When people die suddenly and unexpectedly ethical issues often come to the fore. The aim of the study was to describe experiences of members of stroke teams in stroke units of ethical problems and how the teams manage the situation when caring for patients faced with sudden and unexpected death from stroke. Data were collected through four focus group interviews with 19 team members in stroke-unit teams, and analysed using interpretive content analysis. Three themes emerged from the analysis characterized by (...) information, decisions about care and support for the next-of-kin in the changing and uncertain situation, with mutual trust as the core. Mutual trust, both within the stroke team and with next-of-kin was seen by the stroke-team members as a way of handling ethical problems by administering care with the patient’s best interest at heart. (shrink)

Valuable insights into eukaryotic regulatory circuits can emerge from studying interactions of bacterial pathogens such as Helicobacter pylori with host tissues. H. pylori uses a type IV secretion system (T4SS) to deliver its CagA virulence protein to epithelial cells, where much of it becomes phosphorylated. CagA's phosphorylated and non‐phosphorylated forms each interact with host regulatory proteins to alter cell structure and cell fate. Kwok and colleagues1 showed that CagA destined for phosphorylation is delivered using host integrin as receptor and H. (...) pylori's CagL protein as an integrin‐specific adhesin, and that CagL–integrin‐binding activates the kinase cascade responsible for CagA phosphorylation. This research contributes to understanding infectious disease and the control of cell fates. BioEssays 30:515–520, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

Background: Thrombolytic drugs to treat an acute ischaemic stroke reduce the risk of death or major disability. The treatment is, however, also associated with an increased risk of potentially fatal intracranial bleeding. This confronts the patient with the dilemma of whether or not to take a risk of a serious side effect in order to increase the likelihood of a favourable outcome. Objective: To explore acute stroke patients’ perception of risk and willingness to accept risks associated with thrombolytic drug treatment. (...) Design: Eleven patients who had been informed about thrombolytic drug treatment and had been through the process of deciding whether or not to participate in a thrombolytic drug trial went through repeated qualitative, semistructured interviews. Results: Many patients showed a limited perception of the risks connected with thrombolytic drug treatment. Some perceived the risk as not relevant to them and were reluctant to accept that treatment could cause harm. Others seemed to be aware that treatment would mean exposure to risk. The patients’ willingness to take a risk also varied substantially. Several statements revealed ambiguity and confusion about being involved in a decision about treatment. The patients’ reasoning about risk was put into the context of their health-related experiences and life histories. Several patients wanted the doctor to be responsible for the decisions. Conclusion: Acute stroke patients’ difficulties in perceiving and processing information about risk may reduce their ability to be involved in clinical decisions where risks are involved. (shrink)

Background Genuine uncertainty on superiority of one intervention over the other is called equipoise. Physician-investigators in randomized controlled trials need equipoise at least in studies with more than minimal risks. Ideally, this equipoise is also present in patient-participants. In pediatrics, data on equipoise are lacking. We hypothesize that 1) lack of equipoise at enrolment among parents may reduce recruitment; 2) lack of equipoise during participation may reduce retention in patients assigned to a less favoured treatment-strategy. Methods We compared preferences of (...) parents/patients at enrolment, documented by a questionnaire, with preferences developed during follow-up by an interview-study to investigate equipoise of child-participants and parents in the BeSt-for-Kids-study. This trial in new-onset Juvenile Idiopathic Arthritis-patients consists of three strategies. One strategy comprises initial treatment with a biological disease-modifying-antirheumatic-drug, currently not standard-of-care. Semi-structured interviews were conducted with 23 parents and 7 patients, median 11 months after enrolment. Results Initially most parents and children were not in equipoise. Parents/patients who refused participation, regularly declined due to specific preferences. Many participating families preferred the biological-first-strategy. They participated to have a chance for this initial treatment, and would even consider stopping trial-participation when not randomized for it. Their conviction of superiority of the biological-first strategy was based on knowledge from internet and close relations. According to four parents, the physician-investigator preferred the biological-first-strategy, but the majority stated that she had no preferred strategy. In phase 2, preferences tended to change to the treatment actually received. Conclusions Lack of equipoise during enrolment did not reduce study recruitment, mainly due to the fact that preferred treatment was only available within the study. Still, when developing a trial it is important to evaluate whether the physicians’ research question is in line with preferences of the patient-group. By exploring so-called ‘informed patient-group’-equipoise, successful recruitment may be enhanced and bias avoided. In our study, lack of equipoise during trial-participation did not reduce retention in those assigned to a less favoured option. We observed a change for preference towards treatment actually received, possibly explained by comparable outcomes in all three arms. (shrink)

This volume addresses the intriguing issue of indirect reports from an interdisciplinary perspective. The contributors include philosophers, theoretical linguists, socio-pragmaticians, and cognitive scientists. The book is divided into four sections following the provenance of the authors. Combining the voices from leading and emerging authors in the field, it offers a detailed picture of indirect reports in the world’s languages and their significance for theoretical linguistics. Building on the previous book on indirect reports in this series, this volume adds an empirical (...) and cross-linguistic approach that covers an impressive range of languages, such as Cantonese, Japanese, Hebrew, Persian, Dutch, Spanish, Catalan, Armenian, Italian, English, Hungarian, German, Rumanian, and Basque. (shrink)

Background: Informed consent is regarded as a contract between autonomous and equal parties and requires the elements of information disclosure, understanding, voluntariness and consent. The validity of informed consent for critically ill patients has been questioned. Little is known about how these patients experience the process of consent.Objective: The aim of this study was to explore critically ill patients’ experience with the principle of informed consent in a clinical trial and their ability to give valid informed consent.Design: 11 stroke patients (...) who had been informed about thrombolytic treatment and had been through the process of deciding whether or not to participate in a thrombolysis trial went through repeated qualitative semistructured interviews.Results: None of the patients had any clear understanding of the purpose of the trial. Neither did they understand the principles of randomisation and voluntariness. Reasons for giving or not giving consent were trust, conceptions of benefits and risks and altruism. Several patients found it immoral to involve patients in the consent procedure and argued that this was the doctors’ responsibility. Others argued that it is a duty to question patients and perceived it as a sign of being treated with respect and dignity. A majority of the patients found the consent process vague and ambiguous.Conclusions: The results indicate that the principle of informed consent from critically ill patients cannot be seen as a contract between equal and autonomous parties. Further studies are needed to explore critically ill patients’ experiences with the process of informed consent. (shrink)

Background: Informed consent is regarded as a contract between autonomous and equal parties and requires the elements of information disclosure, understanding, voluntariness and consent. The validity of informed consent for critically ill patients has been questioned. Little is known about how these patients experience the process of consent.Objective: The aim of this study was to explore critically ill patients’ experience with the principle of informed consent in a clinical trial and their ability to give valid informed consent.Design: 11 stroke patients (...) who had been informed about thrombolytic treatment and had been through the process of deciding whether or not to participate in a thrombolysis trial went through repeated qualitative semistructured interviews.Results: None of the patients had any clear understanding of the purpose of the trial. Neither did they understand the principles of randomisation and voluntariness. Reasons for giving or not giving consent were trust, conceptions of benefits and risks and altruism. Several patients found it immoral to involve patients in the consent procedure and argued that this was the doctors’ responsibility. Others argued that it is a duty to question patients and perceived it as a sign of being treated with respect and dignity. A majority of the patients found the consent process vague and ambiguous.Conclusions: The results indicate that the principle of informed consent from critically ill patients cannot be seen as a contract between equal and autonomous parties. Further studies are needed to explore critically ill patients’ experiences with the process of informed consent. (shrink)

Features essays on moral philosophy written in honor of Elizabeth Flower's retirement.

This thought-provoking book discusses the concept of progress in economics and investigates whether any advance has been made in its different spheres of research. The authors look back at the history, successes and failures of their respective fields and thoroughly examine the notion of progress from an epistemological and methodological perspective. The idea of progress is particularly significant as the authors regard it as an essentially contested concept which can be defined in many ways – theoretically or empirically; locally or (...) globally; or as encouraging or impeding the existence of other research traditions. The authors discuss the idea that for progress to make any sense there must be an accumulation of knowledge built up over time rather than the replacement of ideas by each successive generation. Accordingly, they are not concerned with estimating the price of progress, reminiscing in the past, or assessing what has been lost. Instead they apply the complex mechanisms and machinery of the discipline to sub-fields such as normative economics, monetary economics, trade and location theory, Austrian economics and classical economics to critically assess whether progress has been made in these areas of research. -/- Bringing together authoritative and wide-ranging contributions by leading scholars, this book will challenge and engage those interested in philosophy, economic methodology and the history of economic thought. It will also appeal to economists in general who are interested in the advancement of their profession. (shrink)

Involuntary autobiographical memories are conscious memories of personal events that come to mind with no preceding attempts at retrieval. It is often assumed that such memories are closely related to current concerns – i.e., uncompleted personal goals. Here we examined involuntary versus voluntary autobiographical memories in relation to earlier registered current concerns measured by the Personal Concern Inventory . We found no differences between involuntary and voluntary memories with regard to frequency or characteristics of current concern-related contents. However, memories related (...) to current concerns were rated as more central to the person’s identity, life story and expectations for the future than non-concern-related memories, irrespective of mode of recall. Depression and PTSD symptoms correlated positively with the proportion of current concern-related involuntary and voluntary memories. The findings support the view that involuntary and voluntary remembering is subject to similar motivational constraints. (shrink)

The focus on animal welfare in society has increased during the last 50 years. Animal welfare legislation and private standards have developed, and today many farmers within animal production have both governmental legislation and private standards to comply with. In this paper intentions and values are described that were expressed in 14 animal welfare legislation and standards in four European countries; Sweden, United Kingdom, Germany and Spain. It is also discussed if the legislation and standards actually accomplish what they, in (...) their overall description and ethics, claimed to do, i.e. if this is followed up by relevant paragraphs in the actual body of the text in the legislation and standards respectively. The method used was an on-line questionnaire from the EconWelfare research project and text analyses. This study shows that the ethical values within a set of legislation or private standards are not always consistently implemented, and it is not always possible to follow a thread between the intentions mentioned initially and the actual details of the legislation or standard. Since values will differ so will also the animal welfare levels and the implications of similar concepts in the regulations. In general, the regulations described were not based on animal welfare considerations only, but also other aspects, such as food safety, meat quality, environmental aspects and socio-economic aspects were taken into account. This is understandable, but creates a gap between explicit and implicit values, which we argue, can be overcome if such considerations are made more transparent to the citizens/consumers. (shrink)

Kant’s account of the feeling of moral respect has notoriously puzzled interpreters: on the one hand, moral action is supposed to be autonomous and, in particular, free of the mediation of any feeling on the other hand, the subject’s grasp of the law somehow involves the feeling of moral respect. I argue that moral respect for Kant is not, pace both the ‘intellectualists’ and ‘affectivists,’ an effect of the determination of the will by the law – whether it be a (...) mere effect or the motivating cause of action – but is instead identical to it. Drawing on Kant’s general account of feeling as the awareness of how representations and their objects harm or benefit our own powers, I argue that the identity between moral respect and the determination to action contains two elements. Moral respect is, first, a form of practical self-consciousness which constitutes the subject’s recognition of the moral law and thus of herself as intrinsically bound by it, i. e., as a moral agent. Second, respect is a capacity for receptive awareness of particular features of our environment as well as other persons insofar as they benefit and harm us as moral agents. Thereby moral respect affords us awareness in concreto of particular, morally-conditioned ends. In this way moral respect provides the key for a Kantian account of genuinely free practical receptivity. (shrink)

This paper introduces a new solution concept for games with incomplete preferences. The concept is based on rationalizability and it is more general than the existing ones based on Nash equilibrium. In rationalizable strategies, we assume that the players choose nondominated strategies given their beliefs of what strategies the other players may choose. Our solution concept can also be used, e.g., in ordinal games where the standard notion of rationalizability cannot be applied. We show that the sets of rationalizable strategies (...) are the maximal mutually nondominated sets. We also show that no new rationalizable strategies appear when the preferences are refined, i.e., when the information gets more precise. Moreover, noncooperative multicriteria games are suitable applications of incomplete preferences. We apply our framework to such games, where the outcomes are evaluated according to several criteria and the payoffs are vector valued. We use the sets of feasible weights to represent the relative importance of the criteria. We demonstrate the applicability of the new solution concept with an ordinal game and a bicriteria Cournot game. (shrink)

Drawing on the transformative potential of critical-theoretical learning grounded in the CHAT framework of recognizing the bi-directional relationship between learning and development, the present paper is an investigation of how nine American community college students participating in a critical learning community (Peer Activist Learning Community) make sense of and position themselves towards the pursuit of higher education. The paper has two key findings: (1) students primarily draw on vocational discourse paired with a conceptualization of learning as rote learning (i.e. memorization (...) and acquisition of skills) in making sense of their pursuit of higher education, and (2) students embody a transitional positioning toward the community college, which poses the ontological challenge of belonging to an academic institution while seeking to negate this belonging. The findings are framed and discussed in particular through the lens of the transformative activist stance (Stetsenko) with an emphasis on the recognition of education as the process of becoming human as well as with a focus on the transformative potential of meaningful learning experiences. I conclude by suggesting the need for transforming the aim of retention studies as well as put forward the suggestion of re-conceptualization the concept of belongingness in educational psychology in light of the CHAT framework. (shrink)

I argue that Plato holds a medical model of virtue as health which does not have themorally unacceptable implications which have led some to describe it as authoritarian.This model, which draws on the educational virtues of the elenchos, lacks anyimplication that all criminals are mad or all mad people criminals – this implication beingat the source of many criticisms of Plato’s analogy of virtue and health. After setting upthe analogy and the model, I defend my argument against two objections. The (...) firstclaims that Plato's picture of virtue as health is unacceptable because it entails that vice isa defect and therefore that criminals are all mad. The second resists Kenny'sinterpretation but does so by attacking its first premise, i.e. that Plato believes virtue issome kind of health. I reply that both objections are misguided. (shrink)

Heterogeneous beliefs and decision processes generate positive externalities for social and economic systems, analogous to biodiversity in biological systems. Although some aspects of biodiversity (e.g., pests, parasites and bacteria) can lead to ecological and economic problems, biodiversity provides flows of beneficial ecological services and is widely regarded as a valuable natural resource and informational asset, whose value increases as we learn more and science progresses (Wilson in Bioscience 35(11):700–706, 1985). Heterogeneous beliefs and decision processes (and heterogeneous behaviors they generate) similarly (...) provide flows of beneficial economic services. Behavioral diversity should therefore be seen as a natural resource and informational asset likely to improve human wellbeing in surprising ways in the future. Paternalistic policies motivated by the goal of “correcting” allegedly suboptimal beliefs and behavior that diverge from expert recommendations jeopardize behavioral diversity at a substantial cost to social welfare. The risk of encroaching on this beneficial behavioral heterogeneity with policies that aim to induce behavioral and belief monocultures should be included explicitly as costs when evaluating nudges and other paternalistic policies. (shrink)

We introduce constructive and classical systems for nonstandard arithmetic and show how variants of the functional interpretations due to Gödel and Shoenfield can be used to rewrite proofs performed in these systems into standard ones. These functional interpretations show in particular that our nonstandard systems are conservative extensions of E-HAω and E-PAω, strengthening earlier results by Moerdijk and Palmgren, and Avigad and Helzner. We will also indicate how our rewriting algorithm can be used for term extraction purposes. To conclude the (...) paper, we will point out some open problems and directions for future research, including some initial results on saturation principles. (shrink)

This paper presents GlamMap, a visualization tool for large, multi-variate georeferenced humanities data sets. Our approach visualizes the data as glyphs on a zoomable geographic map, and performs clustering and data aggregation at each zoom level to avoid clutter and to prevent overlap of symbols. GlamMap was developed for the Galleries, Libraries, Archives, and Museums (GLAM) domain in cooperation with researchers in philosophy. We demonstrate the usefulness of our approach by a case study on history of logic, which involves navigation (...) and exploration of 7100 bibliographic records, and scalability on a data set of sixty million book records. (shrink)

In this paper I aim to refute the claim that Plato and Nietzsche are at opposite poles regarding the treatment of the non-rational elements of the soul, and argue that, instead, they share a complex and psychologically rich view of the role of reason towards the appetites and the emotions. My argument makes use of the Freudian distinction between sublimation, i.e. the re-channelling of certain undesirable appetitive and emotional forces towards more beneficial ends, and repression. I show that both Plato (...) and Nietzsche argue in favour of sublimation and against repression of the non-rational elements of the soul. (shrink)

Sen and Nussbaum's capability approach has in the past twenty years become an increasingly popular and influential approach to issues in global justice. Its main tenet is that when assessing quality of life or asking what kind of policies will be more conducive to human development, we should look not to resources or preference satisfaction, but to what people are able to be and to do. This should then be measured against a more or less narrow conception of what any (...) human being should be able to be and do, i.e. which functions are essentially human. To have a capability is to be able to function in that way. Thomas Pogge has recently argued that despite its many attractions, the capability approach did not present a sufficiently strong challenge to Rawlsian resourcism. In this paper, I address Pogge's criticisms of the capability approach, and I argue that from the point of view of Nussbaum's Aristotelian version of the approach, his objections are not successful. (shrink)

El resurgir en los últimos años de los movimientos feministas en todo el mundo ha llevado a numerosas autoras a hablar de una cuarta ola del feminismo. Este es también el caso de España, donde ha tomado fuerza no solo el movimiento feminista autónomo sino también la participación de grupos y activistas feministas en diferentes protestas, movimientos sociales e incluso partidos políticos. Ejemplo de ello fue la alta implicación de activistas feministas en el movimiento 15-M, muchas de las cuales dieron (...) posteriormente el paso a la representación política, entrando a formar parte de partidos de nueva creación como Podemos. Esta participación constituye una muestra de su compromiso por el cambio social y del reconocimiento de la interseccionalidad de opresiones, pero también exige un complejo ejercicio de reconstrucción y defensa del espacio feminista. Precisamente, en este artículo proponemos el análisis de los debates en torno a propuestas y estrategias que han mantenido las feministas de Podemos que, después de haber militado en movimientos sociales, han decidido colaborar con esta plataforma política. (shrink)

Summary This paper investigates the nature of creativity in language and linguistics. Following Sampson (2016), it distinguishes between F-creativity (which roughly equals linguistic productivity) and E-creativity (which leads to new and unexpected innovations). These two notions of creativity are discussed on the basis of examples from three different domains: snow cloning, mismatch/coercion, and aberration. It is shown that pure E-creativity may only be found in the case of aberration. Both snow cloning and mismatch/coercion are examples for F-creativity, but to varying (...) degrees. As a consequence, it is suggested that in practice, F- and E-creativity actually form a cline, rather than a dichotomy. (shrink)

The apolipoprotein E gene plays an important role in the pathogenesis of Alzheimer's disease , and amyloid plaque comprised mostly of the amyloid-beta peptide ) is one of the major hallmarks of AD. However, the relationship between these two important molecules is poorly understood. We examined how A treatment affects APOE expression in cultured cells and tested the role of the transcription factor NF-B in APOE gene regulation. To delineate NF-B's role, we have characterized a 1098 nucleotide segment containing the (...) 5'-flanking region of the human APOE gene . Sequence analysis of this region suggests the presence of two potential NF-B elements. To demonstrate promoter activity, the region was cloned upstream of a promoterless luciferase gene. This segment was able to drive expression of luciferase in transient transfections of human fetal glial cells. Promoter activity was stimulated twofold by A treatment. Pretreatment with double-stranded DNA decoy oligonucleotides against NF-B reduced A stimulation. Deletion and mutagenetic analyses demonstrated that the distal NF-B element was functional and showed a strong DNA-protein complex band in gel shift analysis, similar to that from control NF-B consensus element. An anti-inflammatory and anti-NF-B drug, sodium salicylate, significantly blocked A-induced APOE promoter function. Our data provide evidence that upregulation of APOE by A in astroglial cells is mediated by an NF-B-element present in the 5'-flanking region of the APOE gene. (shrink)

The History of Ideas is presently enjoying a certain renaissance after a long period of disrepute. Increasing quantities of digitally available historical texts and the availability of computational tools for the exploration of such masses of sources, it is suggested, can be of invaluable help to historians of ideas. The question is: how exactly? In this paper, we argue that a computational history of ideas is possible if the following two conditions are satisfied: (i) Sound Method . A computational history (...) of ideas must be built upon a sound theoretical foundation for its methodology, and the only such foundation is given by the use of models , i.e., fully explicit and revisable interpretive frameworks or networks of concepts developed by the historians of ideas themselves. (ii) Data Organisation. Interpretive models in our sense must be seen as topic-specific knowledge organisation systems (KOS) implementable (i.e. formalisable) as e.g. computer science ontologies. We thus require historians of ideas to provide explicitly structured semantic framing of domain knowledge before investigating texts computationally, and to constantly re-input findings from the interpretive point of view. In this way, a computational history of ideas maximally profits from computer methods while also keeping humanities experts in the loop. We elucidate our proposal with reference to a model of the notion of axiomatic science in 18th -19th century Europe. (shrink)

ExtractPhilosophers and others with inquisitive minds have busied their brains for millennia with questions such as: ‘Does god exist? What is the meaning of life? Are we free or determined? What is truth? Is there any knowledge which is so certain that no reasonable person could doubt it? What is reality? What is good? What is beautiful? Why exist? What is “to be”? What is justice? What did Kant mean by the categorical imperative?’ Are all these topics equally important or (...) is there a ranking of philosophical problems? If there is such a ranking, is there a need to set priorities? What philosophical problem is most urgent?Send article to KindleTo send this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle. Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service.IS THERE A BIGGEST PROBLEM IN PHILOSOPHY? SOME REFLECTIONS ON SETTING PRIORITIESVolume 12, Issue 34Floris van den BergDOI: https://doi.org/10.1017/S1477175613000055Your Kindle email address Please provide your Kindle [email protected]@kindle.com Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Dropbox To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox. IS THERE A BIGGEST PROBLEM IN PHILOSOPHY? SOME REFLECTIONS ON SETTING PRIORITIESVolume 12, Issue 34Floris van den BergDOI: https://doi.org/10.1017/S1477175613000055Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Google Drive To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive. IS THERE A BIGGEST PROBLEM IN PHILOSOPHY? SOME REFLECTIONS ON SETTING PRIORITIESVolume 12, Issue 34Floris van den BergDOI: https://doi.org/10.1017/S1477175613000055Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Export citation. (shrink)

This article introduces a new hybrid intake procedure developed for posttraumatic stress disorder (PTSD) screening, which combines an automated textual assessment of respondents’ self-narratives and item-based measures that are administered consequently. Text mining technique and item response modeling were used to analyze long constructed response (i.e., self-narratives) and responses to standardized questionnaires (i.e., multiple choices), respectively. The whole procedure is combined in a Bayesian framework where the textual assessment functions as prior information for the estimation of the PTSD latent trait. (...) The purpose of this study is twofold: first, to investigate whether the combination model of textual analysis and item-based scaling could enhance the classification accuracy of PTSD, and second, to examine whether the standard error of estimates could be reduced through the use of the narrative as a sort of routing test. With the sample at hand, the combination model resulted in a reduction in the misclassification rate, as well as a decrease of standard error of latent trait estimation. These findings highlight the benefits of combining textual assessment and item-based measures in a psychiatric screening process. We conclude that the hybrid test design is a promising approach to increase test efficiency and is expected to be applicable in a broader scope of educational and psychological measurement in the future. (shrink)