Most models of patient-physician communication take decision-making as a central concept. However, we found that often the treatment course of metastatic cancer patients is not easy to describe in straightforward terms used in decision-making models but is instead frequently more erratic. Our aim was to analyse these processes as trajectories. We used a longitudinal case study of 13 patients with metastatic colorectal and pancreatic cancer for whom palliative chemotherapy was a treatment option, and analysed 65 semi-structured interviews. We analysed three (...) characteristics of the treatment course that contributed to the ‘erraticness’ of the course: (1) The treatment (with or without chemotherapy) contained many options; (2) these options were not stable entities to be decided upon, but changed identity over the course of treatment, and (3) contrary to the closure (option X means no option Y, Z, etc.) a decision implies, the treatment course was a continuous process in which options instead remained open. When the treatment course is characterised by these many and changeable options that do not result in closure, the shared decision-making model should take these into account. More attention needs to be paid to the erratic character of the process in which the doctor has to provide continuous information that is related to the changing situation of the patient; also, flexibility in dealing with protocols is warranted, as is vigilance about the overall direction of the process. (shrink)
In this paper we explore the extent to which implicit learning is subtended by somatic markers, as evidenced by skin conductance measures. On each trial subjects were asked to decide which ‘word’ from a pair of ‘words’ was the ‘correct’ word. Unknown to subjects, each ‘word’ of a pair was constructed using a different set of rules (grammar ‘A’ and grammar ‘B’). A (monetary) reward was given if the subject choose the ‘word’ from grammar ‘A’. Choosing the grammar ‘B’ word (...) resulted in (monetary) punishment. Skin conductance was measured during each of 100 trials. After each set of 10 trials subjects were asked how they selected the ‘correct word’. Task performance increased long before the subjects could even formulate a single relevant rule. In this ‘pre-conceptual’ phase of the experiment, skin conductance was larger before incorrect than before correct choices. Thus it was shown that artificial grammar learning is accompagnied by a somatic marker, possibly ‘warning’ the subject for the incorrect decision. (shrink)
Methods in experimental science assume objective facts, and those effects are generally independent of the observer or experimenter. This objectivity assumption is not warranted in the field of human studies. Results of psychological experiments tend to be dependent on among other things the expectations of the experimenter. The experimenter effect togther with the replication crisis in social psychology are major issues in experimental parapsychology. We use Houtkooper's Hierarchical Observational Theory to look at a model for dealing with this issue, and (...) conclude that multiple-experimenter projects might be able to sort out experimenter effects from intrinisic effects. Keywords: experimenter effect; replication crisis; psi; parapsychology. (shrink)
To the standard propositional modal system of provability logic constants are added to account for the arithmetical fixed points introduced by Bernardi-Montagna in . With that interpretation in mind, a system LR of modal propositional logic is axiomatized, a modal completeness theorem is established for LR and, after that, a uniform arithmetical (Solovay-type) completeness theorem with respect to PA is obtained for LR.
First published in 1912, and originally intended as a textbook for students in secondary school, this book gives an overview of the human and physical geography of the occupied areas of the earth's surface. The text is richly illustrated with diagrams, tables, and contemporary photographs of places of interest. Although in general Dicks manages to rise above the colonial viewpoint prevalent at the time, certain aspects of the text are reflective of racial attitudes during this period of the twentieth century. (...) This book will be of value to anyone with an interest in the history of education. (shrink)