The Oxford Handbook of Happiness is the definitive text for researchers and practitioners interested in human happiness. Its editors and chapter contributors are world leaders in the investigation of happiness across the fields of psychology, organizational behaviour, education, philosophy, social policy and economics.

Nurses die by suicide at a higher rate than the general population. Previous studies have observed mental health problems, including substance use, as a prominent antecedent before death. The purpose of this study was to explore the characteristics of nurses who died by suicide documented in the death investigation narratives from the National Violent Death Reporting System from 2003 to 2017 using thematic analysis and natural language processing. One thousand three hundred and fifty‐eight subjects met these inclusion criteria. Narratives from (...) 601 subjects were thematically analyzed and 2544 individual narratives were analyzed using natural language processing. The analyses revealed five themes: “mental health treatment,” “poor general health and chronic pain,” “substance use,” “worsening mental health after bereavement,” and “repeating a family member's suicide.” Mental health/substance use, chronic illness, and chronic pain were seen to coexist in a complex, interdependent manner that appeared to be entangled in the nurses' narratives before death. These findings echo the need for reducing the stigmatization of mental health problems in nursing and removing barriers to help‐seeking behaviors as early preventative interventions. Future research is needed to determine if a comprehensive healthcare integration approach to address these entangled problems would reduce suicide vulnerability in nurses and improve their quality of life. (shrink)

Narrow views of systemic sustainability risks can result in ecological concerns being neglected, as well as giving rise to unequal distribution and exploitation of natural resources, creating injustice. Given recent advancements in integrating justice with the safe space environmentally, as defined by the planetary boundaries, now is a critical moment for business ethics researchers to deepen the conversation on managing systemic sustainability risks to create a safe and just operating space. We argue that the social-ecological systems approach, that views humans (...) as embedded in and dependent on the natural environment, provides a foundation for business ethics scholars to deepen the conversation. We build on two key dimensions from the social-ecological systems approach, social-ecological connectivity and cross-scale dynamics to develop a framework that illustrates four ways for business ethics scholars to research systemic sustainability risks. We demonstrate the relevance of these dimensions for understanding systemic sustainability risks, discuss their ethical implications, and outline opportunities for future research. (shrink)

Introduction This article is a response to Zagouras, Ellick, and Aulisio who presented a case study justifying the questioning of the capacity and autonomy of a young woman with a physical disability who was pregnant and facing coercive pressure to terminate. Case description Julia is described as a 26-year-old woman with a neurological disability that requires her to receive assistance with activities of daily living. She was described as living with her parents who provided her with personal care assistance. Julia (...) became pregnant and her parents wished her to terminate because they did not want to care for her child in addition to her. In fact, Julia's parents threatened her with institutionalization if she did not elect to terminate the pregnancy. Her health care team questioned her decision-making capacity based on her alleged “mental age” and experiences of being sheltered and excluded. The health care team used directive tactics to convince Julia to terminate the pregnancy, which describe as both an ethical and feminist intervention. Discussion The current authors take issue with the case analysis provided by and argue that they neglected to account for numerous instances of systemic ableism that adversely affected Julia, demonstrated prejudicial and judgmental attitudes toward pregnancy and disability, inappropriately questioned her decision-making capacity by infantilizing her, misconstrued the feminist concept of relational autonomy, and colluded with coercive interference from family members. This is a classic example of discriminatory and culturally incompetent reproductive health care for a disabled woman. (shrink)

This book offers a uniquely authoritative overview of early-modern philosophy, written by an international team of specialists.

Educators continue to struggle with how masculinities are performed and regulated in spaces of learning. In a time of rapid social change, there is a renewed impetus for gender justice reform in schooling, though these approaches themselves remain a shifting picture. Adding a new layer of complexity, we are now witness to educational policy recommendations around surveillance which are designed to counteract boys’ and young men’s vulnerabilities to be radicalised into the misogynies of the ‘manosphere’. These recommendations exist despite limited (...) research and significant gaps in our understanding regarding both the manosphere as well as the emotional lives of young men. The article intentionally shifts the conversation from reactive surveillance in schools to educative gender justice approaches. We focus, in particular, on the significance of ‘pedagogic discomfort’ in terms of fostering gender transformative dialogue which is critical of ideas associated with the manosphere. We consider how a constructive dialogue might be fostered with a particular focus on pedagogies that recognise the emotional intensities of gender justice work. (shrink)

In the past decade, experimental philosophy---the attempt at making progress on philosophical problems using empirical methods---has thrived in a wide range of domains. However, only in recent years has aesthetics succeeded in drawing the attention of experimental philosophers. The present paper constitutes the first survey of these works and of the nascent field of 'experimental philosophy of aesthetics'. We present both recent experimental works by philosophers on topics such as the ontology of aesthetics, aesthetic epistemology, aesthetic concepts, and imagination, as (...) well as research from other disciplines that not only are relevant to philosophy of aesthetics but also open new avenues of research for experimental philosophy of aesthetics. Overall, we conclude that the birth of an experimental philosophy of aesthetics is good news not only for aesthetics but also for experimental philosophy itself, as it contributes to broaden the scope of experimental philosophy. (shrink)

The Cambridge History of 17th Century Philosophy offers a uniquely comprehensive and authoritative overview of early-modern philosophy written by an international team of specialists. As with previous Cambridge histories of philosophy the subject is treated by topic and theme, and since history does not come packaged in neat bundles, the subject is also treated with great temporal flexibility, incorporating frequent reference to medieval and Renaissance ideas. The basic structure of the volumes corresponds to the way an educated seventeenth - century (...) European might have organized the domain of philosophy. Thus, the history of science, religious doctrine, and politics feature very prominently. The narrative that unfolds begins with an intellectual world dominated by a synthesis of Aristotelianism and scholastic philosophy, but by the end of the period the mechanistic or "corpuscularian" philosophy has emerged and exerted its full impact on traditional metaphysics, ethics, theology, logic, and epistemology. (shrink)

Many real-world agents recognise that they impose harms by choosing to emit carbon, e.g., by flying. Yet many do so anyway, and then attempt to make things right by offsetting those harms. Such offsetters typically believe that, by offsetting, they change the deontic status of their behaviour, making an otherwise impermissible action permissible. Do they succeed in practice? Some philosophers have argued that they do, since their offsets appear to reverse the adverse effects of their emissions. But we show that (...) they do not. In practice, standard carbon offsetting does not reverse the harms of the original action, nor does it even benefit the same group as was harmed. Standard moral theories hence deny that such offsetting succeeds. Indeed, we show that any moral theory that allows offsetting in this setting faces a dilemma between allowing any wrong to be offset, no matter how grievous, and recognising an implausibly sharp discontinuity between offsettable actions and non-offsettable actions. The most plausible response is to accept that carbon offsetting fails to right our climate wrongs. (shrink)

Antinatalism is an emerging philosophy and practice that challenges pronatalism, the prevailing philosophy and practice in reproductive matters. We explore justifications of antinatalism—the arguments from the quality of life, the risk of an intolerable life, the lack of consent, and the asymmetry of good and bad—and argue that none of them supports a concrete, understandable, and convincing moral case for not having children. We identify concentration on possible future individuals who may or may not come to be as the main (...) culprit for the failure and suggest that the focus should be shifted to people who already exist. Pronatalism’s hegemonic status in contemporary societies imposes upon us a lifestyle that we have not chosen yet find almost impossible to abandon. We explicate the nature of this imposition and consider the implications of its exposure to different stakeholders with varying stands on the practice of antinatalism. Imposition as a term has figured in reproductive debates before, but the argument from postnatal, mental, and cultural imposition we launch is new. It is the hitherto overlooked and underdeveloped justification of antinatalism that should be solid and comprehensible enough to be used even by activists in support of their work. (shrink)

Why is it that most fictions present one and only one ending, rather than multiple ones? Fictions presenting multiple endings are possible, because a few exist; but they are very rare, and this calls for an explanation. We argue that such an explanation is likely to shed light on our engagement with fictions, for fictions having one and only one ending seem to be ubiquitous. After dismissing the most obvious explanations for this phenomenon, we compare the scarcity of multiple endings (...) in traditional kinds of fiction to their profusion in the case of interactive fictions. This contrast poses a challenge to accounts of our engagement with fictions in terms of games of make-believe. We conclude that solving this puzzle is likely to improve our philosophical understanding of fictions. (shrink)

What, if anything, is problematic about the involvement of celebrities in democratic politics? While a number of theorists have criticized celebrity involvement in politics (Meyer 2002; Mills 1957; Postman 1987) none so far have examined this issue using the tools of social epistemology, the study of the effects of social interactions, practices and institutions on knowledge and belief acquisition. This paper will draw on these resources to investigate the issue of celebrity involvement in politics, specifically as this involvement relates to (...) democratic theory and its implications for democratic practice. We will argue that an important and underexplored form of power, which we will call epistemic power, can explain one important way in which celebrity involvement in politics is problematic. This is because unchecked uses and unwarranted allocations of epistemic power, which celebrities tend to enjoy, threaten the legitimacy of existing democracies and raise important questions regarding core commitments of deliberative, epistemic, and plebiscitary models of democratic theory. We will finish by suggesting directions that democratic theorists could pursue when attempting to address some of these problems. (shrink)

European Journal of Philosophy, EarlyView.

Language provides rich social information about its speakers. For instance, adults and children make inferences about a speaker's social identity, geographic origins, and group membership based on her language and accent. Although infants prefer speakers of familiar languages, little is known about the developmental origins of humans’ sensitivity to language as marker of social identity. We investigated whether 9-month-olds use the language a person speaks as an indicator of that person's likely social relationships. Infants were familiarized with videos of two (...) people who spoke the same or different languages, and then viewed test videos of those two individuals affiliating or disengaging. Results suggest that infants expected two people who spoke the same language to be more likely to affiliate than two people who spoke different languages. Thus, infants view language as a meaningful social marker and use language to make inferences about third-party social relationships. (shrink)

Public participation in scientific research has gained prominence in many scientific fields, but the theory of participatory research is still limited. In this paper, we suggest that the divergence of values and goals between academic researchers and public participants in research is key to analyzing the different forms this research takes. We examine two existing characterizations of participatory research: one in terms of public participants' role in the research, the other in terms of the virtues of the research. In our (...) view, each of these captures an important feature of participatory research but is, on its own, limited in what features it takes into account. We introduce an expanded conception of norms of collaboration that extends to both academic researchers and public participants. We suggest that satisfying these norms requires consideration of the two groups' possibly divergent values and goals, and that a broad characterization of participatory research that starts from participants' values and goals can motivate both public participants’ role in the research and the virtues of the research. The resulting framework clarifies the similarities and differences among participatory projects and can help guide the responsible design of such projects. (shrink)

A rarely studied motive for engaging in face-to-face arguing is to display one’s identity. One way people can manage their impressions is to give reasons for their commitments. This appears to be the first study to focus on this reason for arguing. 461 undergraduates recalled an episode in which they had argued to display own identity. They filled out trait measures as well as instruments describing the episode. Identity display arguments do not require controversy, are not very emotional episodes, can (...) partly serve many communication goals, and are polite. People who have high predilection to argue for identity display are both self- and other-oriented, although the correlations with self-oriented measures are stronger. This study not only describes episodes containing arguments for identity display, but also indicates the balance between self- and other-orientations that are involved. (shrink)

Harris, Barnier, Sutton and Savage examine the communication styles that boost the mnemonic consequences associated with conversations for long‐term married couples and the circumstances under which the couples form a TMS. Harris and colleagues demonstrated that specific communication styles (e.g., cueing each other) promote group memory success whereas others (e.g., correcting each other) did not enhance group recall performance. These results showed that even in well‐established and enduring distributed cognitive systems such as long‐term intimate couples (Harris, Barnier, Sutton & Keil, (...) 2014), memory benefits depend on effective communication and the specificities of the task performed (e.g., remembering lists of words vs. remembering shared, autobiographical experiences). (shrink)

IntroductionAcademic integrity policy that is inaccessible, ambiguous or confusing is likely to result in inconsistent policy enactment. Additionally, policy analysis and development are often undertaken as top down processes requiring passive acceptance by users of policy that has been developed outside the context in which it is enacted. Both these factors can result in poor policy uptake, particularly where policy users are overworked, intellectually critical and capable, not prone to passive acceptance and hold valuable grass roots intelligence about policy enactment.Case (...) descriptionThe case study presented in this paper describes the actions of a community of practice at a regional Australian university to deconstruct and translate ambiguous academic integrity policy into a suite of accessible academic integrity resources that were intelligible to staff and students, and which assisted academic staff to consistently enact policy. The paper narrates the formation of the CoP, the tangible and intangible value it created, the social learning practices enacted by its members, its grassroots policy work and the material resources produced from that work.Discussion and evaluationAn evaluation of the CoP was conducted using a value creation framework to explore its immediate value, potential value, applied value, realised value, and reframing value. These values were considered at each stages of the CoP’s lifespan. The evaluation was a useful process that demonstrated the wide-ranging value created by the CoP. Six insights were drawn from the evaluation which promote understanding of the value created for a university by a CoP, particularly in contributing to academic integrity culture over a sustained period of time.ConclusionsThis paper contributes to a research gap on specific examples of discretion within rule-based systems. It illustrates how academics and members of the CoP used their discretion to interpret and enact academic integrity policy within a higher education setting. Drawing from the evaluation of the CoP we argue for greater understanding of the grass-roots contribution of academic and professional staff to academic integrity policy translation and enactment. (shrink)

Patient narratives from two investigational deep brain stimulation trials for traumatic brain injury and obsessive‐compulsive disorder reveal that injury and illness rob individuals of personal identity and that neuromodulation can restore it. The early success of these interventions makes a compelling case for continued post‐trial access to these technologies. Given the centrality of personal identity to respect for persons, a failure to provide continued access can be understood to represent a metaphorical identity theft. Such a loss recapitulates the pain of (...) an individual's initial injury or illness and becomes especially tragic because it could be prevented by robust policy. A failure to fulfill this normative obligation constitutes a breach of disability law, which would view post‐trial access as a means to achieve social reintegration through this neurotechnological accommodation. (shrink)

Coupledom and notions of intimacy and family formation with one committed partner are hallmarks of family and relationship science. Recent national surveys in the United States and Canada have found that consensually non-monogamous relationships are common, though prevalence of specific types of consensual non-monogamy are unknown. The present research draws on a United States Census based quota sample of single adults to estimate the prevalence of desire for, familiarity with, and engagement in polyamory—a distinct type of consensually non-monogamous relationship where (...) people typically engage in romantic love and sexual intimacy with multiple partners. Results show that 1 out of 6 people desire to engage in polyamory, and 1 out of 9 people have engaged in polyamory at some point during their life. Approximately 1 out of 15 people reported that they knew someone who has been or is currently engaged in polyamory. Among participants who were not personally interested in polyamory, 1 out of 7 indicated that they respect people who engage in polyamory. Few sociodemographic correlates emerged; no differences in prevalence were found based on political affiliation, income, religion, geographic region, or race/ethnicity. Sexual minorities, men, and younger adults reported greater desire to engage in polyamory. Men and people with lower education backgrounds were more likely to have previously engaged in polyamory. Given that emotional and sexual intimacy is an important part of most people’s lives, understanding the varied ways in which people navigate their intimate lives is critical for the fields of relationship, sexuality, and family science. (shrink)

In this paper we consider the modal logic with both $$\Box $$ and $$\Diamond $$ arising from Kripke models with a crisp accessibility and whose propositions are valued over the standard Gödel algebra $$[0,1]_G$$. We provide an axiomatic system extending the one from Caicedo and Rodriguez (J Logic Comput 25(1):37–55, 2015) for models with a valued accessibility with Dunn axiom from positive modal logics, and show it is strongly complete with respect to the intended semantics. The axiomatizations of the most (...) usual frame restrictions are given too. We also prove that in the studied logic it is not possible to get $$\Diamond $$ as an abbreviation of $$\Box $$, nor vice-versa, showing that indeed the axiomatic system we present does not coincide with any of the mono-modal fragments previously axiomatized in the literature. (shrink)

Some children living with life-shortening medical conditions may wish to attend school without the threat of having resuscitation attempted in the event of cardiopulmonary arrest on the school premises. Despite recent attention to in-school do-not-attempt-resuscitation (DNAR) orders, no assessment of state laws or school policies has yet been made. We therefore sought to survey a national sample of prominent school districts and situate their policies in the context of relevant state laws. Most (80%) school districts sampled did not have policies, (...) regulations, or protocols for dealing with student DNARs. A similar majority (76%) either would not honor student DNARs or were uncertain about whether they could. Frequent contradictions between school policies and state laws also exist. Consequently, children living with life-shortening conditions who have DNARs may not have these orders honored if cardiopulmonary arrest were to occur on school premises. Coordinated efforts are needed to harmonize school district, state, and federal approaches in order to support children and families' right to have important medical decisions honored. (shrink)

Childcare robots are being manufactured and developed with the long term aim of creating surrogate carers. While total childcare is not yet being promoted, there are indications that it is ‘on the cards’. We examine recent research and developments in childcare robots and speculate on progress over the coming years by extrapolating from other ongoing robotics work. Our main aim is to raise ethical questions about the part or full-time replacement of primary carers. The questions are about human rights, privacy, (...) robot use of restraint, deception of children and accountability. But the most pressing ethical issues throughout the paper concern the consequences for the psychological and emotional wellbeing of children. We set these in the context of the child development literature on the pathology and causes of attachment disorders. We then consider the adequacy of current legislation and international ethical guidelines on the protection of children from the overuse of robot care. (shrink)

IntroductionAllocation of research funds relies on peer review to support funding decisions, and these processes can be susceptible to biases and inefficiencies. The aim of this work was to determine which past interventions to peer review and decision-making have worked to improve research funding practices, how they worked, and for whom.MethodsRealist synthesis of peer-review publications and grey literature reporting interventions in peer review for research funding.ResultsWe analysed 96 publications and 36 website sources. Sixty publications enabled us to extract stakeholder-specific context-mechanism-outcomes (...) configurations for 50 interventions, which formed the basis of our synthesis. Shorter applications, reviewer and applicant training, virtual funding panels, enhanced decision models, institutional submission quotas, applicant training in peer review and grant-writing reduced interrater variability, increased relevance of funded research, reduced time taken to write and review applications, promoted increased investment into innovation, and lowered cost of panels.ConclusionsReports of 50 interventions in different areas of peer review provide useful guidance on ways of solving common issues with the peer review process. Evidence of the broader impact of these interventions on the research ecosystem is still needed, and future research should aim to identify processes that consistently work to improve peer review across funders and research contexts. (shrink)

As of this writing, twenty‐one states have passed laws barring transgender youth‐athletes from competing on public‐school sports teams in accordance with their gender identity. Proponents of these regulations claim that transgender females in particular have inherent physiological advantages that threaten a “level playing field” for their cisgender competitors. Existing evidence is limited but does not support these restrictions. Gathering more robust data will require allowing transgender youth to compete (rather than preemptively barring them), but even if trans females are shown (...) to retain some advantage, this would not have greater moral significance than the many other “fair” physical and economic advantages found across sports. These regulations deprive transgender youth, an exceptionally vulnerable population, from the vast physical, mental, and social benefits of sports. While we advocate for transgender inclusion under our current, gender‐segregated model of sport, we propose changes to the overarching structure that would promote a more inclusive and fairer athletic environment. (shrink)

Drawing on insights from social learning and social cognitive perspectives and research on the multilevel reality of leadership influences, we developed and tested a multilevel model that examines mechanisms and conditions through which ethical leadership deters work unit- and individual-level ostracism. Based on two field studies using multiple measurement points, we found that at the work unit level of analysis, relational climate partially mediates the negative relationship between ethical leadership and work unit-level ostracism whereas state mindfulness partially mediates the cross-level (...) influence of ethical leadership on individual-level ostracism. Contrary to our hypothesis, we found that the relationship between ethical leadership and relational climate was stronger when work units had a more mechanistic structure, and not when it had an organic work unit structure. Finally, we found that relational climate not only moderates the relationship between state mindfulness and individual-level ostracism, but also moderates the indirect influence of ethical leadership on individual-level ostracism through state mindfulness such that the indirect effect is stronger when relational climate is high as opposed to low. These findings highlight the individual- and work unit-level conditions and mechanisms through which ethical leadership relates to decreased ostracism at work, and thus extends theory and research on ethical leadership and ostracism. (shrink)

Conversations about the past can involve voicing and silencing; processes of validation and invalidation that shape recall. In this experiment we examined the products and processes of remembering a significant autobiographical event in conversation with others. Following the death of Australian celebrity Steve Irwin, in an adapted version of the collaborative recall paradigm, 69 participants described and rated their memories for hearing of his death. Participants then completed a free recall phase where they either discussed the event in groups of (...) three or wrote about the event on their own. Finally, participants completed the original questionnaire again, both 1 week and 1 month after the free recall phase. Discussion influenced later memories for hearing of Irwin’s death, particularly memories for emotion and shock. Qualitative analysis of the free recall phase suggested that during conversation a shared understanding of the event developed, but that emotional reactions to the event were silenced in ways that minimised the event’s impact. These findings are discussed in terms of the processes and consequences of sharing public and personal memories in conversation. (shrink)

Contrary to the emotions we feel in everyday contexts, the emotions we feel for fictional characters do not seem to require a belief in the existence of their object. This observation has given birth to a famous philosophical paradox (the ‘paradox of fiction’), and has led some philosophers to claim that the emotions we feel for fictional characters are not genuine emotions but rather “quasi-emotions”. Since then, the existence of quasi-emotions has been a hotly debated issue. Recently, philosophers and psychologists (...) have proposed to solve this debate by using empirical methods and experimentally studying differences between ‘real’ and ‘fictional’ emotions. In this paper, our goal is to assess the success of these attempts. We begin by surveying the existing empirical literature and stressing the methodological problems that plague most studies that might seem relevant to the debate, before focusing on recent studies that avoid this pitfall. We then argue that, due to conceptual problems, these studies fail to be relevant to the philosophical debate and emphasize new directions for future empirical research on the topic. (shrink)

We argue that a phenomenological approach to social space, as well as its relation to embodiment and affectivity, is crucial for understanding how the social world shows up as social in the first place—that is, as affording different forms of sharing, connection, and relatedness. We explore this idea by considering two cases where social space is experientially disrupted: Moebius Syndrome and schizophrenia. We show how this altered sense of social space emerges from subtle disruptions of embodiment and affectivity characteristic of (...) these conditions. These disruptions are instructive, we suggest, in that they highlight the foundational role that body and affect play in organizing social space—the lived context in which we first encounter one another as social agents. (shrink)

Internationally, the research on the education of boys has sought to understand how social practices, behaviours and rituals contribute to identity construction. We are interested in approa...

Two experiments report on the construction of the Sense of Agency Rating Scale (SOARS), a new measure for quantifying alterations to agency. In Experiment 1, 370 participants completed a preliminary version of the scale following hypnosis. Factor analysis revealed two underlying factors: Involuntariness and Effortlessness. In Experiment 2, this two factor structure was confirmed in a sample of 113 low, medium and high hypnotisable participants. The two factors, Involuntariness and Effortlessness, correlated significantly with hypnotisability and pass rates for ideomotor, challenge (...) and cognitive items. Twelve week test-retest correlations showed that Involuntariness was highly stable, but Effortlessness only moderately stable. Analysis of the combined datasets from Experiments 1 and 2 showed both SOARS scores were significantly related to the derived factors of Woody, Barnier, and McConkey's (2005) 4-factor model of hypnotisability. This scale clarifies conceptual confusion around agentive action and provides empirical support for a multifactorial account of sense of agency. (shrink)

The latter part of the twentieth century saw the Chinese economy moving towards a socialist market economy rather than a planned system. Despite growing interest in Chinese business ethics, little work has examined ethical issues concerning the Chinese sales force. This study draws from existing work on Chinese and Western business and sales ethics to develop hypotheses regarding the perceptions of unethical selling behaviour of modern Chinese salespeople. A survey of Chinese sales executives is conducted and statistically analysed. Results are (...) compared with those reported in previous US-based research with regard to differences in perceptions of unethical selling behaviour. The results indicate that contemporary Chinese salespeople were more favourably disposed than expected towards unethical selling behaviour, and also more favourably disposed than previously studied US salespeople. Younger Chinese salespeople evaluated unethical behaviours more favourably than older ones. The results are discussed, along with implications for theory, practice and future work. (shrink)

Experiences of substitute decision-makers with requests for consent to non-therapeutic research participation during the dying process, including to what degree such requests are perceived as burdensome, have not been well described. In this study, we explored the lived experiences of family members who consented to non-therapeutic research participation on behalf of an imminently dying patient. We interviewed 33 family members involved in surrogate research consent decisions for dying patients in intensive care. Non-therapeutic research involved continuous physiological monitoring of dying patients (...) prior to and for 30 min following cessation of circulation. At some study centres participation involved installation of bedside computers. At one centre electroencephalogram monitoring was used with a subset of participants. Aside from additional monitoring, the research protocol did not involve deviations from usual end-of-life care. Thematic analysis of interviews suggests most family members did not perceive this minimal-risk, non-therapeutic study to affect their time with patients during the dying process, nor did they perceive research consent as an additional burden. In our analysis, consenting for participation in perimortem research offered families of the dying an opportunity to affirm the intrinsic value of patients’ lives and contributions. This opportunity may be particularly important for families of patients who consented to organ donation but did not proceed to organ retrieval. Our work supports concerns that traditional models of informed consent fail to account for possible benefits and harms of perimortem research to surviving families. Further research into consent models which integrate patient and family perspectives is needed. All data relevant to the study are included in the article. (shrink)

ObjectiveTo compare techniques for computing clustering and switching scores in terms of agreement, correlation, and empirical value as predictors of incident cognitive impairment.MethodsWe transcribed animal and letter F fluency recordings on 640 cases of ICI and matched controls from a national epidemiological study, amending each transcription with word timings. We then calculated clustering and switching scores, as well as scores indexing speed of responses, using techniques described in the literature. We evaluated agreement among the techniques with Cohen’s κ and calculated (...) correlations among the scores. After fitting a base model with raw scores, repetitions, and intrusions, we fit a series of Bayesian logistic regression models adding either clustering and switching scores or speed scores, comparing the models in terms of several metrics. We partitioned the ICI cases into acute and progressive cases and repeated the regression analysis for each group.ResultsFor animal fluency, we found that models with speed scores derived using the slope difference algorithm achieved the best values of the Watanabe–Akaike Information Criterion, but with good net reclassification improvement only for the progressive group. For letter fluency, different models excelled for prediction of acute and progressive cases. For acute cases, NRI was best for speed scores derived from a network model, while for progressive cases, the best model used clustering and switching scores derived from the same network model. Combining variables from the best animal and letter F models led to marginal improvements in model fit and NRI only for the all-cases and acute-cases analyses.ConclusionSpeed scores improve a base model for predicting progressive cognitive impairment from animal fluency. Letter fluency scores may provide complementary information. (shrink)