The ageing population is increasing worldwide with an increase in chronic disorders. At the same time, person‐centred care has become a policy within both health and social care. To facilitate coordination and collaboration and integrate the older adult's perspective in the decision‐making process the collaborative care planning process with the development of a written care plan can be used. In this study, the result of an interpreted analysis of four empirical studies of the collaborative care planning as a person‐centred practice (...) will be discussed and reflected on. A framework based on the French philosopher Paul Ricoeur's little ethics was used in the synthesis of the studies. The findings revealed two common threads: personhood and power asymmetry. Both challenges in achieving a person‐centred collaborative care planning. Ricoeur's dialogical thinking and description of a person served as an underpinning in discussing and reflecting upon the findings of the interpreted synthesis. Collaborative care planning is a complex process. However, Ricoeur's philosophy contributed to a greater understanding of the collaborative care planning as a person‐centred practice and accentuated that ethics, human values, and the older adults and care partners perspectives need to be given the same importance and considerations as the medical and social sciences perspectives for the collaborative care planning process to truly become person‐centred. (shrink)

Benjamin Libet has argued that electrophysiological signs of cortical movement preparation are present before people report having made a conscious decision to move, and that these signs constitute evidence that voluntary movements are initiated unconsciously. This controversial conclusion depends critically on the assumption that the electrophysiological signs recorded by Libet, Gleason, Wright, and Pearl are associated only with preparation for movement. We tested that assumption by comparing the electrophysiological signs before a decision to move with signs present before a decision (...) not to move. There was no evidence of stronger electrophysiological signs before a decision to move than before a decision not to move, so these signs clearly are not specific to movement preparation. We conclude that Libet’s results do not provide evidence that voluntary movements are initiated unconsciously. (shrink)

The nature of nursing has been the subject of discussion for the last 10–15 years. One reason is that in many countries the education of nurses has moved from teaching hospitals to the academies. This move has given rise to the question of the scientific basis for nursing knowledge.Lately, the content of nursing knowledge has become a principal focus in the work on developing expert systems for nursing. Thus theories of knowledge and the nature of new technology are of great (...) concern to the future of the nursing profession. The basic assumptions underlying a chosen theory of knowledge will determine the development and use of advanced technology in the future. (shrink)

The idea that our conscious decisions determine our actions has been challenged by a report suggesting that the brain starts to prepare for a movement before the person concerned has consciously decided to move . Libet et al. claimed that their results show that our actions are not consciously initiated. The current article describes two experiments in which we attempted to replicate Libet et al.'s comparison of participants' movement-related brain activity with the reported times of their decisions to move and (...) also the reported times of their decisions of which hand to move. We also looked at the distribution of participants' reports over time to evaluate an alternative explanation of Libet et al.'s results. Although the Readiness Potential was usually present before all of the decisions to move, consistent with the findings of Keller and Heckhausen and Libet et al. , we found that many reported decision times were before the onset of the Lateralized Readiness Potential, which measures hand-specific movement preparation. The latter finding is consistent with the conclusion that the LRP always started after the conscious decision to move. We conclude that even though activity related to movement anticipation may be present before a conscious decision to move, the cortical preparation necessary for the movement to happen immediately may not start until after the conscious decision to move. (shrink)

The famous French chemist, Marcelin Berthelot, published his first scientific paper in 1850. However, reference to this paper has been largely ignored in the various accounts of his lasting contributions to chemistry. The probable reason for this is that this paper is concerned with a method of subjecting a liquid to tension, and it is more appropriate to regard it as a paper on physics rather than on chemistry. In the work described in this largely-forgotten paper, written whilst he was (...) still a young research student, Berthelot showed that liquids contained in his ‘Berthelot tube’ could withstand a considerable tension; and he is the first person to have observed cavitation, a phenomenon which has been studied so widely this century. The next mention in the literature of the Berthelot tube method is at the turn of the present century, after which it again seems to have been forgotten until the 1940s; since then there has been considerable progress using the Berthelot tube technique. In this paper the work described in Berthelot's original paper is discussed in some detail, and the subsequent fruitful development of the method is also traced and assessed. (shrink)

Background: Privacy laws have recently created restrictions on how researchers can approach study participants.Method: In a randomised trial of 152 patients, 50–74 years old, in a family practice, 60 were randomly selected to opt-out and 92 to opt-in methods. Patients were sent an introductory letter by their doctor in two phases, opt-out before and opt-in after introduction of the new Privacy Legislation in December 2001. Opt-out patients were contacted by researchers. Opt-in patients were contacted if patients responded by email, free (...) telephone number or a reply-paid card.Results: Opt-in recruited fewer patients after invitation compared with opt-out ; . No proportional difference in recruitment was found between opt-in and opt-out groups varied by age, sex or socioeconomic status. The opt-in group had significantly more people in active decision-making roles . Non-significant trends were observed towards opt-in being less likely to include people with lower education and people who were not screened . Opt-in was more likely to recruit people with a family history of colorectal cancer .Conclusions: The number of participants required to be approached was markedly increased in opt-in recruitment. Existing participants with a vested interest such as increased risk, and those preferring an active role in health decision making and with less education were likely to be recruited in opt-in. Research costs and generalisability are affected by implementing privacy legislation. (shrink)

In 1846 the Belgian scientist François Donny published a very important but still virtually unknown paper. Apparently the first publication on the ability of liquids to withstand tension, it appeared some four years before Marcelin Berthelot's famous paper on this property of liquids. It seems only fair to record the fact that, contrary to accepted belief, Donny, not Berthelot, was really the first pioneer in this field. In his paper Donny describes how he first observed by chance the fact that (...) a column of sulphuric acid in a manometer could sustain a small tension. This led him to investigate the matter further, and he found that a column of this acid could stand a tension of about a quarter of an atmosphere. From later experiments he concluded that a column of water could sustain at least one atmosphere of tension. The work described in Donny's paper is discussed and compared with the related work of Marcelin Berthelot and Osborne Reynolds which was published later in the nineteenth century. The relevance of this to current research work is also discussed briefly. (shrink)

Based on calls to an outsourced call centre in Moldova, where the agents have received training in Swedish, this article deals with some cases when agents are attributed categorical belonging associated with the issue of outsourcing. The aim of the study is to examine how these challenges are handled within interaction. The analysis is implemented by a combination of conversation analysis and membership categorization analysis, primarily through the notion of omnirelevance, used to demonstrate the participants’ orientation to social contexts. A (...) main result is the subtle forms of resistance that agents exhibit when they respond to various category-based compliments, oriented to the location and language skills of the agent. One form of resistance is giving minimal responses and another is to return to the transactional procedure. The calls are part of a corpus of 800 calls. A comparative analysis also includes a call to a centre in Sweden. (shrink)

_ Source: _Volume 40, Issue 1, pp 1 - 31 This anthropologically informed study explores descriptions of communication with invisible, superhuman agents in high functioning young adults on the autism spectrum. Based on material from interviews, two hypotheses are formulated. First, autistic individuals may experience communication with bodiless agents as less complex than interaction with peers, since it is unrestricted by multisensory input, such as body language, facial expressions, and intonation. Second, descriptions of how participants absorb into “imaginary realities” suggest (...) that such mental states are desirable due to qualities that facilitate social cognition: While the empirical world comes through as fragmented and incoherent, imaginary worlds offer predictability, emotional coherence, and benevolent minds. These results do not conform to popular expectations that autistic minds are less adapted to experience supernatural agents, and it is instead argued that imaginative, autistic individuals may embrace religious and fictive agents in search for socially and emotionally comprehensible interaction. (shrink)

Palliative care is provided at a certain timepoint, both in a person's life and in a societal context. What is considered to be a good death can therefore vary over time depending on prevailing social values and norms, and the person's own view and interpretation of life. This means that there are many interpretations of what a good death can actually mean for an individual. On a more general level, research in palliative care shows that individuals have basic common needs, (...) for example physical, mental, social and spiritual well‐being. Therefore, in today's pluralistic Western society, it becomes important that palliative care is person centred to enable individuals to receive, as far as can be achieved, care that promotes as good a life as possible based on the person's own needs and preferences, and in accordance with evidence and current laws. For many years a research group, consisting nurse researchers together with nurses working in palliative care, has developed a model for person‐centred palliative care, the 6S‐model. The model's central concept is Self‐image, where the starting point is the patient as a person and their own experience of the situation. The other concepts: Self‐determination, Symptom relief, Social relationships, Synthesis and Strategies are all related to the patient's self‐image, and often to each other. The model's development, value base and starting assumptions are reported here, as are examples of how the model is applied in palliative care in Sweden. The model has been, and still is, constantly evolving in a collaboration between researchers and clinically active nurses, and in recent years also with patients and close relatives. (shrink)

Nowadays it is increasingly common that the patients in the end of life phase choose to be cared for in their own home. Therefore it is vital to identify significant factors in order to prevent unnecessary suffering for dying patients and their families in end-of-life homecare. This study aimed to describe 10 nurses’ perceptions of significant factors that contribute to good end-of-life care in the patients own home. The transcribed texts from the interviews’ were analyzed using phenomenological hermeneutical method, which (...) focuses on the life-world of human beings. The results demonstrate that good end-of-life care presupposes that the aim of the caring staff is to provide safety, autonomy and integrity for the patient and family in order to create the respect required for as good and dignified a death as possible. (shrink)

Adverse health care events are a global public health issue despite major efforts, and they have been acknowledged as a complex concern. The aim of this study was to explore the construction of unsafe care using accounts of adverse events concerning the patient, as reported by patients, relatives, and health care professionals. Twenty‐nine adverse events reported in an acute care setting in a Swedish university hospital were analyzed through discourse analysis, where the construction of what was considered to be real (...) and true in the descriptions of unsafe care was analyzed. In the written reports about unsafe events, the patient was spoken of in three different ways: (a) the patient as a presentation of physical signs, (b) the patient as suffering and vulnerable, and (c) the patient as unpredictable. When the patient's voice was subordinate to physical signs, this was described as being something that conflicted with patient safety. The conclusion was that the patient's voice might be the only sign available in the early stages of adverse events. Therefore, it is crucial for health care professionals to give importance to the patient's voice to prevent patients from harm and not unilaterally act only upon abnormal physical signs. (shrink)

Severe obesity has been associated with reduced performance on tests of verbal memory in bariatric surgery candidates. There is also some evidence that bariatric surgery leads to improved verbal memory, yet these findings need further elucidation. Little is known regarding postoperative memory changes in the visual domain and how patients subjectively experience their everyday memory after surgery. The aim of the current study was to repeat and extend prior findings on postoperative memory by investigating visual, verbal, and self-reported everyday memory (...) following surgery, and to examine whether weight loss and somatic comorbidity predict memory performance. The study was a prospective, observational study in which participants underwent cognitive testing at baseline, 1 and 2 years after bariatric surgery. Repeated measures analyses of variance revealed significantly poorer visual and verbal memory performance at the 1-year follow-up, with performance subsequently returning to baseline levels after 2 years. Verbal learning and self-reported everyday memory did not show significant postoperative changes. Memory performance at 1 year was not significantly predicted by weight loss, changes in C-reactive protein levels or postoperative somatic comorbidity. The study demonstrated poorer visual and verbal memory performance at 1-year follow-up that returned to baseline levels after 2 years. These findings are in contrast to most previous studies and require further replication, however, the results indicate that postoperative memory improvements following bariatric surgery are not universal. Findings suggest that treatment providers should also be aware of patients potentially having poorer memory at 1 year following surgery. (shrink)

The aim of this study was to explore patients’ experiences of using the Integrated Palliative care Outcome Scale (IPOS) during specialized palliative home care. The study adopted a qualitative approach with an interpretive descriptive design. Interviews were performed with 10 patients, of whom a majority were diagnosed with incurable cancer. Our findings suggest that the use of IPOS as a basis for conversation promotes safe care by making the patients feel confident that the care provided was adapted to them which (...) gives them a sense of safety. IPOS facilitated discussions between patients and nurses about care needs. The patients believed that using IPOS enabled reflection on their well‐being and life situation. In conclusion, the study finds that using IPOS is beneficial and provide ways to enable person‐centered care and with advantage could be used in specialized palliative home care. The results may help overcome barriers and facilitate the use of patient‐reported outcome measures (PROMs). To enable the use of PROMs such as IPOS in palliative home care, nurses need education and opportunities to develop routines that enable patients’ voice to be heard and thereby compose a basis for care. (shrink)

The aim of this study was to illuminate the meaning of receiving help from home nursing care for the chronically ill, elderly persons living in their homes. The study was carried out in Norway. Data were collected by narrative interviews and analysed by phenomenological hermeneutic interpretations. Receiving help from home nursing care sometimes meant ‘Being ill and dependent on help’. Other times it meant ‘Being at the mercy of help’. It could also mean ‘Feeling inferior as a human being’. Sometimes (...) help was given by nurses who were respectful and proficient at caring for an elderly person, while at other times nurses seemed to be incompetent and worked with a paternalistic attitude without respect for privacy. Receiving help also meant elderly persons wanted to be regarded and approached as equal human beings, supported in the courage to meet challenges in life. (shrink)

BackgroundBeing pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one’s body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient’s experience. Little is known about how women with a history of eating disorder experience being pregnant.MethodWe interviewed 24 women with a history of eating disorder at the time of pregnancy, recruited from five public pregnancy (...) controls at local family health centers in Norway. Interviews were analyzed by means of ideal type analysis, with a particular focus on how the participants experienced pregnancy and perceived triggers in possible experiences of relapse or worsening during pregnancy. All participants completed the Eating Disorder Examination Questionnaire and were diagnosed by using the Eating Disorder Examination.ResultsOn becoming pregnant, 23 of the 24 participants experienced worsening or relapse of their disorder. This occurred both at first time and after several pregnancies, and either interviewed early or late in pregnancy. Ideal type analyses indicated seven different personal features associated with worsening or relapse: the “chaotic” “rigid” “perfect” “worried” “shameful” “motherhood fearing” and “the mother with lost identity” Perceived triggers of worsening or relapse were: “loss of control” “unpredictability” “competition” “change of appearance” “shame and nausea” and “loss of identity.”ConclusionPregnancy is a vulnerable period for women with a history of eating disorders. A great variation in personal psychological dynamics seems to interact with perceived triggers in worsening or relapse of eating disorder. Our findings have important implications in understanding mechanisms of relapse in pregnancy, preventing relapse and help tailoring adequate intervention. (shrink)

The first priority of this response is to address Libet's rebuttal of my reinterpretation of his data. Then, because many authors have commented on various aspects of the debate, the rest of the response is organized in terms of subject matter, not as replies to each individual commentator. First, I reply to an objection expressed by two separate commentators to part of my reinterpretation of those of Libet's data supposedly supporting backward referral. This leads to a brief discussion of the (...) whole concept of backward referral. The relevance of the flash-lag illusion to possible measurement errors in the Libet/Trevena and Miller paradigm is addressed next. Finally, I have a few words to say on the relationship between quantum mechanical ontology and free will. (shrink)

Trevena and Miller provide further evidence that readiness potentials occur in the brain prior to the time that participants claim to have initiated a voluntary movement, a contention originally forwarded by Libet, Gleason, Wright, and Pearl . In their examination of this issue, though, aspects of their data lead them to question whether their measurement of the initiation of a voluntary movement was accurate. The current article addresses this concern by providing a direct analysis of biases in this task. (...) This was done by asking participants to make subjective timing decisions regarding a stimulus that could be measured objectively. Our findings suggest that their timing task was indeed biased such that participants' tend to report events as happening approximately 70 ms later than they actually happened. Implications for the original Libet et al. claims are discussed. (shrink)

Striking experimental results by Benjamin Libet and colleagues have had an impor- tant impact on much recent discussion of consciousness. Some investigators have sought to replicate or extend Libet’s results (Haggard, 1999; Haggard & Eimer, 1999; Haggard, Newman, & Magno, 1999; Trevena & Miller, 2002), while others have focused on how to interpret those findings (e.g., Gomes, 1998, 1999, 2002; Pockett, 2002), which many have seen as conflicting with our commonsense picture of mental functioning.

S. Pockett and G. Gomes discuss a possible bias in the method by which Libet's subjects estimated the time at which they became aware of their intent to move their hands. The bias, caused by sensory delay processing the clock information, would be sufficient to alter Trevena and Miller's conclusions regarding the timing of the lateralized readiness potential. I show that the flash-lag effect would compensate for that bias. In the last part of my commentary I note that the (...) other target articles do not examine the most interesting aspect of Libet's unfashionable views on free will. I point out that Libet's views are less strange than they at first appear to be. (shrink)

The major findings by Libet et al. are briefly summarized. The criticisms and alternative proposals by Trevena and Miller, Pockett, and Gomes are analyzed and found to be largely unwarranted.

A commentary on articles by Klein, Pockett, and Trevena and Miller, in this issue, is given. Average shift in the point of subjective equality , calculated by Klein on Libet's data, and corresponding change in mean shift, calculated by Libet et al. , may be “corrected,” taking as a reference point the end of the minimum train duration. Values obtained, if significant, indicate a latency for conscious sensation of the skin stimulus of at least 230 ms. Pockett's main conclusions (...) are favored, but her explanation of peripheral–lemniscal couplings is found to be unconvincing. Trevena and Miller's article unsuccessfully tries to rescue a dualist interactionist view. Libet's method of timing intentions is thoroughly criticized. (shrink)

This article argues against Benjamin Libet's claim that his experiment has shown that our actions are caused by brain events which begin before we consciously undertake the action. It clarifies what exactly should be meant by saying that the readiness potential causes, initiates, or prepares an action. It shows why Libet's experiment does not support his claim and why the experiments by Herrmann et al. and by Trevena \& Miller provide evidence against it. The empirical evidence is compatible with (...) strong libertarian free will. Neither the readiness potential nor the lateralized readiness potential cause our actions. (shrink)

Benjamin Libet's celebrated experiments concerning freedom elicited numerous attempts of _philosophical_ repudiation. Ten years ago, however, Judy Trevena and Jeff Miller published a _technical_ objection; they claim to have detected a,,smearing artifact" in Libet's calculations. This rests on a misunderstanding of Libet's methodology. In my reconstruction of Libet's argument, he draws an abductive inference to the best explanation. Now, Trevena's and Miller's objection does indeed lead to alternative explanations of Libet's measurements. These alternatives are _ad hoc_ and extremely (...) improbable. They constitute worse explanations than the explanation offered by Libet. _German_ Benjamin Libets bahnbrechende Experimente zur Willensfreiheit aus den Achtziger Jahren des vorigen Jahrhunderts gehören längst zu den Klassikern der Experimentalkunst. Aus _philosophischer_ Perspektive sind sie oft kritisiert worden; unabhängig davon ist zu Beginn des neuen Jahrtausends ein _technischer_ Einwand gegen Libet prominent geworden, der von Freiheitsfreunden gerne zitiert wird. Er geht auf Judy Trevena und Jeff Miller zurück und besteht in dem Vorwurf, dass Libet mit seiner Berechnung der _gemittelten_ Bereitschaftspotential-Kurven die wahren Verhältnisse verschmiere und dabei aus mathematischen Gründen den Anstiegs-Zeitpunkt des Bereitschaftspotentials künstlich nach vorne verschiebe – das ist der Vorwurf des sog. Verschmierungsartefakts. Ich zeige, dass der Vorwurf nicht sticht. Er beruht auf einem Missverständnis der Schlussmethode Libets. Laut meiner wissenschaftstheoretischen Rekonstruktion zieht Libet weder deduktive noch induktive Schlüsse aus seinen Einzelbeobachtungen; er schließt abduktiv, d.h. er schließt auf die beste Erklärung seiner Einzelbeobachtungen. Wie eine genaue arithmetische Analyse zeigt, bieten die Alternativ-Erklärungen, unter denen sich das Verschmierungsartefakt bewahrheiten würde, schlechtere Erklärungen als Libets Erklärung – sie sind an den Haaren herbeigezogen und extrem unwahrscheinlich. (shrink)

L'ampio e documentato studio di Ingela Nilsson conferma l'interesse sempre crescente per i romanzi bizantini, ribadito anche dalla ricca mise au point che Agapitos ha riservato di recente alle opere della Komnenenzeit, tra le quali Ismine e Isminia di Eumazio Macrembolita – la Nilsson accetta questa forma del nome (p. 18), condividendo l'ipotesi di Hunger, che identifica l'autore con il dignitario imperiale che fu per due volte eparchos di Costantinopoli e protoasekretis durante la sinodo del 1166 – costituisce l'unico (...) testo in prosa, solo da poco, per una felice coincidenza, riedito criticamente da M. Marcovich (Teubner, Stutgardiae et Lipsiae 2001). (shrink)

A commentary is given on Trevena and Miller . The comparability of their experimental task and of the potential they recorded with those used and recorded by Libet, Gleason, Wright, and Pearl is questioned. An interpretation is given for the similarity of event-related potentials recorded when subjects decided to move and when they decided not to move.