I propose that it is premature to assert that a fully three-dimensional map has never evolved in any species, as data are lacking to show that space coding in all animals is the same. Instead, I hypothesize that three-dimensional representation is tied to an animal's mode of locomotion through space. Testing this hypothesis requires a large body of comparative data.

Essential skills and attitudes necessary for active citizenship need to be cultivated as early as prekindergarten. This exploratory study investigated if three and four-year olds could be actively engaged in social studies practices through inquiry learning in a school garden. Eleven children openly interacted and conducted personally-driven investigations on a daily basis in the school garden located on their playground over nine-months. Three interviews with children, teacher observation notes, and lesson plans were analyzed to discover whether NCSS preK-12 learning themes (...) (2010) for the social studies curriculum could be correlated with garden inquiries. Three prevalent NCSS themes surfaced from data analysis with Civic Ideals and Practices, People, Places, and Environments, and Time, Continuity, and Change being most prevalent. Results imply that working in a school garden through inquiry learning can foster the development of democratic competencies and thus, could be used to design C3 lessons for preschoolers in the garden. (shrink)

How did I raise my arm? The simple answer is that I raised it as a consequence of intending to raise it. A slightly more complicated response would mention the absence of any factors which would inhibit the execution of the intention- and a more complicated one still would specify the intention in terms of a goal (say, drinking a beer) which requires arm-raising as a means towards that end. Whatever the complications, the simple answer appears to be on the (...) right track. (shrink)

The practice of critical care medicine has long been a difficult task for most critical care physicians in the densely populated city of Hong Kong, where we face limited resources and a limited number of intensive care beds. Our triage decisions are largely based on the potential of functional reversibility of the patients. Provision of graded care beds may help to relieve some of the demands on the intensive care beds. Decisions to forego futile medical treatment are frequently physician-guided family-based (...) decisions, which is quite contrary to the Western focus on patient autonomy. However, as people acquire knowledge about health care and they become more aware of individual rights, our critical care doctors will be able to narrow the gaps between the dif ferent concepts of medical ethics among our professionals as well as in our society. An open and caring attitude from our intensivists will be important in minimizing the cross-cultural conflict on the complex issue of medical futility. (shrink)

In this study, we attempt to explain the divergent results found in the relationships between supervisor–subordinate guanxi and employee work outcomes. Specifically, we propose that the relationships between supervisor–subordinate guanxi and participatory management, turnover intentions, and organizational commitment are mediated by job satisfaction. Based on the data collected from a sample of 196 employees of three local manufacturing firms in Zhejiang Province, China, we found that job satisfaction fully mediated the effects of supervisor–subordinate guanxi on participatory management and intentions to (...) leave, but partially mediated the relationship between supervisor–subordinate guanxi and organizational commitment. Theoretical and practical implications are discussed. (shrink)

Recent findings support the idea that the belief in free will serves as the basis for moral responsibility, thus promoting the punishment of immoral agents. We theorized that free will extends beyond morality to serve as the basis for accountability and the capacity for change more broadly, not only for others but also for the self. Five experiments showed that people attributed higher freedom of will to negative than to positive valence, regardless of morality or intent, for both self and (...) others. In recalling everyday life situations and in classical decision making paradigms, negative actions, negatives outcomes, and negative framing were attributed higher free will than positive ones. Free will attributions were mainly driven by action or outcome valence, but not intent. These findings show consistent support for the idea that free will underlies laypersons’ sense-making for accountability and change under negative circumstances. (shrink)

:Empirical work has shown that patients and physicians have markedly divergent understandings of treatability statements in the context of serious illness. Patients often understand treatability statements as conveying good news for prognosis and quality of life. In contrast, physicians often do not intend treatability statements to convey improvement in prognosis or quality of life, but merely that a treatment is available. Similarly, patients often understand treatability statements as conveying encouragement to hope and pursue further treatment, though this may not be (...) intended by physicians. This radical divergence in understandings may lead to severe miscommunication. This paper seeks to better understand this divergence through linguistic theory—in particular, H.P. Grice’s notion of conversational implicature. This theoretical approach reveals three levels of meaning of treatability statements: the literal meaning, the physician’s intended meaning, and the patient’s received meaning. The divergence between the physician’s intended meaning and the patient’s received meaning can be understood to arise from the lack of shared experience between physicians and patients, and the differing assumptions that each party makes about conversations. This divergence in meaning raises new and largely unidentified challenges to informed consent and shared decision making in the context of serious illness, which indicates a need for further empirical research in this area. (shrink)

Ambient assisted living technologies can provide assistance and support to persons with dementia. They might allow them the possibility of living at home for longer whilst maintaining their comfort and security as well as offering a way towards reducing the huge economic and personal costs forecast as the incidence of dementia increases worldwide over coming decades. However, the development, introduction and use of AAL technologies also trigger serious ethical issues. This paper is a systematic literature review of the on-going scholarly (...) debate about these issues. More specifically, we look at the ethical issues involved in research and development, clinical experimentation, and clinical application of AAL technologies for people with dementia and related stakeholders. In the discussion we focus on: the value of the goals of AAL technologies, the special vulnerability of persons with dementia in their private homes, the complex question of informed consent for the usage of AAL technologies. (shrink)

PurposeIn Western society, the measurement of weight is prioritized over a person’s bodily experience. Hermeneutic philosopher Gadamer warned against the emphasis on measurement, rather than experience, in the medical sciences. An examination of the complexity of the experience of weight provides the opportunity to shift focus from quantifying the connection between health and weight to the experience of the person being weighed.MethodsThis qualitative hermeneutic study aims to understand people’s experiences of weight from the interviews of professionals and lay experts. Interviews (...) were analyzed using an interpretive hermeneutic method.ResultsThe interviews revealed that weight was experienced as a number imbued with meaning and bias, as a number that could be manipulated, and as a constant and anticipated bodily change. Weight change was expected and often unwelcomed, despite weight being a quality of the body that is always in flux. External measures of weight meant to monitor wellness and health inadvertently became an unhealthy fixation that prevented some participants from fully participating in life events and appreciating the stages their bodies were in.ConclusionWeight change is a necessary condition of being human, and bodies are and will be constantly changing. To achieve health and harmony, one must fit together the acceptance of change and their bodily experience of weight. It is often the preoccupation with weight, not weight itself, that gets in the way of living. (shrink)

Prior research suggests that most people perceive themselves to be more altruistic than the average population, an observation known as the better-than-average (BTA) effect. Understanding the BTA effect carries significant public health implications, as self-perceived altruism is closely related to altruistic behaviors, which plays a significant role in individual and societal well-being. However, little is known about whether subpopulations with specific sociodemographic profiles are more likely to hold BTA altruistic self-perceptions, making it difficult to design targeted programs based on multiple (...) sociodemographic characteristics to promote altruistic behaviors. This study addresses this gap by identifying the sociodemographic profiles of populations who are more likely to exhibit BTA effects on trait altruism. Data were derived from a representative sample of Hong Kong citizens (n= 1,185) in the 2017 Hong Kong Altruism Survey. A latent class analysis was performed using four domains of sociodemographic characteristics: sex, age, religion, and socioeconomic status. Multivariate multinomial logistic regressions were conducted to examine associations between class membership, BTA effect, and altruistic behaviors. The results yielded four classes of sociodemographic profiles. Middle-aged, Christian/Catholic, highly educated, and high-income individuals (Class 4, 17.8%) were most likely to exhibit BTA effects and behave altruistically; Class 3 (14.0%) were older, male, no/other religious belief, low education, and least likely to exhibit BTA effects and behave altruistically. Findings improve the understanding of the sociodemographic profiles of people showing BTA effects and facilitate targeted policy development to effectively promote altruism. (shrink)

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in (...) biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. (shrink)

The progress of electronic health technologies and biobanks holds enormous promise for efficient research. Evidence shows that studies based on sharing and secondary use of data/samples have the potential to significantly advance medical knowledge. However, sharing of such resources for international collaboration is hampered by the lack of clarity about ethical and legal requirements for transfer of data and samples across international borders. Here, the International Clinical Trial Center Network reports the legal and ethical requirements governing data and sample exchange (...) across four continents. The most recurring requirement is ethical approval, whereas only in specific conditions approval of national health authorities is required. Informed consent is not required in all sharing situations. However, waiver of informed consent is only allowed in certain countries/regions and under certain circumstances. The current legal and ethical landscape appears to be very complex and under constant evolution. Regulations differ between countries/regions and are often incomplete, leading to uncertainty. With this work, ICN illuminates the unmet need for a single international collaborative framework to facilitate DSE. Harmonising requirements for global DSE will reduce inefficiency and waste in research. There are many challenges to realising this ambitious vision, including inconsistent terminology and definitions, and heterogeneous and dynamic legal constraints. Here, we identify areas of agreement and significant difference as a necessary first step towards facilitating international collaboration. We propose the establishment of a working group to continue the comparison across jurisdictions, create a standardised glossary and define a set of basic principles and fundamental requirements for DSE. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 37.3 (2003) 104-107 [Access article in PDF] Motivating Aesthetics Cynthia C. Rostankowski Humanities Department San Jose State University The territory of philosophical aesthetics remains a conceptual hinterland in the world of academic disciplines. It is not the only hinterland, but in comparison to other disciplines in arts and letters, few scholars engage in the subject professionally, and many people avoid the territory it (...) occupies as a place to visit, let alone to tarry or reside. Why is this? Usually people do not wish to visit places that are uncomfortable in some way. Frozen wastelands, blazing deserts, war zones, and places with nothing to do or see are usually avoided because they are perceived as unpleasant, dangerous, or boring,and the same is very likely true of their conceptual analogs. In what senses might some people perceive aesthetics as analogous to Siberia, Sudan, or central Kansas? I would like to investigate what it is about aesthetics that causes people to shy away from it more often than to flock to it. I have long been fascinated by the responses of students who express amazement or confusion when exposed to the field of aesthetics as a part of an introductory philosophy class, or of arts educators who do not know what to do with aesthetics since it does not seem quite to fit with the rest of what they do, or the responses of some artists or other arts practitioners who are occasionally disdainful of aesthetics. It would be easy to say that aesthetics has merely had bad press or inadequate exposure in the classroom, but I suspect there is more to it than that. I have experienced many of the situations I have just mentioned, and they have usually surprised and sometimes demoralized [End Page 104] me. They have always motivated me to think harder about my beloved field of interest, to try to reveal its attractions to those who do not find it as appealing and engaging as I do, or as you, my reader does. (I am presuming that one who is reading an essay in a journal about aesthetic education has already found his or her comfort zone in the field.) I will also presume to offer some thoughts about motivating an interest in aesthetics among the aesthetically uninterested — why one might want to do it, and what one might do. Please note, I am not speaking of the aesthetically disinterested 1 ; they too have already found their place in the discipline!It is likely that the problem of aesthetics has to do in part with misunderstandings, and those misunderstandings are multi-layered. If one looks up the word "aesthetic" in the Oxford English Dictionary, one finds the following: (F)rom the Greek for perception...and, being pre-occupied;...pertaining to things perceptible by the senses, things material;..."criticism of taste"...the science which treats of the conditions of sensuous perception...of or pertaining to the appreciation or criticism of the beautiful...Recent extravagances in the adoption of a sentimental archaism as the ideal of beauty have still further removed aesthetic and its derivatives from their etymological and purely philosophical meaning. There are varied suggestions about the use of the term, including the mention of its removal in contemporary parlance from its original meanings. If one looks up the keyword "aesthetic" on the Internet, one may find the following sites: skin care, plastic surgery, dentistry, exterior and interior design, tattoos, and some art, art theory, and philosophy among other things. An exemplification in practice of what is suggested in the OED. It is clear that the meaning of the word "aesthetic" has become at best imprecise, at worst confusing in common parlance.So, the first misunderstanding regarding aesthetics is the meaning of the term. What is philosophical aesthetics? It is not what some misconstrue as the imposition of value judgments on society. Unfortunately, some presume that because matters of taste or definitions of beauty are considered in the field, someone must be telling someone what they ought to think is pleasing or beautiful. This is not the focus... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 37.3 (2003) 104-107 [Access article in PDF] Motivating Aesthetics Cynthia C. Rostankowski Humanities Department San Jose State University The territory of philosophical aesthetics remains a conceptual hinterland in the world of academic disciplines. It is not the only hinterland, but in comparison to other disciplines in arts and letters, few scholars engage in the subject professionally, and many people avoid the territory it (...) occupies as a place to visit, let alone to tarry or reside. Why is this? Usually people do not wish to visit places that are uncomfortable in some way. Frozen wastelands, blazing deserts, war zones, and places with nothing to do or see are usually avoided because they are perceived as unpleasant, dangerous, or boring,and the same is very likely true of their conceptual analogs. In what senses might some people perceive aesthetics as analogous to Siberia, Sudan, or central Kansas? I would like to investigate what it is about aesthetics that causes people to shy away from it more often than to flock to it. I have long been fascinated by the responses of students who express amazement or confusion when exposed to the field of aesthetics as a part of an introductory philosophy class, or of arts educators who do not know what to do with aesthetics since it does not seem quite to fit with the rest of what they do, or the responses of some artists or other arts practitioners who are occasionally disdainful of aesthetics. It would be easy to say that aesthetics has merely had bad press or inadequate exposure in the classroom, but I suspect there is more to it than that. I have experienced many of the situations I have just mentioned, and they have usually surprised and sometimes demoralized [End Page 104] me. They have always motivated me to think harder about my beloved field of interest, to try to reveal its attractions to those who do not find it as appealing and engaging as I do, or as you, my reader does. (I am presuming that one who is reading an essay in a journal about aesthetic education has already found his or her comfort zone in the field.) I will also presume to offer some thoughts about motivating an interest in aesthetics among the aesthetically uninterested — why one might want to do it, and what one might do. Please note, I am not speaking of the aesthetically disinterested 1 ; they too have already found their place in the discipline!It is likely that the problem of aesthetics has to do in part with misunderstandings, and those misunderstandings are multi-layered. If one looks up the word "aesthetic" in the Oxford English Dictionary, one finds the following: (F)rom the Greek for perception...and, being pre-occupied;...pertaining to things perceptible by the senses, things material;..."criticism of taste"...the science which treats of the conditions of sensuous perception...of or pertaining to the appreciation or criticism of the beautiful...Recent extravagances in the adoption of a sentimental archaism as the ideal of beauty have still further removed aesthetic and its derivatives from their etymological and purely philosophical meaning. There are varied suggestions about the use of the term, including the mention of its removal in contemporary parlance from its original meanings. If one looks up the keyword "aesthetic" on the Internet, one may find the following sites: skin care, plastic surgery, dentistry, exterior and interior design, tattoos, and some art, art theory, and philosophy among other things. An exemplification in practice of what is suggested in the OED. It is clear that the meaning of the word "aesthetic" has become at best imprecise, at worst confusing in common parlance.So, the first misunderstanding regarding aesthetics is the meaning of the term. What is philosophical aesthetics? It is not what some misconstrue as the imposition of value judgments on society. Unfortunately, some presume that because matters of taste or definitions of beauty are considered in the field, someone must be telling someone what they ought to think is pleasing or beautiful. This is not the focus... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Future Directions for Oversight of Stem Cell Research in the United States: An UpdateMary A. Majumder (bio) and Cynthia B. Cohen (bio)On 9 March 2009, President Barack Obama (2009a) signed an executive order revoking the statement issued by President George W. Bush during a televised speech in August 2001, in which the latter had sharply restricted the scope of federally funded human embryonic stem cell (hESC) research to (...) cell lines derived (without federal funding) prior to 9:00 P.M. EDT on 9 August 2001. Action by President Obama to remove the cut-off date had been expected. It came as a surprise, however, that he gave authority to determine the scope of eligible research to the Director of the National Institutes of Health (NIH), referencing only general concerns of responsibility, scientific worth, and legality.1 This contrasted not only with the approach of former President Bush, but also with that of former President Clinton, who had expressed personal opposition to the creation of embryos for research and had a distinction between hESCs derived from embryos created for research and those derived from spare embryos enshrined in NIH policy.President Obama’s remarks upon signing the executive order give some insight into the thinking behind his approach. Implicit in them are the views that earlystage human embryos outside the womb do not have full moral status and that the destruction of human embryos in the effort to care for and ease the suffering of human beings who do have full moral status does not devalue human life. The President also stressed that the decision to pursue hESC research reflected not only his opinion, but also a broad social consensus. He concluded with strong ethical commitments on two fronts:We will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.(Obama 2009b)The specific guarantee that President Obama gave against government support for the development of cloning techniques for human reproductive purposes made his silence on the use of cloning for research seem significant. Comments he had made in the course of the campaign (Obama 2008) suggested that he would affirm [End Page 195] the Clinton-era policy of limiting federal funding to hESCs derived from spare embryos. Did this silence mean that President Obama was opening the door to federal funding of research cloning when and if scientists might manage that feat?2009 NIH GuidelinesThe answer to this question and several others came on 17 April, when Raynard Kington, the acting director of NIH, released Draft NIH Guidelines for Human Stem Cell Research (NIH 2009), developed by an NIH Stem Cell Task Force, along with a request for public comment within 30 days of their publication in the Federal Register.2 The 2009 Draft Guidelines exclude from federal funding the derivation of hESCs, a restriction mandated by the reenactment of the Dickey-Wicker Amendment as part of the 2009 Omnibus Appropriations Act (Public Law 111-8, Division F, Title V, § 509). The 2009 Draft Guidelines also exclude the use of hESCs derived from embryos created for research purposes, and so represent a refusal to open the funding door as broadly as the NIH interpretation of the Dickey-Wicker Amendment might allow, at least for the time being.It appears that the drafters used as their starting point the 2000 NIH Guidelines for Research Using Human Pluripotent Stem Cells (NIH 2000) dating from the Clinton Administration, rather than more recent guidelines from the National Academy of Sciences (National Research Council 2005; 2007; 2008) and other private bodies. Both the format and content of the 2000 and 2009 NIH efforts are similar, making the departures in the latter stand out in high relief. We highlight departures related to informed consent to embryo donation, creation of human-nonhuman chimeras, and the role of an NIH task force, updating our original comment (Cohen and Majumder 2009).Informed Consent to Embryo DonationThe 2009 NIH Draft Guidelines require that certain statements... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hermeneutics, Neuroscience and PsychiatryMichael T. H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM (bio)Hermeneutic practice in mental health has been a theme in Philosophy, Psychiatry, & Psychology (PPP) since its very beginnings. In this essay I argue that hermeneutics, the theory and practice of interpretation, promotes therapeutic interaction between mental health professionals, patients and their family.Why does this patient present in such a way at this (...) particular point in time? The distressing symptoms are there. The changes in behavior are obvious. Impairments of functions are hurting. A mental illness clearly runs in the family. There were early losses of loved ones, physical abuse at home, bullying by peers and self-medication with drugs and alcohol. Three in four adults with a mental illness first experienced that before they turned 24. The brain goes through major reorganization during adolescence and early adulthood. If synaptic pruning went wrong, psychoses emerged. When stresses activated the hypothalamic–pituitary–adrenal axis the elevated cortisol level impacted the size and function of the hippocampus and amygdala in the genetically vulnerable; anxiety, depression, bipolar, and personality disorders developed. The patient needs a voice/language to describe all these experiences and events and the psychiatrist needs a discourse to make sense of them.Eisenberg laments the swings between "brainlessness" and "mindlessness" in psychiatry. Engel argues for a "biopsychosocial" discourse. The major challenge for psychiatry is how to organize clinical information of different nature (categories, dimensions, narratives; i.e., objective vs. subjective, personal vs. interpersonal) into a coherent and comprehensible account for us all. Mental illnesses are not only neuropsychiatric spectrum disorders but also dysfunctions of social relationship and environmental/ecological adaptation. Psychiatry as a clinical neuroscience per se lacks the semantics to address the rich interactions between the physical, psychological, social, cultural, and spiritual in the illness experience of our patients. Explanation in the diagnostic formulation (objective scientific discourse on cause and effect) and understanding in the patient narrative (subjective ordinary everyday discourse on significance and meaning) are irreducible to each other (Wong, 2018). They instead interact with one another to achieve an integrative formulation, not through merging different discourses into a single assertion/monologue but via the dialectic/dialogue of "explaining more in order to understand better," as Ricoeur puts it, and between "the whole and the parts," as Schleiermacher highlights.This "therapeutic hermeneutic circle" of "explanation vs understanding" and "the whole vs the parts" includes symptoms behavior function and life events. It correlates between bio-psychosociocultural-spiritual dimensions/perspectives and does not reduce them to any particular/single [End Page 13] stance. The whole integrates the parts and the parts enrich the whole. It explains but does not explain away. It understands through an articulation of meaning and significance. This discourse is a multilayered (bio-psycho-social-cultural-spiritual) personal narrative that formulates diagnosis and care in a correlative (linking different voices/discourses) and non-reductive (no particular voice/discourse is prejudiced against) manner that is comprehensible to us all (Wong, 2021).PPP will be an excellent forum for discussing clinical hermeneutics in the future. In this digital era of social media and virtual reality, hermeneutics has the never-ending task to tackle the unprecedented challenges to meaning illness and health posed by polarizing discourses.Michael T. H. Wong Michael T.H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM, is Hon Clinical Professor, Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, HKSAR, China. Michael is Chair, Section of Philosophy & Humanities in Psychiatry, World Psychiatric Association. He is an Organizational Partner & International Lead with The Collaborating Centre for Values-Based Practice in Health and Social Care, St Catherine's College Oxford. He is Advisor to the Chinese Health Foundation of Australia.ReferencesWong M. T. H. (2018). Ricoeur and the third discourse of the person: From philosophy and neuroscience to psychiatry and theology. London: Lexington Books. Google ScholarWong, M. T. H. (2021). Values, meanings, hermeneutics and mental health. In Stoyanov, D., Fulford, K. M. W. F., Stanghellini, G., Van Staden, W., & Wong, M. TH. (Eds.), International perspectives in values-based mental health practice: Case studies and commentaries (pp. 341–349... (shrink)

Book reviewed in this article: Deciding for Others: The Ethics of Surrogate Decision Making. By Allen E. Buchanan and Dan W. Brock Abating Treatment with Critically Ill Patients. By Robert F. Weir.

P. F. Strawson suggests an anti-sceptical strategy which consists in offering good reason for ignoring scepticism rather than trying to refute it, and the reason he offers is that beliefs about the external world are indispensable to us. I give an exposition of Strawson's arguments for the indispensability thesis and explain why they are not strong enough. I then propose an argument based on some of Davidson's ideas in his theory of radical interpretation, which I think can establish the indispensability (...) thesis. Finally, I spell out the force of Strawson's anti-sceptical strategy by arguing that we have good reason for ignoring scepticism not only because beliefs about the world are indispensable, but also because it is irrational to have both beliefs about the world and sceptical doubts. (shrink)

Cynthia will leave Rome for the country: how fortunate that there will be no one there to seduce her—provided there is no visitor from the outside world! Propertius will himself go hunting. If Cynthia has any temptations, let her remember that in a few days he will be with her.

Cynthia will leave Rome for the country: how fortunate that there will be no one there to seduce her—provided there is no visitor from the outside world! Propertius will himself go hunting. If Cynthia has any temptations, let her remember that in a few days he will be with her.

Cynthia will leave Rome for the country: how fortunate that there will be no one there to seduce her—provided there is no visitor from the outside world! Propertius will himself go hunting. If Cynthia has any temptations, let her remember that in a few days he will be with her.

IntroductionCognition generally declines gradually over time due to progressive degeneration of the brain, leading to dementia and eventual loss of independent functions. The rate of regression varies among the six cognitive domains. Current modality of cognitive assessment using neuropsychological paper-and-pencil screening tools for cognitive impairment such as the Montreal Cognitive Assessment has limitations and is influenced by age. Virtual reality is considered as a potential alternative tool to assess cognition. A novel, fully immersive automated VR system has been developed to (...) assess the six cognitive domains. As cognition is associated with age, VR performance is postulated to vary with age using this system.AimsThis is a feasibility study to evaluate the VR performance of cognitively healthy adults aged between 35 and 74 years old, based on the performance score and completion time using the CAVIRE system.MethodsConducted in a public primary care clinic in Singapore, 25 multi-ethnic Asian adults were recruited in each of the four age groups in years: 35–44; 45–54; 55–64, and 65–74. The eligibility criteria included a MoCA score of 26 or higher to reflect normal cognition and understanding English instructions. They completed common daily activities ranging from brushing teething to shopping, across 13 VR segments. Their performances scores and completion time were automatically computed by the CAVIRE system. These VR performance indices were compared across the four age groups using one-way ANOVA, F-test of the hypothesis, followed by pair-wise comparisons in the event of a significant F-test.ResultsOne participant dropped out from Group 1. The demographic characteristics of 99 participants were similar across the 4 age groups. Overall, younger participants in Groups 1 and 2 attained higher VR performance scores and shorter completion time, compared to those in Groups 3 and 4, in all six cognitive domains.ConclusionThe CAVIRE VR performance scores and completion time significantly differ between the younger and older Asian participants with normal cognition. Enhancements to the system are needed to establish the age-group specific normal performance indices. (shrink)

Hand function improvement in stroke survivors in the chronic stage usually plateaus by 6 months. Brain-computer interface (BCI)-guided robot-assisted training has been shown to be effective for facilitating upper-limb motor function recovery in chronic stroke. However, the underlying neuroplasticity change is not well understood. This study aimed to investigate the whole-brain neuroplasticity changes after 20-session BCI-guided robot hand training, and whether the changes could be maintained at the 6-month follow-up. Therefore, the clinical improvement and the neurological changes before, immediately after, (...) and 6 months after training were explored in 14 chronic stroke subjects. The upper-limb motor function was assessed by Action Research Arm Test (ARAT) and Fugl-Meyer Assessment for Upper-Limb (FMA), and the neurological changes were assessed using resting-state functional magnetic resonance imaging. Repeated-measure ANOVAs indicated that long-term motor improvement was found by both FMA (F[2,26]= 6.367,p= 0.006) and ARAT (F[2,26]= 7.230,p= 0.003). Seed-based functional connectivity analysis exhibited that significantly modulated FC was observed between ipsilesional motor regions (primary motor cortex and supplementary motor area) and contralesional areas (supplementary motor area, premotor cortex, and superior parietal lobule), and the effects were sustained after 6 months. The fALFF analysis showed that local neuronal activities significantly increased in central, frontal and parietal regions, and the effects were also sustained after 6 months. Consistent results in FC and fALFF analyses demonstrated the increase of neural activities in sensorimotor and fronto-parietal regions, which were highly involved in the BCI-guided training.Clinical Trial Registration:This study has been registered atClinicalTrials.govwith clinical trial registration number NCT02323061. (shrink)