The purpose of this special issue and the conference that inspired it was to address the issue of conceptual integration in a science of consciousness. We felt this to be important, for while current efforts to scientifically investigate consciousness are taking place in an interdisciplinary context, it often seems as though the very terms being used to sustain a sense of interdisciplinary cooperation are working against it. This is because it is this very array of common concepts that generates a (...) sense of unity among consciousness researchers, despite the fact the concepts mean different things in different disciplines. These Concepts of Consciousness include the following: realism, representation, intentionality, information, control, memory and self. Given this list, we believed we could best approach the issue of potential conceptual integration by addressing each concept from different perspectives and asking the following: how do uses of the concept differ, must these meanings be synthesized in order for there to be a unified science of consciousness, is a unified conceptual scheme necessary to establish an independent science of consciousness, is a unified conceptual scheme possible, if it is not possible, why not, and if it is possible, what might it look like? To this end we invited, for each concept, two scholars who made extensive use of the identified concept in their work. The papers entailed in this special issue constitute the outcome of this effort, and in what follows we offer a brief examination of possible forms of integration the papers seem to collectively suggest. (shrink)

In this paper I untangle a recent debate in the philosophy of epidemiology, focusing in particular on the Potential Outcomes Approach to causation. As the POA strategy includes the quantification of ‘contrary-to-fact’ outcomes, it is unsurprising that it has been likened to the counterfactual analysis of causation briefly proposed by David Hume, and later developed by David Lewis. However, I contend that this has led to much confusion. Miguel Hernan and Sarah Taubman have recently argued that meaningful (...) causal inferences cannot be drawn from obesity. This paper prompted Alex Broadbent to criticise the POA conception of causation, accusing two of the four theses its proponents are committed to, of circularity and falsity. Here I scrutinise Broadbent’s claims, and suggest that a Popperian approach to causal inference in epidemiology diffuses both of his objections. However, I move on to argue that the POA’s commitment to granting only manipulable conditions causal-status, renders the position implausible as a conceptual analysis of causation. That said, I conclude that the strategy the POA employs is an effective tool for effect-measurement in intervention-cases; if it is a conceptual analysis of causation at all, it must be restricted to the causal analysis of manipulable conditions. The POA’s failure to successfully demarcate causal from non-causal conditions simpliciter should therefore not be viewed as a serious threat. (shrink)

Causal mediation analysis is complicated with multiple effect definitions that require different sets of assumptions for identification. This article provides a systematic explanation of such assumptions. We define five potential outcome types whose means are involved in various effect definitions. We tackle their mean/distribution’s identification, starting with the one that requires the weakest assumptions and gradually building up to the one that requires the strongest assumptions. This presentation shows clearly why an assumption is required for one estimand and not (...) another, and provides a succinct table from which an applied researcher could pick out the assumptions required for identifying the causal effects they target. Using a running example, the article illustrates the assembling and consideration of identifying assumptions for a range of causal contrasts. For several that are commonly encountered in the literature, this exercise clarifies that identification requires weaker assumptions than those often stated in the literature. This attention to the details also draws attention to the differences in the positivity assumption for different estimands, with practical implications. Clarity on the identifying assumptions of these various estimands will help researchers conduct appropriate mediation analyses and interpret the results with appropriate caution given the plausibility of the assumptions. (shrink)

This article uses the interventionist theory of causation, a counterfactual theory taken from philosophy of science, to strengthen causal analysis in process tracing research. Causal claims from process tracing are re-expressed in terms of so-called hypothetical interventions, and concrete evidential tests are proposed which are shown to corroborate process tracing claims. In particular, three steps are prescribed for an interventionist investigation, and each step in turn is shown to make the causal analysis more robust, amongst others by disambiguating causal claims (...) and clarifying or strengthening the existing methodological advice on counterfactual analysis. The article's claims are then illustrated using a concrete example, Haggard and Kaufman's analysis of the Argentinian transition to democracy. It is shown that interventionism could have strengthened the authors’ conclusions. The article concludes with a short Bayesian analysis of its key methodological proposals. (shrink)

Processing the motivational relevance of a visual scene and reacting accordingly is crucial for survival. Previous work suggests the emotional content of naturalistic scenes affects response speed, such that unpleasant content slows responses whereas pleasant content accelerates responses. It is unclear whether these effects reflect motor-cognitive processes, such as attentional orienting, or vary with the function/outcome of the motor response itself. Four experiments manipulated participants’ ability to terminate the picture and, thereby, the response’s function and motivational value. Attentive orienting was (...) manipulated via picture repetition, which diminishes orienting. A total of N = 81 participants completed versions of a go/no-go task, discriminating between distorted versus intact pictures drawn from six content categories varying in positive, negative, or neutral valence. While all participants responded faster with repetition, only participants without offset control exhibited slower responses to unpleasant and accelerated responses to pleasant content. Emotional engagement, measured by the late positive potential, was not modulated by attentional orienting, suggesting that the interaction between repetition and offset control is not due to altered emotional engagement. Together, results suggest that response time changes as a function of emotional content and sensitivity to attention orienting depends on the motivational function of the motor response. (shrink)

BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation. Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to (...) participation.MethodsA North European field survey among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.ResultsAll outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.ConclusionsThe findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such as moral reflexivity and moral attitude outcomes, should still be included. In the future, a combination of empirical findings and normative reflection will contribute to the revision of the instrument. (shrink)

This paper presents an axiomatization of the principle of maximizing expected utility that does not rely on the independence axiom or sure-thing principle. Perhaps more importantly the new axiomatization is based on an ex ante approach, instead of the standard ex post approach. An ex post approach utilizes the decision maker's preferences among risky acts for generating a utility and a probability function, whereas in the ex ante approach a set of preferences among potential outcomes are on the (...) input side of the theory and the decision maker's preferences among risky acts on the output side. (shrink)

Democratic theorists often distinguish between two views of democratic procedures. ‘Outcomes theorists’ emphasize the instrumental nature of these procedures and argue that they are only valuable because they tend to produce good outcomes. In contrast, ‘proceduralists’ emphasize the intrinsic value of democratic procedures, for instance, on the grounds that they are fair. In this paper. I argue that we should reject pure versions of these two theories in favor of an understanding of the democratic ideal that recognizes a (...) commitment to both intrinsically valuable democratic procedures and democratic outcomes. In instances in which there is a conflict between these two commitments, I suggest they must be balanced. This balancing approach offers a justification of judicial review on the grounds that it potentially limits outcomes that undermine democracy. But judicial review is not justifiable in any instance in which a bad democratic outcome results from democratic procedures. When the loss that would result from overturning a democratic procedure is greater than the gain to democracy that would result from ensuring against an undemocratic outcome; judicial review is not justifiable. Loss or gain to democracy is defined by the negative or positive impact of each action on the core democratic values of equality and autonomy, aspects of the democratic ideal. Even when judicial review is justified, the fact that it overturns intrinsically valuable procedures suggests that such review is never ideal from the standpoint of democracy. (shrink)

Impaired neurodevelopmental outcome, in particular cognitive impairment, after neonatal hypoxic-ischemic encephalopathy is a major concern for parents, clinicians, and society. This study aims to investigate the potential benefits of using advanced quantitative electroencephalography analysis for early prediction of cognitive outcomes, assessed here at 2 years of age. EEG data were recorded within the first week after birth from a cohort of twenty infants with neonatal hypoxic-ischemic encephalopathy. A proposed regression framework was based on two different sets of features, (...) namely graph-theoretical features derived from the weighted phase-lag index and entropies metrics represented by sample entropy, permutation entropy, and spectral entropy. Both sets of features were calculated within the noise-assisted multivariate empirical mode decomposition domain. Correlation analysis showed a significant association in the delta band between the proposed features, graph attributes and entropy features from the neonatal EEG data and the cognitive development at age two years. These features were used to train and test the tree ensemble regression models. The highest prediction performance was reached to 14.27 root mean square error, 12.07 mean absolute error, and 0.45 R-squared using the entropy features with a boosted tree regression model. Thus, the results demonstrate that the proposed qEEG features show the state of brain function at an early stage; hence, they could serve as predictive biomarkers of later cognitive impairment, which could facilitate identifying those who might benefit from early targeted intervention. (shrink)

This study examined the role of key causal analysis strategies in forecasting and ethical decision-making. Undergraduate participants took on the role of the key actor in several ethical problems and were asked to identify and analyze the causes, forecast potential outcomes, and make a decision about each problem. Time pressure and analytic mindset were manipulated while participants worked through these problems. The results indicated that forecast quality was associated with decision ethicality, and the identification of the critical causes (...) of the problem was associated with both higher quality forecasts and higher ethicality of decisions. Neither time pressure nor analytic mindset impacted forecasts or ethicality of decisions. Theoretical and practical implications of these findings are discussed. (shrink)

Integrating large language models (LLMs) like GPT-4 into medical ethics is a novel concept, and understanding the effectiveness of these models in aiding ethicists with decision-making can have significant implications for the healthcare sector. Thus, the objective of this study was to evaluate the performance of GPT-4 in responding to complex medical ethical vignettes and to gauge its utility and limitations for aiding medical ethicists. Using a mixed-methods, cross-sectional survey approach, a panel of six ethicists assessed LLM-generated responses to eight (...) ethical vignettes.The main outcomes measured were relevance, reasoning, depth, technical and non-technical clarity, as well as acceptability of GPT-4’s responses. The readability of the responses was also assessed. Of the six metrics evaluating the effectiveness of GPT-4’s responses, the overall mean score was 4.1/5. GPT-4 was rated highest in providing technical (4.7/5) and non-technical clarity (4.4/5), whereas the lowest rated metrics were depth (3.8/5) and acceptability (3.8/5). There was poor-to-moderate inter-rater reliability characterised by an intraclass coefficient of 0.54 (95% CI: 0.30 to 0.71). Based on panellist feedback, GPT-4 was able to identify and articulate key ethical issues but struggled to appreciate the nuanced aspects of ethical dilemmas and misapplied certain moral principles.This study reveals limitations in the ability of GPT-4 to appreciate the depth and nuanced acceptability of real-world ethical dilemmas, particularly those that require a thorough understanding of relational complexities and context-specific values. Ongoing evaluation of LLM capabilities within medical ethics remains paramount, and further refinement is needed before it can be used effectively in clinical settings. (shrink)

To improve the value of pharmaceutical spending, some manufacturers and payers have introduced outcomes-based contracts, where rebates are tied to specified outcomes. We reviewed the literature and interviewed key experts to assess these contracts' potential to slow pharmaceutical spending. We found that while outcomes-based contracts are increasingly common in the US, they are still limited by multiple factors — including the lack of meaningful outcomes data. Moreover, there is no evidence to date that they slow (...) pharmaceutical spending or increase access. Experts favored having CMS test and rigorously evaluate this model to achieve a better understanding of the implications. (shrink)

BackgroundIn paediatric oncology, healthcare professionals face moral challenges. Clinical ethics support services, such as moral case deliberation, aim to assist them in dealing with these challenges. Yet, healthcare professionals can have different expectations and goals related to clinical ethics support services.MethodsIn this study, the perceptions held by healthcare professionals regarding the importance of possible outcomes of MCDs, prior to implementation of MCDs, were investigated. A multisite, cross-sectional, quantitative study was performed at all six Paediatric Oncology Centres in Sweden. Healthcare (...) professionals answered the Euro-MCD instrument with 26 potential MCD outcomes using a scale from Not important to Very important. Descriptive and comparative statistical analyses were carried out.ResultsAll outcomes were rated high, i.e., between 3.12 and 3.78. More open communication, developing skills to analyse ethically difficult situations, better mutual understanding, and deciding on concrete actions were rated as most important. Understanding of ethical theories and critical examination of policies were rated less important. Most often nursing assistants rated higher and physicians lower than the other professions did. Women and participants without previous experience of MCDs perceived outcomes as more important. There were differences between centres as one centre had significantly higher, and one centre had significantly lower ratings compared to the others.ConclusionIt is clear that healthcare professionals want MCDs to improve teamwork and skills in order to analyse and manage ethically difficult situations. When comparing to previous research about important MCD outcomes, there were similarities in what healthcare professionals consider to be important when handling moral challenges regardless of country and potential differences in healthcare settings and systems, such as paediatric vs. adult care. (shrink)

In referendum elections, voters are often required to register simultaneous votes on multiple proposals. The separability problem occurs when a voter’s preferred outcome on one proposal depends on the outcomes of other proposals. This type of interdependence can lead to unsatisfactory or even paradoxical election outcomes, such as a winning outcome that is the last choice of every voter. Here we propose an iterative voting scheme that allows voters to revise their voting strategies based on the outcomes (...) of previous iterations. Using a robust computer simulation, we investigate the potential of this approach to solve the separability problem. (shrink)

Recently, interest in the unique pathways linking discrete positive emotions to specific health outcomes has gained increasing attention, but the role of awe is yet to be elucidated. Awe is a complex and transformative emotion that can restructure individuals' mental frames so deeply that it could be considered a therapeutic asset for major mental health major issues, including depression. Despite sparse evidence showing a potential connection between depression and awe, this link has not been combined into a proposal (...) resulting in specific intervention guidelines. The aim of this perspective was three-fold: to provide a new unifying model of awe's functioning—the Matryoshka model; to show systematic and explicit connections between this emotion and depression; and to suggest specific guidelines of intervention utilizing the potential therapeutic role of awe for mental health, specifically for depression. This theoretical endeavor in its entirety has been framed within the health domain. (shrink)

The United Nations (UN), facing increasingly intense challenges in the fulfillment of its mission, also harbors the potential for enhanced effectiveness, relevance, and legitimacy in the form of the human rights-based approach. The human rights-based approach (HRBA) is one model for translating the organization’s values into a more adaptive, inclusive, dynamic, and responsive system of processes and outcomes. In the arena of politics, its meeting with a meaningful degree of receptiveness could signal a growing acceptance of the validity (...) of structural approaches to development and other issues despite traditional defensive positions on human rights. Application of the HRBA in programming is leading to greater appreciation for addressing core disparities and promoting empowerment for sustainable outcomes. It is also cultivating new qualities in development practitioners, advancing creativity, openness and responsiveness in organizational culture. In feeding its evolution in this way, the UN as a system has the potential for deeper, longer-term mission fulfillment and thus ensuring its viability. (shrink)

In this article, I put forward an instrumental justification for the introduction of youth quotas in parliaments on grounds of justice between coexisting generations. I provide a two-fold argument drawing on the distinction between “substantive representation” and “symbolic representation”. I argue that these jointly provide a good basis for a “politics of youth presence” in parliaments. In the first section, I evaluate the impact that youth quotas can have on enhancing the chances of fair youth policies. In the second section, (...) I show that youth quotas can play an important symbolic role in the promotion of a community of political equals, with potential implications for youth political participation. (shrink)

Management plays an important role in reinforcing ethics in organizations. To support this aim, managers must use incentive and goal programs in ethical ways. This study examines experimentally the potential ethical costs associated with incentive-driven and goal-induced employee behavior from a managerial perspective. In a quasi-experimental setting, 243 MBA students with significant professional work experience evaluated a hypothetical employee’s ethical behavior under incentive pay systems modeled on a business case. In the role of the employee’s manager, participants evaluated the (...) ethicality of the employee’s incentive-driven and goal-induced ethical/unethical behavior and the outcomes of behavior, with consequences that were either favorable or unfavorable to the organization. The results indicated that participants discounted the ethical considerations of incentive-driven and goal-induced behavior when consequences were favorable to the organization. Participants’ morals and outcome orientations were also significantly related to their ethical judgments and intentions to intervene. The implications of these findings for research and practice are discussed. (shrink)

Taste-aversion learning has been a popular paradigm for examining associative processes because it often produces outcomes that are different from those observed in other classical conditioning paradigms. One such outcome is taste-mediated odor potentiation in which aversion conditioning with a weak odor and a strong taste results in increased or synergistic conditioning to the odor. Because this strengthened odor aversion was not anticipated by formal models of learning, investigation of taste-mediated odor potentiation was a hot topic in the 1980s. (...) The present manuscript reviews the history of potentiation research with particular focus given to the stimuli that produce potentiation, the conditions that produce potentiation, the possible mechanism of this phenomenon, and possible reasons for the decline of research in this area. Although the number of published reports of potentiation has decreased since the 1980s, recent physiological and behavioral assessments have advanced the field considerably, and the opportunities for future research are bountiful. Recent physiological experiments, for example, have identified the basolateral nucleus of the amygdala as the key brain region to produce taste-mediated odor potentiation (e.g., Hatfield andGallagher, 1995). Also, recent behavioral experiments have extended the generality of synergistic conditioning effects. Studies have shown that odor can potentiate responding to taste (Slotnick, Westbrook and Darling, 1997) and that augmented responding can be produced in the A+/AX+blocking design (e.g., Batsell and Batson, 1999). With the current understanding of where synergistic conditioning may occur in the brain and the new tools to explore synergistic conditioning, we propose various directions for future research to determine whether taste-aversion learning and synergistic conditioning require unique explanations. (shrink)

Taste-aversion learning has been a popular paradigm for examining associative processes because it often produces outcomes that are different from those observed in other classical conditioning paradigms. One such outcome is taste-mediated odor potentiation in which aversion conditioning with a weak odor and a strong taste results in increased or synergistic conditioning to the odor. Because this strengthened odor aversion was not anticipated by formal models of learning, investigation of taste-mediated odor potentiation was a hot topic in the 1980s. (...) The present manuscript reviews the history of potentiation research with particular focus given to the stimuli that produce potentiation, the conditions that produce potentiation, the possible mechanism of this phenomenon, and possible reasons for the decline of research in this area. Although the number of published reports of potentiation has decreased since the 1980s, recent physiological and behavioral assessments have advanced the field considerably, and the opportunities for future research are bountiful. Recent physiological experiments, for example, have identified the basolateral nucleus of the amygdala as the key brain region to produce taste-mediated odor potentiation (e.g., Hatfield andGallagher, 1995). Also, recent behavioral experiments have extended the generality of synergistic conditioning effects. Studies have shown that odor can potentiate responding to taste (Slotnick, Westbrook and Darling, 1997) and that augmented responding can be produced in the A+/AX+blocking design (e.g., Batsell and Batson, 1999). With the current understanding of where synergistic conditioning may occur in the brain and the new tools to explore synergistic conditioning, we propose various directions for future research to determine whether taste-aversion learning and synergistic conditioning require unique explanations. (shrink)

Background: Financial conflict of interest in clinical research is an area of active debate. While data exist on the perspectives and roles of academic institutions, investigators, industry sponsors, and scientific journals, little is known about the perspectives of potential research participants.Methods: The authors surveyed potential research participants over the internet, using the Harris Interactive Chronic Illness Database. A potential research participant was defined by: self report of diagnosis by a health care professional and willingness to participate in (...) clinical trials. Email invitations were sent to 20 205 persons with coronary artery disease, breast cancer, or depression; a total of 6363 persons were screened; of these, 86% or 5478 met inclusion criteria and completed the survey. The outcome measures were respondents’ ratings on: importance of knowing conflict of interest information, whether its disclosure ought to be required, and its effect on willingness to participate—across seven widely discussed scenarios of financial conflicts of interest .Results: Majority responded that knowing conflict of interest information was “extremely” or “very” important; a larger majority felt financial conflicts of interest should be disclosed as part of informed consent . In all seven scenarios, a majority was still willing to participate but in some scenarios a sizable minority would be wary of participation. Respondents were more wary of individual than institutional conflicts of interest. Illness group and sociodemographic factors had modest effects and did not affect the main trends.Conclusions: The prevailing practice of non-disclosure of financial conflicts of interest in clinical research appears contrary to the values of potential research participants. (shrink)

Management plays an important role in reinforcing ethics in organizations. To support this aim, managers must use incentive and goal programs in ethical ways. This study examines experimentally the potential ethical costs associated with incentive-driven and goal-induced employee behavior from a managerial perspective. In a quasi-experimental setting, 243 MBA students with significant professional work experience evaluated a hypothetical employee’s ethical behavior under incentive pay systems modeled on a business case. In the role of the employee’s manager, participants evaluated the (...) ethicality of the employee’s incentive-driven and goal-induced ethical/unethical behavior and the outcomes of behavior, with consequences that were either favorable or unfavorable to the organization. The results indicated that participants discounted the ethical considerations of incentive-driven and goal-induced behavior when consequences were favorable to the organization. Participants’ morals and outcome orientations were also significantly related to their ethical judgments and intentions to intervene. The implications of these findings for research and practice are discussed. (shrink)

Genetic and early environmental factors are interwoven in the etiology of Borderline Personality Disorder (BPD). Epigenetic mechanisms offer the molecular machinery to adapt to environmental conditions. There are gaps in the knowledge about how epigenetic mechanisms are involved in the effects of early affective environment, development of BPD, and psychotherapy response. We reviewed the available evidence of the effects of psychotherapy on changes in DNA methylation and conducted a pilot study in a sample of 11 female adolescents diagnosed with BPD, (...) exploring for changes in peripheral DNA methylation of FKBP5 gene, which encodes for a stress response protein, in relation to psychotherapy, on symptomatology and underlying psychological processes. For this purpose, measures of early trauma, borderline and depressive symptoms, psychotherapy outcome, mentalization, and emotional regulation were studied. A reduction in the average FKBP5 methylation levels was observed over time. Additionally, the decrease in FKBP5 methylation observed occurred only in those individuals who had early trauma and responded to psychotherapy. The results suggest an effect of psychotherapy on epigenetic mechanisms associated with the stress response. The finding that epigenetic changes were only observed in patients with early trauma suggests a specific molecular mechanism of recovery. The results should be taken with caution given the small sample size. Also, further research is needed to adjust for confounding factors and include endocrinological markers and therapeutic process variables. (shrink)

Altruism (a costly action that benefits others) and reciprocity (the repayment of acts in kind) differ in that the former expresses preferences about the outcome of a social interaction, whereas the latter requires, in addition, ascribing intentions to others. Interestingly, an individual’s behavior and neurophysiological activity under outcome- versus intention-based interactions has not been compared directly using different endowments in the same subject and during the same session. Here, we used a mixed version of the Dictator and the Investment games, (...) together with electroencephalography, to uncover a subject’s behavior and brain activity when challenged with endowments of different sizes in contexts that call for an altruistic (outcome-based) versus a reciprocal (intention-based) response. We found that subjects displayed positive or negative reciprocity (reciprocal responses greater or smaller than that for altruism, respectively) depending on the amount of trust they received. Furthermore, a subject’s late frontal negativity differed between conditions, predicting responses to trust in intentions-based trials. Finally, brain regions related with mentalizing and cognitive control were the cortical sources of this activity. Thus, our work disentangles the behavioral components present in the repayment of trust, and sheds light on the neural activity underlying the integration of outcomes and perceived intentions in human economic interactions. (shrink)

I argue that advancing “second-generation” or mechanistic causal knowledge of individual outcomes requires a comprehensive research programme that uses a variety of different methods in addition to the ones described in the paper under discussion. I also highlight that environment-focused approaches can be as instrumental in identifying potential phenotypic causes as gene-focused approaches.

Domestic violence is one of the most common forms of violence against women. Domestic violence during pregnancy is associated with adverse perinatal and maternal outcomes. We aimed to assess whether domestic violence was associated with mode of delivery, low birthweight and preterm birth in two sites in Nepal. In this prospective cohort study we consecutively recruited 2004 pregnant women during antenatal care at two hospitals between June 2015 and September 2016. The Abuse Assessment Screen was used to assess fear (...) and violence. Having ever experienced either fear or violence was defined as any domestic violence. Obstetric outcomes were obtained from hospital records for 1381 women, selecting singleton pregnancies only. Mode of delivery was assessed as birth by cesarean section or not. A birthweight of less than 2500 g was defined as low birthweight and preterm birth as birth before completion of 37 weeks gestation. Descriptive and multiple logistic regression analyses were performed to assess associations. Twenty percent of the women reported any domestic violence. Among all 1381 women, 37.6% gave birth by cesarean section. Of those women who delivered by cesarean section, 84.7% had an emergency cesarean section. Less than 10% of the babies were born prematurely and 13.5% were born with low birthweight. We found no significant association between exposure to any domestic violence during pregnancy and risk of a low birthweight baby or birth by cesarean section. However, having experienced both violence and fear was significantly associated with giving birth to a preterm infant [aOR 2.33 ]. Domestic violence is common in Nepal. This is a potential risk factor for severe morbidity and mortality in newborns. We found that the risk of having a preterm baby was higher for pregnant women who experienced both fear and violence. This should be recognized by the health sector. In this study, no significant differences were found in the rate of cesarean section nor low birthweight for women who had experienced any domestic violence compared to those who did not. (shrink)

Current methods of obtaining an informed consent leave much to be desired. Patients rarely read consent forms or understand all of the risks, benefits, or alternatives associated with their treatment. Evaluating the advantages and disadvantages of treatment options often presents a more significant challenge for patients with lower levels of health literacy. This article reviews the evidence of shortcomings in our informed consent system and then explores the potential for a new approach to engage patients at all levels of (...) health literacy in their treatment decisions. Specifically, the article will examine the potential of shared decision-making to bridge gaps in knowledge, increase patient adherence to treatment, and improve health outcomes in low health literacy patient populations. Leveling barriers to treatment information for disadvantaged populations should be a public health imperative, especially if it can be shown to improve health outcomes and reduce health disparities. (shrink)

Current methods of obtaining an informed consent leave much to be desired. Patients rarely read consent forms or understand all of the risks, benefits, or alternatives associated with their treatment. Evaluating the advantages and disadvantages of treatment options often presents a more significant challenge for patients with lower levels of health literacy. This article reviews the evidence of shortcomings in our informed consent system and then explores the potential for a new approach to engage patients at all levels of (...) health literacy in their treatment decisions. Specifically, the article will examine the potential of shared decision-making to bridge gaps in knowledge, increase patient adherence to treatment, and improve health outcomes in low health literacy patient populations. Leveling barriers to treatment information for disadvantaged populations should be a public health imperative, especially if it can be shown to improve health outcomes and reduce health disparities. (shrink)

Comparative effectiveness research (CER) is one of the Patient Protection and Affordable Care Act's significant initiatives that aims to improve treatment outcomes and lower health care costs. This article takes CER a step further and suggests a novel clinical application for it. The article proposes the development of a national framework to enable physicians to rapidly perform, through a computerized service, medically sound personalized comparisons of the effectiveness of possible treatments for patients' conditions. A treatment comparison for a given (...) patient would be based on data from electronic health records of a cohort of clinically similar patients who received the treatments previously and whose outcomes were recorded. This framework has unique potential to simultaneously improve the quality of health care, reduce its cost, and alleviate public concerns about rationing and “one size fits all” medicine. (shrink)

Mild and moderate mental illnesses can hinder labor force participation, lead to work interruptions, and hamper earning potential. Targeted interventions have proven effective at addressing these problems. But their potential depends on labor protections that enable people to take advantage of these interventions while keeping jobs and income.

Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centred outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have (...) effectively remediated patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centred TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centred TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centred outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarised, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilisation of multivariate prediction models to inform individually-tailored interventions targeting a range of health conditions. (shrink)

continent. 1.2 (2011): 136-140. In early 2011, Cow Heavy Books published The Official Catalog of the Library of Potential Literature , a compendium of catalog 'blurbs' for non-existent desired or ideal texts. Along with Erinrose Mager, I edited the project, in a process that was more like curation as it mainly entailed asking a range of contemporary writers, theorists, and text-makers to send us an entry. What resulted was a creative/critical hybrid anthology, a small book in which each page (...) opens to a new iteration of textual desire. These texts explore the material possibilities of the book. Somewhat parallel to the call of N. Katherine Hayles who, in her book Writing Machines , urges literary theorists to take up the practice of Medium Specific Analysis (to account for the way the medium in which it is presented conditions or at least bears on a literary text). I see in the imagined works of The Official Catalog a call for the innovative writers of today to become Medium-Responsive. This would mean thinking through the specific (materially constrained) possibilities offered by the media in which texts are presented, and in thinking of the literary text as a kind of art in the greater context of other arts and the book as a medium situated within the context of many other media. In doing so, the contemporary writer refutes the chorus of critics who lament the death of the book by consistently reinvigorating literary innovation. The following are selections from The Official Catalog of the Library of Potential Literature that show possible paths for (thinking about) new writing that engages with its medium. —Ben Segal, Editor THE CUBE Even the most radical non-linear texts have tended to exploit or subvert only the sequential possibilities of print—from the continuous loop of Joyce's Finnegans Wake to the shuffled cards of Marc Saporta's Composition No. 1 —but The Cube takes such multiplicities to an entirely new level. Set in a grid, the book's words can be read conventionally, across the page, as well as down each column—with either route making complete grammatical sense. But they can also be read as stacked strata and mined like lexical core samples through the layered pages of the book. Each path tells the same story from a different perspective (the narrative, naturally, hinges on the potential outcomes of a throw of cubed dice). By opening up the z-axis to reading in this way, The Cube recognizes the book as a three-dimensional sculptural space. Taking its lead from Armand Schwerner's (If Personal) and Raymond Queneau's Cent mille milliards de poèmes , The Cube reads like a experiment by Christian Bök precision printed by Emily McVarish. Craig Dworkin is the editor, most recently, of The Consequence of Innovation: 21st Century Poetics (Roof Books, 2008), The Sound of Poetry/The Poetry of Sound , with Marjorie Perloff (U. Chicago Press, 2009), and Against Expression: An Anthology of Conceptual Writing , with Kenneth Goldsmith (Northwestern UP, 2010). He teaches at the University of Utah. HE GOES In He Goes , we read notes, letters and e-mails from a scholar father to his novelist daughter. We read of the father's musings on Beckett, on Pinter, on Anne Frank; his description of a woman hanging laundry from a line. We read about his journey toward dying, followed by a brief, third person account of his death, and his obituary. Then a long series of blank pages that demand to be read in real time, non-sentence by non-sentence, blank page by blank page. Finally—and it is here that this peculiar little book begins to soar—the dead father writes to his as-of-yet-still-living daughter. He does not write from death. He does not write from life. The words unprint, unstamp, unkindle. Still, they require no translation. The father "writes" (for lack of a better word) about the serendipitous, the commonplace; he recommends another book. He jokes. He asks his daughter how her stomach is. He says forget about presence in absence, darling; screw words as memorial and the guys in garbage cans and loss as redemption and I can't go on I must go on. He goes, "Love, Fodder." He goes, "incidentally." He goes, "I thought you might like to know." Elizabeth Graver is the author of a story collection, Have You Seen Me? , and three novels: Unravelling ; The Honey Thief ; and Awake . Her work has been anthologized in Best American Short Stories , Best American Essays , and Prize Stories: the O. Henry Awards . She teaches at Boston College. THE PAPER ARCHIVIST A stunning package and a triumph of imagination, The Paper Archivist at times looks to be less a book than an abstract expressionist painting. Softly bound, its contents unfold to a single sheet of uneven thickness and texture—a canvas splattered with colored lines, stickers, broken sentences, and nonsense pictographs. But by following the directions to fold, dip, smell, rub, scratch, and tear the sheet according to the contingencies of the weather and using only the objects at hand, the reader slowly brings the forces hidden in the noise into a glorious sculptural convergence, processing a different story and shape each time. This is the rare book that continues to stir, whirl, and pop on every new reading. Sean Higgins blogs at BOMBlog where he is responsible for the column Volumes and Territories, as well as Ghost Island , a fledgling collaborative intellectual collective. THE SLOW BOOK The Slow Book , written by an anonymous author at the dawn of literacy, on a minor planet (otherwise notable only as the source of that exceptionally hardy, not very tasty grain called “shef” sowed on hostile planets as an early step to colonization), and encoded into a series of punctures on a strip of copper coiled inside a clever device, something between a player piano and an old-fashioned film projector, is being released into print, as was the author’s intention, at a rate of one word per century (local time). Each word is, across the Forty Galaxies, agreed to be uncannily apt for the century in which it appears—even “of,” in a century during which the highest value was attached to fidelity, whether to ideals, worlds, or romantic love; even “the,” which governed two centuries, one extraordinarily materialistic, during which advances in propulsion and navigation accelerated the exchange of exceptional objects between the remotest planets of the Forty, and one in which the central concern, both of philosophers and the common man, was whether, in an age of rapidly proliferating hypothetical worlds, anyone or anything concretely existed at all. Even those words published long before interstellar contact can be seen in retrospect to have transgalactic pertinence. As a result, attempts to abstract the machine from its publishers, Hobson & Hui, in order to “predict the future” for insight or gain by “fast- forwarding” the copper strip have been many and ingenious. While, in centuries of skepticism (“maybe”), or of unrest (“go”) the book has been nearly forgotten, in others it seems to haunt every thought, every deed, despite the fact that the subject of The Slow Book is still unclear. So far only a few sentences exist in print; everyone knows them, can quote them, offer the standard exegeses and assorted heresies; yet certainties are the stuff of adolescence; mature readers are forced to acknowledge that these sentences are probably only a preamble to the main argument. They contain no proper nouns, nor can we identify any definite theme. There is even disagreement about their tone, whether coolly ironic, as some insist, or ardent. The appearance of an unusual grammatical case, sometimes called the future pluperfect continuous, used to describe events that at some future point will have always been true (but are not yet)—hitherto known to appear only in the synthetic dogmas of the Thanatographical Society, and in certain highly circumscribed religious contexts—has suggested to some scholars that the Slow Book was originally intended for ritual use, but the proximity of the usage to a term designating a small hand plow that, as Pott and Mielcke have convincingly shown, would have borne a distinctly obscene double meaning in its culture of origin in the author’s time, argues otherwise. It is likewise unclear whether the situation that seems to be—with teasing incompleteness—sketched out in these few lines is intended as an illustration of general principles, a case study, a dramatic scene, or an extended metaphor. In short, we have no idea what The Slow Book is about. In our own time, we believe that it is almost certainly a work of fiction, but that may be because we live in the century of “if”. In each age, perhaps, we see the book we most need to read. Some have dared to suggest that the metal strip is blank until, with millennial fanfare, it advances into its new position, that no ur-text exists, that the book itself is brought into being—written—by our need. But that is exactly the sort of thing we would believe, in 7645. Shelley Jackson is the author of the story collection The Melancholy of Anatomy , the novel Half Life , and hypertexts including Patchwork Girl . The recipient of a Howard Foundation grant, a Pushcart Prize, and the 2006 James Tiptree Jr Award, she has also written and illustrated several children's books, including The Old Woman and the Wave ; Sophia, the Alchemist's Dog ; and Mimi's Dada Catifesto . Her stories and essays have appeared in Conjunctions , McSweeney's , The Paris Review , and Cabinet Magazine . In 2004 she launched her project SKIN , a story published in tattoos on 2095 volunteers. THE BOOK OF SOUNDS The Book of Sounds is just that: a book of sounds made when letters are construed in new ways to bring forth out of the alphabet new forms of speech. A book meant to be read out loud, The Book of Sounds is not unlike Laurie Anderson's O Superman or Brian Eno's Music for Airports in its attempt to make music out of the most primary and simplest of methods. It breaks language down to its barest bones and makes out of the page a drum that has never before been beaten upon. Peter Markus is the author of a novel, Bob, or Man on Boat (Dzanc Books) as well as two books of short fiction, Good, Brother and The Singing Fish , both of which were published by Calamari Press. A new collection of stories, We Make Mud , is now available from Dzanc Books. PARADISE OF THE BLIND by Celan Solen Although the reclusive Celan Solen published his first and only book in 1963—paying out-of-pocket for a limited edition of the slim collection No One May Have the Same Knowledge Again —he remained in American obscurity for almost three decades. In 1992 a micro-press in Istanbul brought out No One in Turkish. A German translation followed in 1995. Soon it became clear in literary circles Solen was a world-class (if highly unclassifiable) artist—lyrical, dense, enigmatic—who could undo the conventional short story in 397 words by inventing impossible worlds housed in impossible whirls (in “Small Sadnesses,” a single chartreuse tree frog in Borneo unknowingly holds time together by its very presence in the universe, while each letter of its tale refers, not to itself, but to the one preceding it in the alphabet). By his disappearance last year, Solen was considered master by a generation of writers and critics (except, alas, for those gentlemen in the Swedish Academy). Imagine, then, that generation’s delight at the discovery, locked away in the author’s safe-deposit box, of his second and final composition. Had Lynch’s Lost Highway been book instead of film, and had it been penned by Beckett at his least certain, revised by Barthelme at his most formally deranged, and typeset by Derrida at his most semiotically catastrophic, the result might have been something like Paradise of the Blind : interlacing narratives of a man composed of borrowed organs (whose most cheerless and difficult to locate, god, could only have been invented by an empty heart), a nonexistent medieval painting blamed for the ruin of future hope, and the spread of a philosophy that holds earth a mistake constantly recurring in the dream of a fish lying on the floor of the Atlantic (if the fish wakes, our world winks off)—all contained in a text packed with typed-over passages, torn postcards, poems that can be deciphered only when held up to a mirror, pages ornamented with trompe-l'œil paperclips and coffee stains and buzzing houseflies, some busy with illegible runes that dissolve when exposed to light, three that smell like roses or lemons (depending on whether a man or woman is reading), two that stain with the bloody fingerprints of the those who handle them, one that ignites when brushed with breath, thirteen sewn from baby skin, one that moans when touched, and one that screams—yet all without mass, unimaginable, and invisible. Lance Olsen is author of more than 20 books of and about innovative fiction, including, most recently, the novels Calendar of Regrets (2010) and Head in Flames (2009). He teaches experimental narrative theory and practice at the University of Utah. SUPERSTRUCTURE! by Barbara D'Albi As soon as I opened the third drawer of Barbara D'Albi's wooden novel, everything became hopeless. Now in Ithaca, there was no going back. And it wasn't just the intricate series of shelves, hinged doors and locked drawers which D'Albi layered into the book, no, lo, I was constructed anew by the story. Who else but D'Albi to imagine a God who becomes a carpenter and gets killed?! And makes it good! You want stories? D'Albi is a skyscraper, built with planes and levers. Momentarily I wondered where I could shelve this book, and then I thought: no matter; I couldn't put it down. Adam Robinson lives in Baltimore, where he runs Publishing Genius. He is the author of Adam Robison and Other Poems and Say, Poem. 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Motor training to improve walking and balance function is a common aspect of rehabilitation following motor-incomplete spinal cord injury. Evidence suggests that moderate- to high-intensity exercise facilitates neuroplastic mechanisms that support motor skill acquisition and learning. Furthermore, enhancing corticospinal drive via transcranial direct current stimulation may augment the effects of motor training. In this pilot study, we investigated whether a brief moderate-intensity locomotor-related motor skill training circuit, with and without tDCS, improved walking and balance outcomes in persons with MISCI. (...) In addition, we examined potential differences between within-day and between-day effects of MST. Twenty-six adults with chronic MISCI, who had some walking ability, were enrolled in a 5-day double-blind, randomized study with a 3-day intervention period. Participants were assigned to an intensive locomotor MST circuit and concurrent application of either sham tDCS or active tDCS. The primary outcome was overground walking speed measured during the 10-meter walk test. Secondary outcomes included spatiotemporal gait characteristics, peak trailing limb angle, intralimb coordination, the Berg Balance Scale, and the Falls Efficacy Scale-International questionnaire. Analyses revealed a significant effect of the MST circuit, with improvements in walking speed, cadence, bilateral stride length, stronger limb TLA, weaker limb ACC, BBS, and FES-I observed in both the MST+tDCSsham and MST+tDCS groups. No differences in outcomes were observed between groups. Between-day change accounted for a greater percentage of the overall change in walking outcomes. In persons with MISCI, brief intensive MST involving a circuit of ballistic, cyclic locomotor-related skill activities improved walking outcomes, and selected strength and balance outcomes; however, concurrent application of tDCS did not further enhance the effects of MST.Clinical Trial Registration[ClinicalTrials.gov], identifier [NCT03237234]. (shrink)

This article explores the uses of Agamben’s philosophy for understanding the educational meaning of practices that typically take/took place at school, such as the collective rehearsal of the alphabet or the multiplication tables. More precisely, I propose that these forms of ‘practising’ show what schooling, as a particular and historically contingent institution, is all about. Instead of immediately assessing the ‘practice of practising’ in terms of learning outcomes, I turn to Bollnow’s attempt to analyze this phenomenon in a substantially (...) educational way, which for him essentially consists in opposing practising and learning. I show that his analysis is superficial and that we need Agamben’s notion of ‘potentiality’ in order to come to grips with the sense of this phenomenon. This will allow to see that practising concerns an uncommon way to relate to a subject matter that makes possible a transformation of individual and collective existence. The main objective of this investigation is not to hold a plea for reintroducing obsolete pedagogical methods, but to rethink the very meaning of education. (shrink)

IntroductionDuring the COVID-19 pandemic, healthcare workers in Italy have been exposed to an unprecedented pressure and traumatic events. However, no direct comparison with the general population is available so far. The aim of this study is to detail mental health outcomes in healthcare workers compared to the general population.Methods24050 respondents completed an on-line questionnaire during the contagion peak, 21342 general population, 1295 second-line healthcare workers, and 1411 front-line healthcare workers. Depressive, anxious, post-traumatic symptoms and insomnia were assessed. Specific COVID-19 (...) related potential risk factors were also considered in healthcare workers.ResultsDepressive symptoms were more frequent in the general population and front-line healthcare workers compared to the second-line healthcare workers groups. Anxiety symptoms showed a prevalence of 21.25% in the general population, 18.05% for second-line healthcare workers, and 20.55% for front-line healthcare workers. Insomnia showed a prevalence of 7.82, 6.58, and 9.92% for the general population, second-line healthcare workers, and front-line healthcare workers, respectively. Compared to the general population, front-line healthcare workers had higher odds of endorsing total trauma-related symptoms. Both second-line healthcare workers and front-line healthcare workers had higher odds of endorsing core post-traumatic symptoms compared to the general population, while second-line healthcare workers had lower odds of endorsing negative affect and dissociative symptoms. Higher total traumatic symptom score was associated with being a front-line healthcare worker, having a colleague infected, hospitalized, or deceased, being a nurse, female gender, and younger age.ConclusionThis study suggests a significant psychological impact of the COVID-19 pandemic on the Italian general population and healthcare workers. Front-line healthcare workers represent a specific at-risk population for post-traumatic symptoms. These findings underline the importance of monitoring and intervention strategies. (shrink)

We investigate the role of social-media-triggered public pressure on corporate social responsibility that includes expectations of transparency and accountability on the firm’s part, and participative/evaluative inputs on the public’s part. Using the date when S&P 500 firms established corporate Twitter accounts, we investigate the impact of corporate social media exposure on CSR outcomes. Results from baseline regressions indicate that firms with Twitter accounts significantly outperform industry peers in CSR rating, after controlling for firm and industry characteristics. To test (...) class='Hi'>potential reverse causality, we use a dynamic treatment effect model to explore within firm changes of CSR, and find that firms’ CSR rating improves in year one- and year two after establishing a Twitter account, while no difference emerged in similar comparisons with peers prior to the Twitter account establishment. Additionally, Granger causality tests results show that corporate Twitter presence improves CSR performance; it is also shown that CSR outcomes do not motivate corporations to establish a social media presence on Twitter. Finally, firms with more experience on Twitter, and those with more followers, tweets or Twitter accounts are associated with improved CSR outcomes. We draw on two theories and qualitative interviews with senior CSR executives to explain why social media influences CSR firm behaviors. (shrink)

In this article; I put forward an instrumental justification for the introduction of youth quotas in parliaments on grounds of justice between coexisting generations. I provide a two-fold argument drawing on the distinction between “substantive representation” and “symbolic representation”. I argue that these jointly provide a good basis for a “politics of youth presence” in parliaments. In the first section; I evaluate the impact that youth quotas can have on enhancing the chances of fair youth policies. In the second section; (...) I show that youth quotas can play an important symbolic role in the promotion of a community of political equals; with potential implications for youth political participation. (shrink)

Background: Post-traumatic stress disorder is a prevalent, debilitating, and costly psychiatric disorder. Evidenced-based psychotherapies, including Cognitive Processing Therapy, are effective in treating PTSD, although a fair proportion of individuals show limited benefit from such treatments. CPT requires cognitive demands such as encoding, recalling, and implementing new information, resulting in behavioral change that may improve PTSD symptoms. Individuals with PTSD show worse cognitive functioning than those without PTSD, particularly in acquisition of verbal memory. Therefore, memory dysfunction may limit treatment gains in (...) CPT in some individuals with PTSD. Methods and Analysis: Here, we present a protocol describing the Cognition and PsychoTherapy in PTSD study, a prospective, observational study examining how cognitive functioning affects treatment response in CPT for PTSD. The study aims to recruit 105 outpatient veterans with PTSD between the ages of 18 and 70 years. Prior to beginning 12 sessions of CPT, Veteran participants will have standardized assessments of mood and functioning and complete a comprehensive neurocognitive battery assessing episodic learning, attention and speed of processing, language ability, executive control, and emotional functioning. This study aims to fill gaps in the current literature by: examining the specificity of memory effects on treatment response; exploring how baseline cognitive functioning impacts functional outcomes; and examining potential mechanisms, such as memory for treatment content, that might explain the effects of baseline memory functioning on PTSD symptom trajectory. Discussion: If successful, this research could identify clinically relevant neurocognitive mechanisms that may impact PTSD psychotherapy and guide the development of individualized treatments for PTSD. (shrink)

Varying conceptions of and purposes for dialogue exist. Recent dialogic theorists and advocates urge exploration of forms of dialogue for learning and applying relational responsibilities within stakeholder networks. A related phenomenon has been the recent emergence of multi-stakeholder dialogues that involve parties significantly affected by major issues or concerns, such as environmental sustainability, that have complex and wide-spread implications. The extent to which these recent multi-stakeholder dialogues assume anything resembling the relationship or caring and the learning potentials of dialogic goals (...) and processes suggested by recent advocates, however, can certainly be questioned. This article explores potential directions for research on enhanced forms of multi-stakeholder dialogues that emphasize goals of dialogic learning, relationship building, and business social responsiveness within a more reflective practice of corporate citizenship. Many issues and questions concerning appropriate antecedents, processes, and outcomes for these enhanced multi-stakeholder dialogues are raised and discussed. (shrink)

Differences in perception and potential disagreements between parents and professionals regarding the attitude for resuscitation at the limit of viability are common. This study evaluated in healthcare professionals whether the decision to resuscitate at the limit of viability are influenced by the way information on incurred risks is given or received. This is a prospective randomized controlled study. This study evaluated the attitude of healthcare professionals by testing the effect of information given through graphic fact sheets formulated either optimistically (...) or pessimistically. The written educational fact sheet included three graphical presentations of survival and complication/morbidity by gestational age. The questionnaire was submitted over a period of 4 months to 5 and 6-year medical students from the Geneva University as well as physicians and nurses of the neonatal unit at the University Hospitals of Geneva. Our sample included 102 healthcare professionals. Forty-nine responders were students, 32 paediatricians and 21 nurses in NICU. The received risk tended to be more severe in both groups compared to the graphically presented facts and current guidelines, although optimistic representation favoured the perception of “survival without disability” at 23 to 25 weeks. Therapeutic attitudes did not differ between groups, but healthcare professionals with children were more restrained and students more aggressive at very low gestational ages. Written information on mortality and morbidity given to healthcare professionals in graphic form encourages them to overestimate the risk. However, perception in healthcare staff may not be directly transferable to parental perception during counselling as the later are usually naïve to the data received. This parental information are always communicated in ways that subtly shape the decisions that follow. (shrink)

Healthcare professionals decide wisely about personalized medicine, treatment plans, and resource allocation by utilizing big data analytics and machine learning. To guarantee that algorithmic recommendations are impartial and fair, however, ethical issues relating to prejudice and data privacy must be taken into account. Big data analytics and machine learning have a great potential to disrupt healthcare, and as these technologies continue to evolve, new opportunities to reform healthcare and enhance patient outcomes may arise. In order to investigate the (...) patient’s outcomes with empirical evidence, this research was conducted using an online survey to incorporate healthcare professionals, patient’s reviews, and clinical staff. The data were analyzed using SmartPLS 4.0 to predict the structural model. The findings revealed a direct impact as positive influence of using machine learning on healthcare performance and patient outcomes through big data analytics. Moreover, it is evident that this can lead to personalized treatment plans, early interventions, and improved patient outcomes. Additionally, big data analytics can help healthcare providers optimize resource allocation, improve operational efficiency, and reduce costs. The impact of big data analytics on patient outcome and healthcare performance is expected to continue to grow, making it an important area for investment and research. (shrink)