obtain a universal meaning. The paper shows that Berman’s philosophy reflects and accepts this multiplicity allowing thereby the logic of difference/otherness to flourish in translation. (shrink)

Should the assessment of decision‐making capacity (DMC) be risk sensitive, that is, should the threshold for DMC vary with risk? The debate over this question is now nearly five decades old. To many, the idea that DMC assessments should be risk sensitive is intuitive and commonsense. To others, the idea is paternalistic or incoherent, or both; they argue that the riskiness of a given decision should increase the epistemic scrutiny in the evaluation of DMC, not increase the threshold for DMC. (...) We respond to the critics’ main concerns by providing a comprehensive account of how risk‐sensitive DMC is coherent, avoids paternalism, and best fulfills the epistemic goal of DMC evaluations. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

The determination of the place of life in nature has been a major philosophic issue. Some, in their attempt to show the continuity of nature, have resorted to the reductive method and have argued that the living differ in no significant sense from the non-living, unless it be in their complexity; others, in their desire to emphasize the qualitatively varied aspects of nature, have drifted to disjunctive method and have claimed that there is an unbridgeable gap between the living and (...) the non-living. Yet life in its natural setting presents both continuity with the physical world and a distinctive difference from it. One need neither sunder the continuity in nature nor deny the empirically observable qualitative differences. It is this principle that will guide the present discussion of life. (shrink)

Meanings have an empirical genesis and status. This simple claim has often been denied or ignored. Some metaphysicians in their exaltation of the eternal have regarded meanings as essences, or eternal objects, or neutral entities, in a subsistential or supernatural realm that is changeless and has no roots in nature. Some logicians in their zest to manipulate meanings isolate them so completely as forms of reason, or as syntactical symbols that at no point is their connection with natural events made (...) intelligible. Yet meanings, all meanings, have relation to mind. It is this empirical, psychological aspect of meaning that I shall analyze. The larger philosophic question as to what the relation of the psychological aspect is to the metaphysical or the logical will not concern us except indirectly. (shrink)

We are grateful to Jongsma et al 1 for their interest in our article analysing the case of ‘Mrs A’, a Dutch woman with Alzheimer’s disease who received euthanasia based on her advance euthanasia directive.2 Their commentary criticises two elements of our analysis. First, the authors believe our reasons for doubting that Mrs A had the capacity to write and revise an AED rely on ‘partial’ empirical data and rest on normative errors. Second, they use two of our statements to (...) suggest we must endorse some implausible claims, for example, that ‘… in all situations and for all people, current well-being should always take precedence over all other values’. Jongsma et al assert: ‘Miller et al argue that people with dementia are impaired to make decisions.’ This casts our probabilistic claim about Mrs A’s capacity as an absolute claim about persons with dementia in general. It also implies we are using an outdated diagnosis-based view of capacity. The accusation then becomes explicit : > … several empirical studies have shown that patients with dementia are able to actively participate in qualitative studies and can respond to open questions in a meaningful way,[2-8] as well that they are able to complete an advance directive in the early phases of dementia.[9, 10] One can therefore not simply conclude on the basis of the diagnosis of dementia …. (shrink)

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

In presence of predator population, the prey population may significantly change their behavior. Fear for predator population enhances the survival probability of prey population, and it can greatly reduce the reproduction of prey population. In this study, we propose a predator-prey fishery model introducing the cost of fear into prey reproduction with Holling type-II functional response and prey-dependent harvesting and investigate the global dynamics of the proposed model. For the system without harvest, it is shown that the level of fear (...) may alter the stability of the positive equilibrium, and an expression of fear critical level is characterized. For the harvest system, the existence of the semitrivial order-1 periodic solution and positive order- q periodic solution is discussed by the construction of a Poincaré map on the phase set, and the threshold conditions are given, which can not only transform state-dependent harvesting into a cycle one but also provide a possibility to determine the harvest frequency. In addition, to ensure a certain robustness of the adopted harvest policy, the threshold condition for the stability of the order- q periodic solution is given. Meanwhile, to achieve a good economic profit, an optimization problem is formulated and the optimum harvest level is obtained. Mathematical findings have been validated in numerical simulation by MATLAB. Different effects of different harvest levels and different fear levels have been demonstrated by depicting figures in numerical simulation using MATLAB. (shrink)

By analyzing a gedanken experiment designed to measure the distance l between two spatially separated points, we find that this distance cannot be measured with uncertainty less than (ll 2 P) 1/3 , considerably larger than the Planck scale lP (or the string scale in string theories), the conventional-wisdom uncertainty in distance measurements. This limitation to space-time measurements is interpreted as resulting from quantum fluctuations of space-time itself. Thus, at very short distance scales, space-time is “foamy.” This intrinsic foaminess of (...) space-time provides another source of noise in the interferometers. The LIGO/VIRGO and LISA generations of gravity-wave interferometers, through future refinements, are expected to reach displacement noise levels low enough to test our proposed degree of foaminess in the structure of space-time. (shrink)

The Patient Preference Predictor (PPP) proposal places a high priority on the accuracy of predicting patients’ preferences and finds the performance of surrogates inadequate. However, the quest to develop a highly accurate, individualized statistical model has significant obstacles. First, it will be impossible to validate the PPP beyond the limit imposed by 60%–80% reliability of people’s preferences for future medical decisions—a figure no better than the known average accuracy of surrogates. Second, evidence supports the view that a sizable minority of (...) persons may not even have preferences to predict. Third, many, perhaps most, people express their autonomy just as much by entrusting their loved ones to exercise their judgment than by desiring to specifically control future decisions. Surrogate decision making faces none of these issues and, in fact, it may be more efficient, accurate, and authoritative than is commonly assumed. (shrink)

Most jurisdictions require that a mental capacity assessment be conducted using a functional model whose definition includes several abilities. In England and Wales and in increasing number of countries, the law requires a person be able to understand, to retain, to use or weigh relevant information and to communicate one’s decision. But interpreting and applying broad and vague criteria, such as the ability ‘to use or weigh’ to a diverse range of presentations is challenging. By examining actual court judgements of (...) capacity, we previously developed a descriptive typology of justifications used in the application of the Mental Capacity Act criteria. We here critically optimise this typology by showing how clear definitions—and thus boundaries—between the criteria can be achieved if the ‘understanding’ criterion is used narrowly and the multiple rationales that fall under the ability to ‘use or weigh’ are specifically enumerated in practice. Such a typology-aided practice, in theory, could make functional capacity assessments more transparent, accountable, reliable and valid. It may also help to create targeted supports for decision making by the vulnerable. We also discuss how the typology could evolve legally and scientifically, and how it lays the groundwork for clinical research on the abilities enumerated by the MCA. No data are available. This paper does not report any original data. (shrink)

Bioethicists have long been concerned that seriously ill patients entering early phase (‘phase I’) treatment trials are motivated by therapeutic benefit even though the likelihood of benefit is low. In spite of these concerns, consent forms for phase I studies involving seriously ill patients generally employ indeterminate benefit statements rather than unambiguous statements of unlikely benefit. This seeming mismatch between attitudes and actions suggests a need to better understand research ethics committee members’ attitudes toward communication of potential benefits and risks (...) of early phase studies to potential subjects. We surveyed the members of two U.S. research ethics committees using a phase I gene transfer study scenario, and compared the results to a previous survey of potential subjects’ perceptions and attitudes toward benefit and risk for the same protocol. The results show that there is indeed a gap between the subjects’ perceptions and the committee members’ views on what is appropriate to be communicated to research subjects. This discrepancy is the product of both the commonly assumed optimism of the subjects and to a “protective pessimism” of the research ethics committee members. We discuss this discrepancy using “frameworks of trust” and demonstrate the need to incorporate these frameworks into the existing model of informed consent. (shrink)

The routine practice of clinical research involving patient-subjects without informed consent prior to 1966 unquestionably was unethical. Does it follow that all clinical research involving competent adult patient-subjects is unethical without informed consent?In his landmark 1966 paper, Henry Beecher noted that of the 50 example studies he had originally compiled in preparation for that paper, only two even mentioned consent, and he observed further that mention of consent is “meaningless unless one knows how fully the patient was informed”. Some of (...) the studies in Beecher’s paper, such as one comparing sulfadiazine with no treatment to assess the complications of streptococcal pharyngitis (when the... (shrink)

Drawing on the general ethics and social psychology literature, this study presents a model to delineate the major factors likely to affect consumers’ intentions to bring their own shopping bags when visiting a supermarket (called “bring your own bags” or “BYOB” intention). The model is empirically validated using a survey of 250 Chinese consumers. Overall, the findings support the hypothesized direct influence of teleological evaluation and habit on BYOB intention, as well as that of deontological evaluation and teleological evaluation on (...) ethical judgment about the BYOB practice. Teleological evaluation exerts a much stronger influence on ethical judgment than does deontological evaluation. In addition, the findings reveal that consumers who perceive the BYOB practice to be more important are more inclined to rely on their ethical judgment to derive their BYOB intention. Academically, these findings provide some encouraging evidence for the application of general ethics theories to explain green consumption-related practices. Practically, the findings also suggest that a utilitarian approach (i.e., emphasizing the consequences of BYOB) may represent an effective means for the Chinese government to promote BYOB practice among consumers. (shrink)

Group-based emotions have been conceptualised as being rooted in perceivers' social identity. Consistent with this idea, previous research has shown that social identity salience affects group-based emotions, but no research to date has directly examined the role of group-based appraisals in comparison with individual appraisals. In the present studies, we measured group-based appraisals through a thought-listing procedure. In Experiment 1, we explicitly reminded people of their group identity, which led to the predicted change in group-based anger. This effect was mediated (...) by group-based appraisals. In Experiment 2, participants either discussed a group-relevant scenario in small groups or a related topic irrelevant to the group. The group-relevant condition not only led to stronger indignation but the perceived presence of group-based appraisals was also related to participants' reports of indignation. These results provide further evidence for the importance of group-based appraisals as components of group-based emotions. (shrink)

_ Source: _Volume 40, Issue 1, pp 104 - 115 It is intended in this study to present initial reliability and validity data for the Russian adaptation of the Multidimensional Inventory of Religious/Spiritual Well-being, as being related to personality factors and psychopathology. Therefore, the first version of the MI-RSWB-R was applied to a sample of 192 non-clinical subjects, together with the NEO Five Factor Inventory and the Symptom-Check-List. The original six-factor structure of the scale could be replicated for the MI-RSWB-R, (...) which also provides satisfying psychometric properties. In accordance with previous research the RSWB total score was linked to more favorable personality traits such as Extraversion, Openness to Experience, and Agreeableness, which was paralleled by substantial negative correlations with increased psychopathology. Our findings support the reliability and structural validity of the MI-RSWB-R as a standardized instrument for addressing the spiritual dimension in Russian populations. Further research in clinical surroundings is now recommended. (shrink)

Objectives The objective of this research was to develop ethics accreditation standards for hospitals. Research design Our research methods included a literature review, an expert focus group, the Delphi technique and a hospital survey. The entire process was separated into two stages: (1) the development of a draft of hospital ethics accreditation standards; and (2) conducting a nationwide hospital survey of the proposed standards. Results This study produced a tentative draft of hospital ethics accreditation standards comprised of six chapters and (...) 62 standards based on the expert focus group and Delphi technique. The six chapters are: Medical ethics policies, regulations and leadership; The establishment and operation of a medical ethics committee; The establishment and operation of research-related ethics committees; Medical ethics education; Organisational ethical climate; and Respect for patients' rights and establishment of good hospital-patient relationships. The hospital survey indicated that the concept of an organisational ethical climate was new to most hospital managers, most hospitals disliked the idea of having a separate hospital ethics accreditation system, and small hospitals were concerned about their ability to comply with all of the standards. Conclusions Regardless of whether hospital ethics accreditation can be a stand-alone accreditation or just part of existing hospital accreditation programmes, we hope this draft can serve as a good reference for future endeavours by hospital accreditation authorities. (shrink)

BackgroundIt is commonly reported by editors that it has become harder to recruit reviewers for peer review and that this is because individuals are being asked to review too often and are experiencing reviewer fatigue. However, evidence supporting these arguments is largely anecdotal.Main bodyWe examine responses of individuals to review invitations for six journals in ecology and evolution. The proportion of invitations that lead to a submitted review has been decreasing steadily over 13 years (2003–2015) for four of the six (...) journals examined, with a cumulative effect that has been quite substantial (average decline from 56% of review invitations generating a review in 2003 to just 37% in 2015). The likelihood that an invitee agrees to review declines significantly with the number of invitations they receive in a year. However, the average number of invitations being sent to prospective reviewers and the proportion of individuals being invited more than once per year has not changed much over these 13 years, despite substantial increases in the total number of review invitations being sent by these journals—the reviewer base has expanded concomitant with this growth in review requests.ConclusionsThe proportion of review invitations that lead to a review being submitted has been declining steadily for four of the six journals examined here, but reviewer fatigue is not likely the primary explanation for this decline. (shrink)