Background In the ethical and clinical literature, cases of parents who want treatment for their child to be withdrawn against the views of the medical team have not received much attention. Yet resolution of such conflicts demands much effort of both the medical team and parents. Objective To discuss who can best protect a child9s interests, which often becomes a central issue, putting considerable pressure on mutual trust and partnership. Methods We describe the case of a 3-year-old boy with acquired (...) brain damage due to autoimmune-mediated encephalitis whose parents wanted to stop treatment. By comparing this case with relevant literature, we systematically explored the pros and cons of sharing end-of-life decisions with parents in cases where treatment is considered futile by parents and not (yet) by physicians. Conclusions Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt. Moreover, a request from parents on behalf of their child to discontinue treatment is, and should be, hard to over-rule in cases with significant prognostic uncertainty and/or in cases with divergent opinions within the medical team. (shrink)

Research has shown the importance of engaging in networking behaviors for employees’ career success. Networking behaviors can be seen as a proactive way of creating access to career-related social resources and we argue that this type of proactive career behaviors might be particularly relevant for freelancers who cannot depend on an organizational career system supporting their further development, yet whose careers are characterized by high levels of uncertainty and unpredictability. To date, however, our understanding of how freelancers, being a category (...) of workers that are deprived of an organizational context of support for career development, can safeguard their employability, is limited. Therefore, this study addresses this gap and investigates whether freelancers’ networking behaviors are positively associated with career outcomes, through the mediating role of the need for relatedness fulfillment and employability-enhancing competencies. Hypotheses are tested via Structural Equation Modelling using a sample of 1,874 freelancers from Belgium, France, Germany, the Netherlands and the United Kingdom. The results generally support our hypotheses, providing evidence for a significant association between networking behaviors and need for relatedness fulfillment, and between networking behaviors and employability-enhancing competencies. Moreover, we found a significant association between need for relatedness fulfillment and employability-enhancing competencies, being the mediators in our research model and the outcomes of career satisfaction and future career opportunities. Implications for career development in the contemporary workplace are discussed, with particular attention for need for relatedness fulfillment, employability, and sustainable careers of freelance workers. (shrink)

BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were (...) asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

The blackbody radiation field is studied from different points of view. The existence of zero-point fluctuations is shown to be crucial in determining the form of the thermal part of the spectrum. The notion of a continuous field is seen to be compatible with a discrete structure for its interaction: The description normally used in the quantum context does not refer to the field but to its interaction with atomic systems, which involves statistically independent elementary acts of absorption and emission. (...) The same classical field has different effects on absorption and on emission, and these are conveniently, but not necessarily, described in terms of non-commuting operators. (shrink)

Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences. Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences. Design: Single group pre-/post-test design with two questionnaires. Methods: Questionnaires used were the Rushton Moral (...) Resilience Scale measuring Moral Resilience and the Euro-MCD, measuring Moral Competences. Respondents mainly consisted of nurses and nurse assistants who used CURA in daily practice. Forty-seven respondents contributed to both pre- and post-test with 18 months between both tests. Analysis was done using descriptive statistics and Wilcoxon signed rank tests. This study followed the SQUIRE checklist. Ethical considerations: This study was approved by the Institutional Review Board of Amsterdam UMC. Informed consent was obtained from all respondents. Results: The total Moral Resilience score and the scores of two subscales of the RMRS, that is, Responses to Moral Adversity and Relational Integrity, increased significantly. All subscales of the Euro-MCD increased significantly at posttest. Using CURA more often did not lead to significant higher scores on most (sub) scales. Conclusion: This study indicates that CURA can be used to foster moral resilience and moral competences of healthcare professionals. CURA therefore is a promising instrument to support healthcare professionals in dealing with moral challenges in everyday practice. (shrink)

Purрose of the рaрer is to emphasize affinity and succession in the aррroaches of Descartes and Kierkegaard to the interpretation of key factors of their philosophical search. It could be implemented through understanding such viewpoints of both thinkers as a) appropriate reasons for human existence; b) possible factors for human freedom as a condition of self-actualization; c) original approach to prove the existence of God. Theoretical basis. The use of phenomenology and hermeneutics enable us to comprehend the key philosopher’s ideas (...) as the manifestation of their personalities. Originality. The author believes that it is quite right to refer to the philosophy of the early modern period as a form of its demand fulfillment for human development. An essential prerequisite for revealing the toрic of the article is a focus on the latest investigations of Descartes’ philosophy, which demonstrate the anthropological significance. Since Kierkegaard’s viewpoint was developed through depersonalized understanding of philosophy, related motives of their thoughts are expressed by emphasizing their personal motives of philosophizing. This affinity is reflected firstly, in distancing from depersonalized and dehumanized world view; secondly, in religion-oriented search and proof of God’s existence based on human nature. Conclusions. Due to the modern state of historical and philosophical science, it is possible to argue that Descartes and Kierkegaard had content-related philosophizing motives, which are close to current search. Interpreting Descartes’ anthropological project by Kierkegaard, the author states the accepted determining influence of Hegel’s philosophy interpretation in general and his interpretation of Descartes, in particular. This argument allows to understand Kierkegaard’s search as Hegel’s deconstruction, because further uncritical retention and reproduction of his viewpoints are evaluated as a threat to fulfill human spiritual calling. A common and important thing in the views of both thinkers is their strong interest in individual and personal aspects of human nature as a constituent factor of God’s existence. (shrink)

Ethics support services like Moral Case Deliberation intend to support healthcare professionals in ethically difficult situations. To assess outcomes of MCD, the Euro-MCD Instrument has been developed. Field studies to test this instrument are needed and have been conducted, examining important outcomes before MCD participation and experienced outcomes. The current study aimed to describe how participants’ perceive the importance of MCD outcomes after MCD; compare these perceptions with those before MCD participation; and test the factor structure of these outcomes. Swedish, (...) Norwegian and Dutch healthcare professionals rated the importance of outcomes in the Euro-MCD Instrument after four and eight MCDs. Ratings were compared with those before MCD participation using paired and independent samples t-tests. The factor structure was tested using exploratory factor analyses. After 4 and 8 MCDs, 443 respectively 247 respondents completed the instrument. More than 69% rated all MCD outcomes as ‘quite’ or ‘very’ important, especially outcomes from Enhanced Collaboration, Improved Moral Reflexivity and Improved Moral Attitude. Significant differences for 16 outcomes regarding ratings before and after MCD participation were not considered meaningful. Factor analyses suggested three categories, which seemingly resemble the domains Improved Moral Reflexivity, Enhanced Collaboration and a combination of Improved Moral Attitude and Enhanced Emotional Support. After participation in MCDs, respondents confirmed the importance of outcomes in the Euro-MCD Instrument. The question on perceived importance and the categorization of outcomes need reconsideration. The revised instrument will be presented elsewhere, based on all field studies and theoretical reflections. (shrink)

In recent years, functional connectivity in the developmental science received increasing attention. Although it has been reported that the anatomical connectivity in the preterm brain develops dramatically during the last months of pregnancy, little is known about how functional and effective connectivity change with maturation. The present study investigated how effective connectivity in premature infants evolves. To assess it, we use EEG measurements and graph-theory methodologies. We recorded data from 25 preterm babies, who underwent long-EEG monitoring at least twice during (...) their stay in the NICU. The recordings took place from 27 weeks postmenstrual age until 42 weeks PMA. Results showed that the EEG-connectivity, assessed using graph-theory indices, moved from a small-world network to a random one, since the clustering coefficient increases and the path length decreases. This shift can be due to the development of the thalamocortical connections and long-range cortical connections. Based on the network indices, we developed different age-prediction models. The best result showed that it is possible to predict the age of the infant with a root mean-squared error equal to 2.11 weeks. These results are similar to the ones reported in the literature for age prediction in preterm babies. (shrink)

The geometric system of deduction called N-Graphs was introduced by de Oliveira in 2001. The proofs in this system are represented by means of digraphs and, while its derivations are mostly based on Gentzen's sequent calculus, the system gets its inspiration from geometrically based systems, such as the Kneales' tables of development, Statman's proofs-as-graphs, Buss' logical flow graphs, and Girard's proof-nets. Given that all these geometric systems appeal to the classical symmetry between premises and conclusions, providing an intuitionistic version of (...) any of these is an interesting exercise in extending the range of applicability of the geometric system in question. In this article we produce an intuitionistic version of N-Graphs, based on Maehara's LJ' system, as described by Takeuti. Recall that LJ' has multiple conclusions in all but the essential intuitionistic rules, e.g., implication right and negation right. We show soundness and completeness of our intuitionistic N-Graphs with respect to LJ'. We also discuss how we expect to extend this work to a version of N-Graphs corresponding to the intuitionistic logic system FIL (Full Intuitionistic Logic) of de Paiva and Pereira and sketch future developments. (shrink)

The transition towards sustainable and just food systems is ongoing, illustrated by an increasing number of initiatives that try to address unsustainable practices and social injustices. Insights are needed into what a just transition entails in order to critically engage with plural and potentially conflicting justice conceptualisations. Researchers play an active role in food system transitions, but it is unclear which conceptualisations and principles of justice they enact when writing about food system initiatives. To fill this gap this paper investigates: (...) Which conceptualisations of justice emerge from the literature related to food system initiatives and which principles of justice do authors use? We developed an initial framework for which we drew on political philosophy literature. We then undertook an extensive review of the food system transitions literature using this framework and were able to identify a range of recognition, distributive, and procedural justice conceptualisations and associated principles of justice. Recognised as subjects of justice were those with a particular role in the food system, people who are marginalised, Indigenous communities, those with experiences of negative consequences of the food system, future generations, and nonhumans. The identified conceptualisations and the developed framework can be used by those involved in food system initiatives to reflect on how they conceptualise justice. We challenge them to be more explicit about who they do and do not recognise as subjects of justice and which principles of justice they use. Such clarity is needed to reflexively enact a just transition towards sustainable and just food systems. (shrink)

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called (...) early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)

Byun et al. describe how deaf signers deal with communication problems in first encounters with signers of different languages. They show that the basic Conversation Analytic repair mechanisms for dealing with verbal troubles are largely reproduced in gesture and sign, including details of turn‐taking structure, timing and form. This underlines the role of repair as a basic resource for linguistic and interactional creativity across modalities.

Byun et al. describe how deaf signers deal with communication problems in first encounters with signers of different languages. They show that the basic Conversation Analytic repair mechanisms for dealing with verbal troubles are largely reproduced in gesture and sign, including details of turn‐taking structure, timing and form. This underlines the role of repair as a basic resource for linguistic and interactional creativity across modalities.

Resumen Se estudia comparativamente el desempeño de adultos mayores y de adultos jóvenes en una tarea concurrente que consiste en leer oraciones ecuacionales mientras, al mismo tiempo, se retienen en la memoria tres palabras. El propósito del experimento es averiguar si existe un efecto de las variables edad, memoria operativa, complejidad sintáctica e interferencia de una carga concurrente de memoria en el procesamiento y comprensión de oraciones de sintaxis compleja. El análisis estadístico multinivel realizado revela que tanto el procesamiento en (...) línea de las oraciones ecuacionales como su comprensión se ven afectados significativamente por la edad de los participantes cuando opera una carga de memoria concurrente. Las variables memoria operativa y complejidad sintáctica, por su parte, afectan también significativamente el desempeño de los sujetos, pero independientemente de su edad.The performance of older and young adults in a concurrent task -to read equational sentences while at the same time the subjects retain in memory three words- is comparatively studied. The purpose of the experiment is to find out if there is an effect of the variables of age, working memory, syntactic complexity and interference of a concurrent memory load processing on the comprehension of syntactically complex sentences. The multilevel statistical analysis reveals that both online processing of cleft sentences as their understanding is significantly affected by the age of participants when operating a concurrent memory load. The working memory variables and syntactical complexity, meanwhile, also significantly affect the performance of subjects, but regardless of age. (shrink)

The knower paradox states that the statement ‘We know that this statement is false’ leads to inconsistency. This article presents a fresh look at this paradox and some well-known solutions from the literature. Paul Égré discusses three possible solutions that modal provability logic provides for the paradox by surveying and comparing three different provability interpretations of modality, originally described by Skyrms, Anderson, and Solovay. In this article, some background is explained to clarify Égré’s solutions, all three of which hinge on (...) intricacies of provability logic and its arithmetical interpretations. To check whether Égré’s solutions are satisfactory, we use the criteria for solutions to paradoxes defined by Susan Haack and we propose some refinements of them. This article aims to describe to what extent the knower paradox can be solved using provability logic and to what extent the solutions proposed in the literature satisfy Haack’s criteria. Finally, the article offers some reflections on the relation between knowledge, proof, and provability, as inspired by the knower paradox and its solutions. (shrink)

This is a study of the effects of a number of background variables on ethical perceptions of Mexican and U.S. marketers. This research investigates how a marketer's personal religiousness, relativism, and the ethical values influence in perceptions of the degree of ethical problems in hypothetical marketing scenarios. It also examines differences between Mexican and U.S. marketers on these variables. The results show significant differences in perception between the countries, and we discuss the implications of these differences for cross-cultural business activities.

Los niños con trastorno por déficit de atención con hiperactividad presentan alteraciones en el desarrollo de la función ejecutiva que se traducen en dificultades del control atencional y de la flexibilidad cognitiva. Considerando la complejidad de los procesos involucrados en la comprensión de lectura y el papel fundamental que en ellos cumple la función ejecutiva, puede esperarse que los niños con TDAH presenten diferencias en su desempeño lector en comparación con sus pares sin TDAH. El presente estudio, de carácter correlacional-predictivo, (...) tiene como propósito determinar si tales diferencias de comprensión lectora existen realmente y si es posible predecirlas a partir de la función ejecutiva. Para ello se seleccionaron 71 escolares de tercer y cuarto año de enseñanza básica y se les evaluó la habilidad de comprensión de lectura, el reconocimiento de palabras, la amplitud de la memoria de trabajo verbal, el control atencional y la velocidad de procesamiento. Con el fin de determinar qué variables tenían capacidad para predecir el nivel de comprensión de los escolares se aplicó un análisis de regresión logística binaria. Los resultados ponen en evidencia que el TDAH afecta significativamente el desempeño lector de los escolares y que las variables vinculadas a la función ejecutiva, especialmente la memoria de trabajo, son buenos predictores del rendimiento en comprensión de lectura. (shrink)

Computer science advocates institutional frameworks as an effective tool for modelling policies and reasoning about their interplay. In practice, the rules or policies, of which the institutional framework consists, are often specified using a formal language, which allows for the full verification and validation of the framework (e.g. the consistency of policies) and the interplay between the policies and actors (e.g. violations). However, when modelling large-scale realistic systems, with numerous decision-making entities, scalability and complexity issues arise making it possible only (...) to verify certain portions of the problem without reducing the scale. In the social sciences, agent-based modelling is a popular tool for analysing how entities interact within a system and react to the system properties. Agent-based modelling allows the specification of complex decision-making entities and experimentation with large numbers of different parameter sets for these entities in order to explore their effects on overall system performance. In this paper we describe how to achieve the best of both worlds, namely verification of a formal specification combined with the testing of large-scale systems with numerous different actor configurations. Hence, we offer an approach that allows for reasoning about policies, policy making and their consequences on a more comprehensive level than has been possible to date. We present the institutional agent-based model methodology to combine institutional frameworks with agent-based simulations). We furthermore present J-InstAL, a prototypical implementation of this methodology using the InstAL institutional framework whose specifications can be translated into a computational model under the answer set semantics, and an agent-based simulation based on the jason tool. Using a simplified contract enforcement example, we demonstrate the functionalities of this prototype and show how it can help to assess an appropriate fine level in case of contract violations. (shrink)

In spoken interactions, interlocutors carefully plan and time their utterances, minimising gaps and overlaps between consecutive turns. Cross-linguistic comparison has indicated that spoken languages vary only minimally in terms of turn-timing, and language acquisition research has shown pre-linguistic vocal turn-taking in the first half year of life. These observations suggest that the turn-taking system may provide a fundamental basis for our linguistic capacities. The question remains however to what extent our capacity for rapid turn-taking is determined by modality constraints. The (...) avoidance of overlapping turns could be motivated by the difficulty of hearing and speaking at the same time. If so, turn-taking in sign might show greater toleration for overlap. Alternatively, signed conversations may show a similar distribution of turn-timing as spoken languages, thus avoiding both gaps and overlaps. To address this question we look at turn-timing in question-answer sequences in spontaneous conversations of Sign Language of the Netherlands. The findings indicate that although there is considerable overlap in two or more signers' articulators in conversation, when proper allowance is made for onset preparation, post-utterance retraction and the intentional holding of signs for response, turn-taking latencies in sign look remarkably like those reported for spoken language. This is consistent with the possibility that, at least with regard to responses to questions, speakers and signers follow similar time courses in planning and producing their utterances in on-going conversation. This suggests that turn-taking systems may well be a shared cognitive infrastructure underlying all modern human languages, both spoken and signed. (shrink)

Signed utterances are densely packed with pointing signs, reaching a frequency of one in six signs in spontaneous conversations (de Vos, 2012; Johnston, 2013a; Morford & MacFarlane, 2003). These pointing signs attain a wide range of functions and are formally highly diversified. Based on corpus analysis of spontaneous pointing signs in Kata Kolok, a rural signing variety of Bali, this paper argues that the full meaning potentials of pointing signs come about through the integration of a varied set of linguistic (...) and extralinguistic cues. Taking this hybrid nature of pointing phenomena into account, it is argued that pointing signs may become an intrinsic aspect of sign language grammars through two mechanisms: morphemization and syntactic integration. Although not entailed in this research, this approach could implicate that some highly systematized pointing systems of speaking communities may to a degree be grammatical as well. (shrink)

Cell line immortalisation is a growing component of African genomics research and biobanking. However, little is known about the factors influencing consent to cell line creation and immortalisation in African research settings. We contribute to addressing this gap by exploring three questions in a sample of Xhosa participants recruited for a South African psychiatric genomics study: First, what proportion of participants consented to cell line storage? Second, what were predictors of this consent? Third, what questions were raised by participants during (...) this consent process? 760 Xhose people with schizophrenia and 760 controls were matched to sex, age, level of education and recruitment region. We used descriptive statistics to determine the proportion of participants who consented to cell line creation and immortalization. Logistic regression methods were used to examine the predictors of consent. Reflections from study recruiters were elicited and discussed to identify key questions raised by participants about consent. Approximately 40% of participants consented to cell line storage. The recruiter who sought consent was a strong predictor of participant’s consent. Participants recruited from the South African Eastern Cape, and older participants, were more likely to consent; both these groups were more likely to hold traditional Xhosa values. Neither illness nor education were significant predictors of consent. Key questions raised by participants included two broad themes: clarification of what cell immortalisation means, and issues around individual and community benefit. These findings provide guidance on the proportion of participants likely to consent to cell line immortalisation in genomics research in Africa, and reinforce the important and influential role that study recruiters play during seeking of this consent. Our results reinforce the cultural and contextual factors underpinning consent choices, particularly around sharing and reciprocity. Finally, these results provide support for the growing literature challenging the stigmatizing perception that people with severe mental illness are overly vulnerable as a target group for heath research and specifically genomics studies. (shrink)

A rapidly emerging hegemonic neuro-culture and a booming neural subjectivity signal the entry point for an inquiry into the status of the signifier neuro as a universal passe-partout. The wager of this paper is that the various appropriations of the neurosciences in the media and in academia itself point to something essential, if not structural, in connection with both the discipline of the neurosciences and the current socio-cultural and ideological climate. Starting from the case of neuroeducation, the genealogy of the (...) neurological turn is linked to the history of psychology and its inextricable bond with processes of psychologisation. If the neurological turn risks not merely neglecting the dimension of critique, but also obviating its possibility, then revivifying a psy-critique might be necessary in order to understand today’s neural subjectivity and its place within current biopolitics. (shrink)