The papers in this series of five volumes provide a snapshot of current trends in European Cognitive Science. Each of the volumes deals with problems in cognitive science from a different perspective, covering the interacting disciplines of cognitive psychology, logic and linguistics, human-computer interaction, neuroscience and artificial intelligence respectively. Linguistics is concerned with the structure and use of languages, and logic with the form and correctness of argumentation in ordinary and scientific language. The two fields are presented with respect to (...) their role in cognitive science and artificial intelligence: How are they realised by psychological mechanisms or biological processes on the one hand or programmed or wired in machines on the other. The contributions in this volume give introductions to the state-of-the-art, emphasizing the analysis of complexity and flexibility in logic and language in the framework of classical approaches (Chapters 3, 4, 5, 7). At the same time some contributions present a broader perspective in which an integration of the formal structure with the structure of the processing systems might be possible (Chapters 2 & 6). In this context, the differences and the perspectives of the classical approaches on the one hand and of connectionist approaches on the other are compared. (Chapters 1 & 6).contributions present a broader perspective in which an integration of the formal structure with the structure of the processing systems might be possible (Chapters 2 & 6). In this context, the differences and the perspectives of the classical approaches on the one hand and of connectionist approaches on the other are compared. (Chapters 1 & 6). (shrink)

In the 20th century, the term “media logic” was introduced to denote the influence of independent mass media on political systems and other institutions. In recent years the idea has been reworked and labeled “mediatization” to widen the framework by including new media and new areas of application. In Section Two the paper discusses different conceptualizations. It is argued that even if they bring new insights, they cannot be unified into one concept, and that they also lack a consistent definition (...) of digital media. Section three provides a definition of digital media in order to identify new trajectories made possible by these media, which have led into a new media matrix built around the internet and mobile devices. It will be argued that the new media matrix cannot be understood from a point of view defined by the framework of 20th century mass media because digital media open new trajectories and because in the new matrix the previously existing media have had to transform themselves. (shrink)

The article presents a conceptual framework for distinguishing different sorts of heterogeneous digital materials. The hypothesis is that a wide range of heterogeneous data resources can be characterized and classified due to their particular configurations of hypertext features such as scripts, links, interactive processes, and time scalings, and that the hypertext configuration is a major but not sole source of the messiness of big data. The notion of hypertext will be revalidated, placed at the center of the interpretation of networked (...) digital media, and used in the analysis of the fast-growing amounts of heterogeneous digital collections, assemblages, and corpora. The introduction summarizes the wider background of a fast-changing data landscape. (shrink)

The purpose of this chapter is to clarify what the concept of digital media might add to the understanding of mediatization and what the concept of mediatization might add to the understanding of digital media. It is argued that digital media open an array of new trajectories in human communication, which were not anticipated in previous conceptualizations of media and mediatization. If digital media are to be included, the concept of mediatization has to be revised and new parameters must be (...) integrated in the concept of media. At the same time, it is argued that the concept of mediatization still provides a variety of perspectives of relevance to the study of digital media. The claim that the concept of mediatization has to be reinterpreted can only be legitimized if digital media are considered distinct from the media formerly referred to in mediatization theory. Such characteristics are presented and digital media are defined in section 2, while section 1 is devoted to theories of mediatization and the notion of media. Section 3 analyses the relation between mediatization and digitization. Finally, in section 4, medium theory is revisited with a view to harvest some missing fruits in contemporary mediatization theory. (shrink)

The composition of a timeline depends on purpose, perspective, and scale – and of the very understanding of the word, the phenomenon referred to, and whether the focus is the idea or concept, an instance of an idea or a phenomenon, a process, or an event and so forth. The main function of timelines is to provide an overview over a long history, it is a kind of a mnemotechnic device or a particular kind of Knowledge Organization System (KOS).b The (...) entries in the timeline should be brief and indisputable. Therefore, timelines often identify the first occurrences rather than the most widespread or most qualified instances leaving the fuller and more complex, and possibly disputable story out. But even first occurrences are often difficult to establish. The first occurrence is most often only the first finding of an instance. Older instances may be found and competing definitions develop either within a field or in different fields. This is further complicated since the phenomena, their names, and their meanings may change over time. Former meanings may become redundant, or they must accommodate and coexist with new meanings. The time and place of the composition of the timeline are to be considered in interpreting the things listed. The following note will discuss these issues as they occur in the development of the notions of text, e-text and hypertext, and the origin of machine translation. (shrink)

Until the late 19th century scientists almost always assumed that the world could be described as a rule-based and hence deterministic system or as a set of such systems. The assumption is maintained in many 20th century theories although it has also been doubted because of the breakthrough of statistical theories in thermodynamics (Boltzmann and Gibbs) and other fields, unsolved questions in quantum mechanics as well as several theories forwarded within the social sciences. Until recently it has furthermore been assumed (...) that a rule-based and deterministic system was also predictable if only the rules were known, but this assumption has now been undermined by modern chaos-theory describing rule-based and deterministic, but unpredictable systems, while catastrophe-theory delivers a set of types describing various kinds of instability and conditions for the stability of a given system. Hence the main trait in the theoretical development in the 20th-century science can be described as a basic modification and limitation of some of the fundamental and strong assumptions forwarded in the previous epochs of modern science. Ironically, the very same process has been a process in which the human capacity to intervene in nature has expanded dramatically and mainly with the help of the very same theories, and not least because they allow nature to be described and made manipulable on a lower level and a more fine-grained scale. While the overall theoretical consistency between the various theories has gone, the reach of human intervention in nature has increased based on quite new dimensions whether in the area of physics (e.g.: energy technologies, chemical technologies, nanotechnologies etc.) or biology (ge¬netic manipulation) or in the area of psychology, sociology and culture (artificial simulations of mental processes, new means of communication, implying changes in the social infrastructure and cultural behaviour etc.). While some of these changes and new conditions can be reflected from within the conceptual framework of rule-based systems, albeit more complex than formerly recognized, others seem to give rise to the question of whether there are »systems« and relations between different systems in the world which are not rule-based? For instance, it seems to be obvious that the notion of instability represents a major conceptual break with former theories of rule-based systems, as the stability of the latter is an axiomatically given property implied in the very notion of rule-based systems, while instability can only be the result of external influence which should be explained as the result of another rule-based sy¬stem. While there are no difficulties implied concerning the stability of rule-based systems, the notion of unstable states of a system raises the question of how there can be a system at all if there are no invariant stabilising principles? This is the first question which I will address. And I shall do so by taking two examples of such systems as my point of departure. The first example will be the computer and the second will be ordinary language. In both cases I will argue that the stability of these systems (which are both defined by the existence/presence of human intentions) are provided by the help of - differently organised - redundancy functions which both allow the maintenance of systems in unstable macro-states, suspension of previous rules, underdetermination and overdetermination and generation/emergence/creation of new rules more or less independent of previous rules by the help of optional recursions to the permanently accessible underlying levels as for instance the level of binary representation in computers. Since the notion of redundancy is both controversial as such and often avoided, the concept is discussed (as defined in Claude Shannon's mathematical theory of information and in the semiotic framework of J. J. Greimas) and leading to a more general definition in which the redundancy functions serve to overcome noisy conditions, but at the cost of rule-based stability, determination, and predictability. A second question will be how the notion of rule-generating systems relates to the notion of anticipatory systems and it will be argued that rule-generating systems share some features with an¬ticipatory systems and that the former from a certain viewpoint can be seen as a subclass of the latter, although anticipative features are not necessarily a part of the definition of rule-generating systems. On the other hand, it will be discussed whether anticipatory systems which are not rule-generating systems can exist and it will be argued that the capacity to anticipate is strongly limited if it is not part of a rule-generating system. Therefore, it is concluded that the most powerful anticipatory systems need to be rule-generating systems. (shrink)

The article discuss the interpretation of modernity in Bruno Latours 'The end of modernity'. On the one hand, it argues that the notion of modernity should be modified as nobody can be only modern. On the other hand, it argues that the notion of modernity changes over the ages and that we are in the middle of a process best understood as a new modernization of modernity.

The article discusses the limitations of psycho-physical parallellism and the implications of a pscycho-physical interaction paradigm considering the notion Downward Causation. The focus is on the notion of levels in nature and their interrelations, and it argues that the notion of rule-based systems should be considered a subcategory of rule-generating systems partly based on redundancy functions rather than rules.

Since World War II the concept of Information has received several new definitions. Information can be understood as knowledge in general, as theoretical, formalized knowledge in general or as knowledge related to specific domains or specific representational forms. Because of these mutually inconsistent concepts the common traits are to be found in a perspective transcendent to those theories. The central cultural changes, it is argued, take place on the level of the societal knowledge infrastructure, evolving from the knowledge infrastructure of (...) the industrial societies as a long-term secularization process, resulting in new forms for representation and manipulation of knowledge. The process is seen as rooted in changes of the primary domains for knowledge extraction and in a change in the human relations to the languages in which we interpret the relations to nature. (shrink)

Throughout what is now the more than 50-year history of the computer many theories have been advanced regarding the contribution this machine would make to changes both in the structure of society and in ways of thinking. Like other theories regarding the future, these should also be taken with a pinch of salt. The history of the development of computer technology contains many predictions which have failed to come true and many applications that have not been foreseen. While we must (...) reserve judgment as to the question of the impact on the structure of society and human thought, there is no reason to wait for history when it comes to the question: what are the properties that could give the computer such far-reaching importance? The present book is intended as an answer to this question. The fact that this is a theoretical analysis is due to the nature of the subject. No other possibilities are available because such a description of the properties of the computer must be valid for any kind of application. An additional demand is that the description should be capable of providing an account of the properties which permit and limit these possible applications, just as it must make it possible to characterize a computer as distinct from a) other machines whether clocks, steam engines, thermostats, or mechanical and automatic calculating machines, b) other symbolic media whether printed, mechanical, or electronic and c) other symbolic languages whether ordinary languages, spoken or written or formal languages. This triple limitation, however, (with regard to other machines, symbolic media and symbolic languages) raises a theoretical question as it implies a meeting between concepts of mechanical-deterministic systems, which stem from mathematical physics, and concepts of symbolic systems which stem from the description of symbolic activities common to the humanities. The relationship between science and the humanities has traditionally been seen from a dualistic perspective, as a relationship between two clearly separate subject areas, each studied on its own set of premises and using its own methods. In the present case, however, this perspective cannot be maintained since there is both a common subject area and a new - and specific - kind of interaction between physical and symbolic processes. (shrink)

The notion of authorship has been widely discussed since the proclamation of the Death of the Author in mid 20th century. Authors are still writing, but a variety of new forms of authorship and new kinds of relations between authors, texts and readers have emerged. Many new forms of authorship are enabled by the use of digital media, which provide a new layer of hypertextual and interactive software in between the ‘author’ as a representation of the human creator and the (...) author as an indexical reference to a text. The paper present a number of these forms which are based on the use of ‘avatars’ as intermediaries between the human individuals and the stories told. It is argued that the use of digital media opens for new trajectories in the development of authorship forms, and that such new trajectories calls for new sorts of research questions and development of new methods. (shrink)

In the first decade of the eighteenth century, the Danish astronomer Ole Rømer (1644–1710) set out on a truly visionary project. In 1704, on a family property just outside his hometown Copenhagen,...

Resilience may be referred to as the capacity for positive adaptation and to quickly recover from difficulties and significant adversity. After examining operational definitions of related concepts, the article discusses resilience building exercises for functional fitness at the individual soldier level, to include among others, self-monitoring, self-evaluation, self-reinforcement, emotional regulation exercises, mindfulness training, relaxation and grounding exercises and importance of maintaining discipline and routine in the military. Using an acronym CARRIES, the article examines efforts to enhance resilience building through empirically (...) validated cognitive, behavioural and intrapersonal skills originating from best practices learned in the military. (shrink)

Despite the proliferation of research on ethical leadership, there remains a limited understanding of how specifically the assumingly moral component of this leadership style affects employee behavior. Taking an identity perspective, we integrate the ethical leadership literature with research on the dynamics of the moral self-concept to posit that ethical leadership will foster a sense of moral identity among employees, which then inspires followers to adopt more ethical actions, such as increased organization citizenship behavior. We further argue that these identity (...) effects should be more pronounced when leaders are perceived to be group prototypical, as their actions then speak louder to followers’ sense of identity. Two studies—a scenario experiment with 138 participants and a field study with 225 employees—provided support for our hypothesized moderated mediation model. Perceived ethical leadership positively affected OCB via followers’ moral identity but only under conditions of high perceived leader group prototypicality. We discuss how the identity pathway of ethical leadership can facilitate novel theorizing about moral transference. Our findings also suggest that, when hiring external ethical leaders or training internal managers, practitioners are well advised to consider that these individuals may only be effective in morally transforming followers when they are perceived as prototypical for the group. (shrink)

This article presents results from the national survey conducted in 2018 for the project Research Integrity in Norway. A total of 31,206 questionnaires were sent out to Norwegian researchers by e-mail, and 7291 responses were obtained. In this paper, we analyse the survey data to determine attitudes towards and the prevalence of fabrication, falsification and plagiarism and contrast this with attitudes towards and the prevalence of the more questionable research practices surveyed. Our results show a relatively low percentage of self-reported (...) FFPs, while the number of researchers who report having committed one of the QRPs during the last three years reached a troublesome 40%. The article also presents a ranking of the perceived severity of FFP and QRPs among Norwegian researchers. Overall, there is a widespread normative consensus, where FFP is considered more troublesome than QRPs. (shrink)

Due to constraints on institutional capacity and financial resources, the road to universal health coverage (UHC) involves difficult policy choices. To assist with these choices, scholars and policy makers have done extensive work on criteria to assess the substantive fairness of health financing policies: their impact on the distribution of rights, duties, benefits and burdens on the path towards UHC. However, less attention has been paid to the procedural fairness of health financing decisions. The Accountability for Reasonableness Framework (A4R), which (...) is widely applied to assess procedural fairness, has primarily been used in priority-setting for purchasing decisions, with revenue mobilization and pooling receiving limited attention. Furthermore, the sufficiency of the A4R framework’s four criteria (publicity, relevance, revisions and appeals, and enforcement) has been questioned. Moreover, research in political theory and public administration (including deliberative democracy), public finance, environmental management, psychology, and health financing has examined the key features of procedural fairness, but these insights have not been synthesized into a comprehensive set of criteria for fair decision-making processes in health financing. A systematic study of how these criteria have been applied in decision-making situations related to health financing and in other areas is also lacking. This paper addresses these gaps through a scoping review. It argues that the literature across many disciplines can be synthesized into 10 core criteria with common philosophical foundations. These go beyond A4R and encompass equality, impartiality, consistency over time, reason-giving, transparency, accuracy of information, participation, inclusiveness, revisability and enforcement. These criteria can be used to evaluate and guide decision-making processes for financing UHC across different country income levels and health financing arrangements. The review also presents examples of how these criteria have been applied to decisions in health financing and other sectors. (shrink)

Normative thinking about addiction has traditionally been divided between, on the one hand, a medical model which sees addiction as a disease characterized by compulsive and relapsing drug use over which the addict has little or no control and, on the other, a moral model which sees addiction as a choice characterized by voluntary behaviour under the control of the addict. Proponents of the former appeal to evidence showing that regular consumption of drugs causes persistent changes in the brain structures (...) and functions known to be involved in the motivation of behavior. On this evidence, it is often concluded that becoming addicted involves a transition from voluntary, chosen drug use to non-voluntary compulsive drug use. Against this view, proponents of the moral model provide ample evidence that addictive drug use involves voluntary chosen behaviour. In this paper we argue that although they are right about something, both views are mistaken. We present a third model that neither rules out the view of addictive drug use as compulsive, nor that it involves voluntary chosen behavior. -/- . (shrink)

In recent years, it has become commonplace among the Global Burden of Disease study authors to regard the disability-adjusted life year primarily as a descriptive health metric. During the first phase of the GBD, it was widely acknowledged that the DALY had built-in evaluative assumptions. However, from the publication of the 2010 GBD and onwards, two central evaluative practices—time discounting and age-weighting—have been omitted from the DALY model. After this substantial revision, the emerging view now appears to be that the (...) DALY is primarily a descriptive measure. Our aim in this article is to argue that the DALY, despite changes, remains largely evaluative. Our analysis focuses on the understanding of the DALY by comparing the DALY as a measure of disease burden in the two most significant phases of GBD publications, from their beginning to the most recent releases. We identify numerous assumptions underlying the DALY and group them as descriptive or evaluative. We conclude that while the DALY model arguably has become more descriptive, it remains, by necessity, largely evaluative. (shrink)

This book explores the complexity of two philosophical traditions, extending from their origins to the current developments in neopragmatism. Chapters deal with the first encounters of these traditions and beyond, looking at metaphysics and the Vienna circle as well as semantics and the principle of tolerance. There is a general consensus that North-American pragmatism and European Logical Empiricism were converging philosophical traditions, especially after the forced migration of the European Philosophers. But readers will discover a pluralist image of this relation (...) and interaction with an obvious family resemblance. This work clarifies and specifies the common features and differences of these currents since the beginning of their mutual scientific communication in the 19th century. The book draws on collaboration between authors and philosophers from Vienna, Tübingen, and Helsinki, and their networks. It will appeal to philosophers, scholars in the history of philosophy, philosophers of science, pragmatists and beyond. (shrink)

Although the brain enables us to perceive the external world and our body, it remains unknown whether brain processes themselves can be perceived. Brain tissue does not have receptors for its own activity. However, the ability of humans to acquire self-control of brain processes indicates that the perception of these processes may also be achieved by learning. In this study patients learned to control low-frequency components of their EEG: the so-called slow cortical potentials (SCPs). In particular ''probe'' sessions, the patients (...) estimated the quality of the SCP shift they had produced in the preceding trial. The correspondence between the recorded SCP amplitudes and the subjective estimates increased with training. The ability to perceive the SCPs was related to the ability to control them; this perception was not mediated by peripheral variables such as changes in muscle tonus and cannot be reduced to simple vigilance monitoring. These data provide evidence that humans can learn to perceive the neural activity of their brain. Alternative interpretations are discussed. (shrink)

v. 1. Atomic theory and the description of nature -- v. 2. Essays 1932-1957 on atomic physics and human knowledge -- v. 3. Essays 1958-1962 on atomic physics and human knowledge -- v. 4. Causality and complementarity.

Across the European research area and beyond, efforts are being mobilized to align research and innovation processes and products with societal values and needs, and to create mechanisms for inclusive priority setting and knowledge production. A central concern is how to foster a culture of “Responsible Research and Innovation” (RRI) among scientists and engineers. This paper focuses on RRI teaching at higher education institutions. On the basis of interviews and reviews of academic and policy documents, it highlights the generic aspects (...) of teaching aimed at invoking a sense of care and societal obligation, and provides a set of exemplary cases of RRI-related teaching. It argues that the Aristotelian concept of phronesis can capture core properties of the objectives of RRI-related teaching activities. Teaching should nurture the students’ capacity in terms of practical wisdom, practical ethics, or administrative ability in order to enable them to act virtuously and responsibly in contexts which are often characterized by uncertainty, contention, and controversy. (shrink)

In the present study it was shown that decision heuristics and confidence judgements play important roles in the building of preferences. Based on a dual-process account of thinking, the study compared people who did well versus poorly on a series of decision heuristics and overconfidence judgement tasks. The two groups were found to differ with regard to their information search behaviour in introduced multiattribute choice tasks. High performers on the judgemental tasks were less influenced in their decision processes by numerical (...) information format (probabilities vs. frequencies) compared to low performers. They also looked at more attributes and spent more time on the multiattribute choice tasks. The results reveal that performance on decision heuristics and overconfidence tasks has a bearing both on heuristic and analytic processes in multiattribute decision making. (shrink)

Arts and Humanities in Higher Education, Volume 21, Issue 2, Page 198-219, April 2022. This article presents playfulness as an emerging approach to learning in higher education that emphasises the arts and humanities across disciplines. The article is based on a qualitative, hermeneutical literature review in light of educational culture in higher education. The literature review indicates that playful approaches to learning stand in opposition to educational cultures that focus on rapidness and student performance. However, an educational culture of play (...) is about to establish itself, and this culture of play emphasises creativity in learning and human flourishing in education, perspectives that are connected to arts and humanities. The main findings cultures of time, performance and play lead to several questions about societal, institutional, and organisational educational culture, and regarding approaches to teaching, learning, humanity and society. The main contribution of this article is that a focus on playfulness offer the field of arts and humanities new possibilities in future education. (shrink)

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt to capture a comprehensive (...) overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

The leitmotif of the German contribution to the 12th Architecture Biennial in Venice, “desire“, is at the same time the topic of a survey among architects ; answers are given through drawings. What are you longing for? The response drawings are highly individual, diversity becomes programme: both in picture language and in the presentation in terms of content, reactions are quite different. But there is one thing they all have in common: the burning desire of something concrete. Sometimes it spreads (...) lightning-like on the observer, sometimes time is required for a contemplative involvement with form and content. The architectural sketch, as it may seem, degenerated into a side product of architectural work within the last years, is back! (shrink)

In this article, researchers will introduce readers to the concept of leadership through perspectives of different schools of leadership thoughts. We intend to bring to notice an important discussion on leadership in military organisations and its implications on non-military organisations and institutions. There is a plethora of literature especially borrowing from military literature, which can set the stage for our understanding of what could make up for a robust leadership model comprising of competencies like- power of personal example and influence, (...) adaptive resilience, making critical decisions amid uncertainty, regulated leadership behaviors and thoughts, preparedness, communicating with teams and building trust. (shrink)

§ 219a of the German Penal Code (StGB) – the so-called ban on advertising abortions – has been subject of an increasing legal-political controversy since 2017 and was dropped by legislation in July 2022. This paper examines and reconstructs the extent to which the aforementioned ‘ban on advertising’ was (in–)‌compatible with recognized standards of medical ethics. For this purpose, arguments put forward in public discourse on both sides of the conflict, insofar as they go beyond basic attitudes toward abortion, will (...) be subjected to a plausibility test from the perspective of medical ethics. This will show that (I.) according to the standard understanding of autonomy in medical ethics by Beauchamp and Childress, the provision of information about abortions is not an undue influence, but a necessary precondition for autonomous decisions by pregnant women; that (II.) the feared undesirable social developments after the abolition of § 219a StGB are empirically unfounded and largely implausible; but that on the other hand (iii) a multi-perspective communication landscape with accessible expert information promises to effectively counteract the self- and external stigmatization of unintentionally pregnant women. As a result, this analysis provides two things: a coherent medico-ethical justification for the annulment of § 219a StGB and an argumentative basis for the defense against future efforts to support biopolitical positions by censoring available information. (shrink)

This article explores the tension between standardization and flexibility in information infrastructure. Just like other large technical systems, the geographically dispersed yet highly interconnected II becomes increasingly resistant to change. Still, II design must anticipate and prepare for changes, even substantial ones, if infrastructure is to survive. An II contains a huge number of components that alternate between standardization and change throughout their lifetimes. These components are interdependent: when one is changed, others have to remain stable, and vice versa. The (...) article examines theoretical concepts for frammg these aspects of an II. The empirical underpinning of the article is a study of two existing embryonic manifestations of II. (shrink)

The aim of the present study was to corroborate or undermine a previously presented conjecture that physicians’ estimations of others’ opinions are influenced by their own opinions. We used questionnaire based cross-sectional design and described a situation where an imminently dying patient was provided with alleviating drugs which also shortened life and, additionally, were intended to do so. We asked what would happen to physicians’ own trust if they took the action described, and also what the physician estimated would happen (...) to the general publics’ trust in health services. Decrease of trust was used as surrogate for an undesirable action. The results are presented as proportions with a 95 % Confidence Interval. Statistical analysis was based on inter-rater agreement -test as well as χ2 test and Odds Ratio with 95 % CI. We found a moderate inter-rater agreement between what would happen with the physicians’ own trust in healthcare and their estimations of what would happen with the general population’s trust. We identified a significant difference between being pro et contra the treatment with double intentions and the estimation of the general population’s trust. Focusing on either decreasing or increasing own trust and being pro or contra the action we identified a strong association [OR 79 ]. Although the inter-rater agreement in the present study was somewhat weaker compared to a study about the explicit use of the term ‘physicians assisted suicide’ we found that our hypothesis—physicians’ estimations of others’ opinions are influenced by their own opinions—was corroborated. This might have implications in research as well as in clinical decision-making. We suggest that Merton’s ideal of disinterestedness should be highlighted. (shrink)

Next SectionBackground International and national agencies play a major role in setting HIV care-and-treatment priorities in low-income-countries. Little is known about priority setting at lower health-system levels. The objective of this article is to explore experiences of HIV priority decisions, at what levels these decisions are made and how they might influence the distribution of health benefits in a high-endemic region in Tanzania. Methods This is a qualitative study using observations, key documents and semistructured focus-group and individual interviews (43) with (...) health workers, patients and administrators at one regional and one district hospital. The analysis was based on an editing analysis style. Results Health workers did not perceive themselves as bedside rationing agents and they reported following national recommendations and felt they have little impact on important priority decisions. Health benefit distributions were largely determined by priority decisions made at a national level. External factors, such as eligibility criteria, inadequate funding and barriers to access seemed to play a major role in the actual distribution of health services and benefits in the region. Patient groups who were actually given high priority were the sickest patients, those living near a facility and those who could afford long journeys and frequent visits. Low-priority groups were those experiencing other co-morbidities or treatment failure, children, asymptomatic patients and the poorest. Conclusions/significance The interaction of priority setting across health-system levels and their impact on distribution of health outcomes in the population has been underestimated. The distributional pattern of health outcomes calls for further normative assessment. (shrink)