ABSTRACTDrawing extends the capacity to communicate, since it allows individuals to use graphic objects and symbols to articulate complex ideas not easily communicated using words alone. Similarly,...

Professors are increasingly encouraged to adopt multiple role relationships with their students. Regardless of professor intent, these relationships carry risks. Left unexamined is whether student–faculty social multiple relationships impact student in-class behaviors. Provocatively, our exploratory study provides empirical support suggesting that when undergraduate students perceive that their professors engage in the multiple faculty–student relationships of friendships, drinking relationships, and sexual partnerships, students report they are more likely to engage in uncivil behaviors in the professor’s classroom. Accordingly, our study provides a (...) backdrop against which to think more substantively about the professorial role and the boundaries that accompany it. (shrink)

An increased focus on fake news and misinformation is currently emerging. But what does it mean when information is designated as “fake?” Research on deception has focused on lies of commission, in which people disclose something false as true. However, people can also lie by omission, by withholding important yet true information. In this research, we investigate when people are more likely to tell a lie of omission. In three studies, with tests among undergraduates, online sample respondents, and candidates for (...) U.S. Senate, we found that people in a gain frame were more likely to lie by omission (vs. commission), and vice versa for a loss frame. Moreover, participants rated lies of commission in a gain frame as the least acceptable type of deception, suggesting why people may avoid telling this kind of lie. Overall, our results emphasize that from frame-to-frame, lying is not only different in degree but different in kind. (shrink)

Under higher education’s contemporary consumer model, students are treated as customers and professors are encouraged to increase student engagement through more personal out-of-class interactions, often in social settings. In the course of this more personal student-faculty involvement, students inevitably encounter or learn of their professors’ occasional inappropriate or unethical behavior. In the present study, we investigated the impact of 145 American undergraduate Business students’ perceptions of their professors’ inappropriate out-of-class behavior on student beliefs and in-class behavior. Results indicate that student (...) perceptions of professors engaging in inappropriate out-of-class behavior were associated with students viewing these professors as lower in ethical character and reporting a stronger likelihood of attending these professors’ classes under the influence of alcohol and illicit drugs, swearing and using vulgarity in these professors’ class discussions, and showing disregard for these professors’ rules, time, and effort. These relationships held even when student grade satisfaction and professor in-class behavior were accounted for. Our results suggest professors’ behavior outside the classroom may impact students’ behavior inside the classroom, re-igniting dialogue regarding the professorial role and the boundaries on oversight of that role. We offer suggestions as to how higher education may address these concerns without infringing upon professors’ personal freedoms. (shrink)

The computations involved in statistical learning have long been debated. Here, we build on work suggesting that a basic memory process, chunking, may account for the processing of statistical regularities into larger units. Drawing on methods from the memory literature, we developed a novel paradigm to test statistical learning by leveraging a robust phenomenon observed in serial recall tasks: that short‐term memory is fundamentally shaped by long‐term distributional learning. In the statistically induced chunking recall (SICR) task, participants are exposed to (...) an artificial language, using a standard statistical learning exposure phase. Afterward, they recall strings of syllables that either follow the statistics of the artificial language or comprise the same syllables presented in a random order. We hypothesized that if individuals had chunked the artificial language into word‐like units, then the statistically structured items would be more accurately recalled relative to the random controls. Our results demonstrate that SICR effectively captures learning in both the auditory and visual modalities, with participants displaying significantly improved recall of the statistically structured items, and even recall specific trigram chunks from the input. SICR also exhibits greater test–retest reliability in the auditory modality and sensitivity to individual differences in both modalities than the standard two‐alternative forced‐choice task. These results thereby provide key empirical support to the chunking account of statistical learning and contribute a valuable new tool to the literature. (shrink)

Communication and Conflict Management Training for Clinical Bioethics Committees Content Type Journal Article Pages 341-349 DOI 10.1007/s10730-009-9116-7 Authors Lauren M. Edelstein, Johns Hopkins Medicine’s Howard County General Hospital 5755 Cedar Lane Columbia MD 21044 USA Evan G. DeRenzo, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Elizabeth Waetzig, Change Matrix Inc. 485 Maylin St. Pasadena CA 91105 USA Craig Zelizer, Georgetown University Department of Government 3240 Prospect St. Washington, D.C. NW 20057 USA Nneka O. (...) Mokwunye, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

Ben Saunders claims that actual consent is not necessary for organ donation due to ‘normative consent’, a concept he borrows from David Estlund. Combining normative consent with Peter Singer's ‘greater moral evil principle’, Saunders argues that it is immoral for an individual to refuse consent to donate his or her organs. If a presumed consent policy were thus adopted, it would be morally legitimate to remove organs from individuals whose wishes concerning donation are not known. This paper disputes Saunders' arguments. (...) First, if death caused by the absence of organ transplant is the operational premise, then, there is nothing of comparable moral precedence under which a person is not obligated to donate. Saunders' use of Singer's principle produces a duty to donate in almost all circumstances. However, this premise is based on a flawed interpretation of cause and effect between organ availability and death. Second, given growing moral and scientific agreement that the organ donors in heart-beating and non-heart-beating procurement protocols are not dead when their organs are surgically removed, it is not at all clear that people have a duty to consent to their lives being taken for their organs. Third, Saunders' claim that there can be good reasons for refusing consent clashes with his claim that there is a moral obligation for everyone to donate their organs. Saunders' argument is more consistent with a conclusion of ‘mandatory consent’. Finally, it is argued that Saunders' policy, if put into place, would be totalitarian in scope and would therefore be inconsistent with the freedom required for a democratic society. (shrink)

Writing from a scientifically and philosophically informed perspective, the authors provide a critical overview of the conceptual difficulties encountered in many current neuroscientific and psychological theories.

The book "Philosophical Foundations of Neuroscience" is an engaging criticism of cognitive neuroscience from the perspective of a Wittgensteinian philosophy of ordinary language. The authors' main claim is that assertions like "the brain sees" and "the left hemisphere thinks" are integral to cognitive neuroscience but that they are meaningless because they commit the mereological fallacy—ascribing to parts of humans, properties that make sense to predicate only of whole humans. The authors claim that this fallacy is at the heart of Cartesian (...) dualism, implying that current cognitive neuroscientists are Cartesian dualists. Against this claim, we argue that the fallacy cannot be committed within Cartesian dualism either, for this doctrine does not allow for an intelligible way of asserting that a soul is part of a human being. Also, the authors' Aristotelian essentialistic outlook is at odds with their Wittgensteinian stance, and we were unconvinced by their case against explanatory reductionism. Finally, although their Wittgensteinian stance is congenial with radical behaviorism, their separation between philosophy and science seems less so because it is based on a view of philosophy as a priori. The authors' emphasis on the a priori, however, does not necessarily commit them to rationalism if it is restricted to conceptual or analytical truths. (shrink)

Social norms – rules governing which behaviours are deemed appropriate or inappropriate within a given community – are typically taken to be uniquely human. Recently, this position has been challenged by a number of philosophers, cognitive scientists, and ethologists, who have suggested that social norms may also be found in certain non-human animal communities. Such claims have elicited considerable scepticism from norm cognition researchers, who doubt that any non-human animals possess the psychological capacities necessary for normative cognition. However, there is (...) little agreement among these researchers about what these psychological prerequisites are. This makes empirical study of animal social norms difficult, since it is not clear what we are looking for and thus what should count as behavioural evidence for the presence (or absence) of social norms in animals. To break this impasse, we offer an approach that moves beyond contested psychological criteria for social norms. This approach is inspired by the animal culture research program, which has made a similar shift away from heavily psychological definitions of ‘culture’ and to become organized around a cluster of more empirically tractable concepts of culture. Here, we propose an analogous set of constructs built around the core notion of a normative regularity, which we define as a socially maintained pattern of behavioural conformity within a community. We suggest methods for studying potential normative regularities in wild and captive primates. We also discuss the broader scientific and philosophical implications of this research program with respect to questions of human uniqueness, animal welfare and conservation. (shrink)

A variety of theoretical frameworks predict the resemblance of behaviors between two people engaged in communication, in the form of coordination, mimicry, or alignment. However, little is known about the time course of the behavior matching, even though there is evidence that dyads synchronize oscillatory motions (e.g., postural sway). This study examined the temporal structure of nonoscillatory actions—language, facial, and gestural behaviors—produced during a route communication task. The focus was the temporal relationship between matching behaviors in the interlocutors (e.g., facial (...) behavior in one interlocutor vs. the same facial behavior in the other interlocutor). Cross-recurrence analysis revealed that within each category tested (language, facial, gestural), interlocutors synchronized matching behaviors, at temporal lags short enough to provide imitation of one interlocutor by the other, from one conversational turn to the next. Both social and cognitive variables predicted the degree of temporal organization. These findings suggest that the temporal structure of matching behaviors provides low-level and low-cost resources for human interaction. (shrink)

Whether computational algorithms such as latent semantic analysis (LSA) can both extract meaning from language and advance theories of human cognition has become a topic of debate in cognitive science, whereby accounts of symbolic cognition and embodied cognition are often contrasted. Albeit for different reasons, in both accounts the importance of statistical regularities in linguistic surface structure tends to be underestimated. The current article gives an overview of the symbolic and embodied cognition accounts and shows how meaning induction attributed to (...) a specific statistical process or to activation of embodied representations should be attributed to language itself. Specifically, the performance of LSA can be attributed to the linguistic surface structure, more than special characteristics of the algorithm, and embodiment findings attributed to perceptual simulations can be explained by distributional linguistic information. (shrink)

The notion of patients’ duties has received periodic scholarly attention but remains overwhelmed by attention to the duties of healthcare professionals. In a previous paper the author argued that patients in publicly funded healthcare systems have a duty to participate in clinical research, arising from their debt to previous patients. Here the author proposes a greatly extended range of patients’ duties grounding their moral force distinctively in the interests of contemporary and future patients, since medical treatment offered to one patient (...) is always liable to be an opportunity cost in terms of medical treatment needed by other patients. This generates both negative and positive duties. Ten duties—enjoining obligations ranging from participation in healthcare schemes to promoting one’s own earliest recovery from illness—are proposed. The characteristics of these duties, including their basis, moral force, extent and enforceability, are considered. They are tested against a range of objections—principled, societal, epistemological and practical—and found to survive. Finally, the paper suggests that these duties could be thought to reinforce a regrettably adversarial characteristic, shared with rights-based approaches, and that a preferable alternative might be sought through the notion of a “virtuous patient” contributing to a problem-solving partnership with the clinician. However, in defining and giving content to that partnership, there is a clear role for most, if not all, of the proposed duties; their value thus extends beyond the adversarial context in which they might first be thought to arise. (shrink)

Recent theories of cognition have argued that embodied experience is important for conceptual processing. Embodiment can be contrasted with linguistic factors such as the typical order in which words appear in language. Here, we report four experiments that investigated the conditions under which embodiment and linguistic factors determine performance. Participants made speeded judgments about whether pairs of words or pictures were semantically related or had an iconic relationship. The embodiment factor was operationalized as the degree to which stimulus pairs were (...) presented in the spatial configurations in which they usually occur (i.e., an iconic configuration, e.g., attic presented above basement). The linguistic factor was operationalized as the frequency of the stimulus pairs in language. The embodiment factor predicted error rates and response time better for pictures, whereas the linguistic factor predicted error rates and response time better for words. These findings were modified by task, with the embodiment factor being strongest in iconicity judgments for pictures and the linguistic factor being strongest in semantic judgments for words. Both factors predicted error rates and response time for both semantic and iconicity judgments. These findings support the view that conceptual processing is both linguistic and embodied, with a bias for the embodiment or the linguistic factor depending on the nature of the task and the stimuli. (shrink)

Three experiments examined the influence of argument length on plausibility judgements, in a category-based induction task. The general results were that when arguments were logically invalid they were considered stronger when they were longer, but for logically valid arguments longer arguments were considered weaker. In Experiments 1a and 1b when participants were forewarned to avoid using length as a cue to judging plausibility, they still did so. Indeed, participants given the opposite instructions did not follow those instructions either. In Experiment (...) 2 arguments came from a reliable or unreliable speaker. This manipulation affected accuracy as well as response bias, but the effects of argument length for both reliable and unreliable speakers replicated Experiments 1a and 1b. The results were analysed using receiver operating characteristic (ROC) curves and modelled using multidimensional signal detection theory (SDT). Implications for models of category-based inductive reasoning, and theories of reasoning more generally, are discussed. (shrink)

Patients participating in the shared benefits of publicly funded health care enjoy the benefits of treatments tested on previous patients. Future patients similarly depend on treatments tested on present patients. Since properly designed research assumes that the treatments being studied are—so far as is known at the outset—equivalent in therapeutic value, no one is clinically disadvantaged merely by taking part in research, provided the research involves administering active treatments to all participants. This paper argues that, because no other practical or (...) moral considerations count decisively against so doing, we could and should oblige patients to agree to receive indicated treatment within the terms of any concurrent research protocols. This ensures their treatment will benefit not only themselves but also future patients through contributing to new knowledge. By analogy with the paying of income tax, patients should not be allowed to “veto” their social responsibility to take part in clinical research. (shrink)

In an evolutionary perspective Louwerse elaborates the Symbol Interdependency Hypothesis (Louwerse, 2011), arguing that language has evolved such that it maps onto the perceptual system, allowing to bootstrap meaning also when grounding is limited. The author concludes that in principle the processing of abstract and concrete words is the same and that in both cases language users tend to rely anyway on indexical relationships that words entertain with other words.

Curbside ethics consultations occur when an ethics consultant provides guidance to a party who seeks assistance over ethical concerns in a case, without the consultant involving other stakeholders, conducting his or her own comprehensive review of the case, or writing a chart note. Some have argued that curbside consultation is problematic because the consultant, in focusing on a single narrative offered by the party seeking advice, necessarily fails to account for the full range of moral perspectives. Their concern is that (...) any guidance offered by the ethics consultant will privilege and empower one party’s viewpoint over—and to the exclusion of—other stakeholders. This could lead to serious harms, such as the ethicist being reduced to a means to an end for a clinician seeking to achieve his or her own preferred outcome, the ethicist denying the broader array of stakeholders input in the process, or the ethicist providing wrongheaded or biased advice, posing dangers to the ethical quality of decision-making. Although these concerns are important and must be addressed, we suggest that they are manageable. This paper proposes using conflict coaching, a practice developed within the discipline of conflict management, to mitigate the risks posed by curbside consultation, and thereby create new “spaces” for moral discourse in the care of patients. Thinking of curbside consultations as an opportunity for “clinical ethics conflict coaching” can more fully integrate ethics committee members into the daily ethics of patient care and reduce the frequency of ethically harmful outcomes. (shrink)

Population counts and longitude and latitude coordinates were estimated for the 50 largest cities in the United States by computational linguistic techniques and by human participants. The mathematical technique Latent Semantic Analysis applied to newspaper texts produced similarity ratings between the 50 cities that allowed for a multidimensional scaling (MDS) of these cities. MDS coordinates correlated with the actual longitude and latitude of these cities, showing that cities that are located together share similar semantic contexts. This finding was replicated using (...) a first‐order co‐occurrence algorithm. The computational estimates of geographical location as well as population were akin to human estimates. These findings show that language encodes geographical information that language users in turn may use in their understanding of language and the world. (shrink)

Using a fictional but representative general practice consultation, involving the diagnosis of irritable bowel syndrome in a patient who is anxious for some relief from the discomfort his condition entails, this paper argues that when both a drug fails to out-perform placebo and the condition in question is a functional illness with no demonstrable underlying pathology, then the action of the drug is not only no better than placebo, and it is also no different from it either. The paper also (...) argues that, in the circumstances of the consultation described, it is striking that current governance deems it ethical for a practitioner to prescribe either a drug or a placebo, both of which appear to rely for their effectiveness on a measure of concealment on the part of the doctor, yet deems it unethical for a practitioner openly to prescribe a harmless and enjoyable substance which is likely to be no less effective than either drug or placebo and is also likely to be better-tolerated and cheaper than the drug. (shrink)

Recent sociological/philosophical treatments of expertise, best represented by the work of Steve Fuller, attempt to (1) reduce displays of expertise to sophistic exercises of discretionary power, and (2) refute the claim that because laypeople are epistemically inferior to experts, it is rational to defer to an expert's opinion rather than making up one's own mind. But upon inspection, Fuller fails to provide reasonable grounds for liberating laypeople from the tyranny of cognitive authoritarianism. Rather, he presents a patronizing description of the (...) expert‐lay relation, one that actually makes the public seem more ignorant than is warranted. (shrink)

Two eye-tracking experiments investigated how and when pointing gestures and location descriptions affect target identification. The experiments investigated the effect of gestures and referring expressions on the time course of fixations to the target, using videos of human gestures and human voice, and animated gestures and synthesized speech. Ambiguous, yet informative pointing gestures elicited attention and facilitated target identification, akin to verbal location descriptions. Moreover, target identification was superior when both pointing gestures and verbal location descriptions were used. These findings (...) suggest that gesture not only operates as a context to verbal descriptions, or that verbal descriptions operate as a context to gesture, but that they complement one another in reference resolution. (shrink)

“Run-in” and “washout” periods involving the withholding of medication are widely used in drug research trials in pursuit of both patient safety and scientific reliability. Such no-medication periods can be justified ethically provided that they are apparent to patients, who can thereby properly consent to undergoing them. Less widespread, but still common, is the practice of “single blinding” no-medication periods, concealing them from patients by means of placebo. Whilst all placebos involve a measure of concealment, their use is typically justified (...) in drug research trials by their preserving the uncertainty generated by the random allocation of different treatments within a drug trial; and by the researchers openly declaring both the randomisation process and the chances of receiving placebo. In the single blind placebo “run-in” or “washout”, neither of these conditions is met.This paper considers three possible defences of the practice of using single blind placebo “run-ins” or “washouts” and finds them all to fail; the practice appears ethically unjustified. (shrink)

Paul Feyerabend is famous for presenting a scathing indictment of modern experts as a threat to democracy. While commentators have questioned the accuracy of his portrayal of experts, they have not assessed the accuracy of his depiction of laypeople. Although Feyerabend has political reasons for wanting to demythologize grandiose notions of expertise, his political project hinders clear thinking about the question by idealizing the alternative lay perspective.

Abstract Paul Feyerabend is famous for presenting a scathing indictment of modern experts as a threat to democracy. While commentators have questioned the accuracy of his portrayal of experts, they have not assessed the accuracy of his depiction of laypeople. Although Feyerabend has political reasons for wanting to demythologize grandiose notions of expertise, his political project hinders clear thinking about the question by idealizing the alternative lay perspective.

Spatial mental representations can be derived from linguistic and non‐linguistic sources of information. This study tested whether these representations could be formed from statistical linguistic frequencies of city names, and to what extent participants differed in their performance when they estimated spatial locations from language or maps. In a computational linguistic study, we demonstrated that co‐occurrences of cities in Tolkien’s Lord of the Rings trilogy and The Hobbit predicted the authentic longitude and latitude of those cities in Middle Earth. In (...) a human study, we showed that human spatial estimates of the location of cities were very similar regardless of whether participants read Tolkien’s texts or memorized a map of Middle Earth. However, text‐based location estimates obtained from statistical linguistic frequencies better predicted the human text‐based estimates than the human map‐based estimates. These findings suggest that language encodes spatial structure of cities, and that human cognitive map representations can come from implicit statistical linguistic patterns, from explicit non‐linguistic perceptual information, or from both. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:149. RELATIVE IDEAS REJECTED Hume's claim that ideas copy impressions seems to provide prima facie evidence for the interpretation that he also believed that all thought is restricted to images. Clearly such a view would be fatal to Hume's epistemological framework for at least two reasons. The first reason is quite simply that images are not a necessary element for thought, since we rarely think in images or pictures. (...) The second reason is that the imagistic interpretation prevents the possibility of universal a priori knowledge; since images only represent particulars they can never permit the inference from knowledge of particular instances to knowledge of universal cases. Yolton's paper, "Hume's Ideas", is a valiant effort to save Hume from the crippling imagistic interpretation. Although Yolton presents a reading of the Treatise that might avoid this interpretation, he fails to provide a sufficiently detailed account of any one counter-example to the imagistic view of Hume. However, such a counter-example has been worked out in Flage's 2 recent paper "Hume's Relative Ideas". Although the search for non-picturable ideas in Hume's system, and subsequent destruction of the imagistic interpretation is an admirable path for investigation, I intend to show that Flage's attempt to produce a Humean theory of non3 picturable "relative" ideas is entirely misguided. I shall argue that Flage has produced a theory without application in Hume's framework, a theory actually based on a distinction between relative ideas and relations of ideas, that Hume never intends. Flage argues that Hume has a theory of relative ideas, and that the application of this theory can produce intelligible concepts of essentially imperceptible 150. objects. A relative idea is obtained by an inference, of sorts, from the relations of ideas obtained from impressions; or in Flage' s words, a relative idea "singles out an unperceived entity on the basis of its relations to a perceived entity, i.e. a positive [picturable] idea" (HS 56). Flage admits that "Hume often regarded epistemic claims based upon relative ideas with at least a modicum of scepticism" (HS 55). He also realizes that no such theory of relative ideas can be used to justify ontological claims of the unperceivable objects (HS 63), but that "the doctrine of relative ideas at least accounts for the intelligibility of various concepts" (HS 59). Flage applies the theory of relative ideas to three concepts that Hume discusses in an effort to demonstrate how this theory can make these concepts intelligible. The three concepts are substratum, the missing shade of blue, and the idea of a thousandth part of a grain of sand; however, Flage fails to realize that Hume successfully argues against the intelligibility of these concepts. I shall present the arguments that Hume gives to show that Flage' s theory of relative ideas does not apply in the cases he argues for. Hopefully this will show that Flage has created a theory that lacks application; however, this is not Flage' s only failing. "Relative" ideas are obtained from relations of ideas (HS 56), and by this description Flage has implicitly distinguished between Hume's use of "relative" and the philosophical "relations of ideas!', a distinction that Hume never intends. In the latter part of this paper I shall show that Hume uses "relative" to refer to the relations of ideas, and that Flage has simply located and produced a theory on the basis of a distinction that has no real difference. In the discussion of substance, Flage correctly points out that Hume distinguishes three definitions of substance in the fourth part of book I of the Treatise (HS 63-4). 151. Flage also correctly points out that at least two of these definitions are unintelligible (HS 64). The definition of substance, as an autonomous object that is distinct from dependent qualities, fails to properly 4 distinguish substance from qualities (T 233), and substance defined as the "subject of inhesion" fails because there is no empirical evidence to justify the claim that qualities inhere in a substance J(T 234). However, Flage incorrectly argues that Hume asserts that the idea of substance as "the entity that is simple and identical through time... (shrink)

While there may be a place in some contexts for high handed, “blanket” legislative prohibitions on dissenting views of what constitutes death, the paper under consideration does not describe such a contextThis stimulating and provocative paper by Professor Appel, Defining death: when physicians and families differ, asks us to consider “whether patients’ families should be permitted to opt out of widely accepted definitions of death in favour of their own standards”. This is a striking question in many ways. It reminds (...) us that, as a simple description of fact, there are indeed different standards for human death in so far as different groups or communities have accepted and continue to accept varying notions of what constitutes human death. The question’s reference to “opting out” suggests, perhaps reasonably, that it seems prima facie odd to think of adopting a definition of death as being a matter of individual choice. The reference to “permission” invites us to suppose limitations, primarily legal, upon the extent to which such a choice could be tolerated. Also, the question ascribes to certain “definitions of death” the authority of being widely accepted. The definitions thus favoured are, we learn, the various formulations of death referring to the state of the brain, chief among them “whole brain death” although the author is troublingly vague over whether all such formulations are morally, legally, or conceptually equivalent; and the relevant communities of acceptance turn out to consist of many—but, as the author admits, not all—physicians labouring under varying and inconsistent jurisdictions in the United States.My preface to the criticisms that follow is a …. (shrink)

Patient-based outcome measures are increasingly important in health care evaluations, often through the use of paper-based questionnaires. The likely impact of questionnaires upon patients is not often considered and therefore, the balance of benefit and harm not fully explored. Harms that might accrue for research staff are even less frequently considered. This paper describes the use of postal questionnaires within a study of breast disease management in primary care. Questionnaire responses are used to describe the nature of discomfort or harms (...) that may occur in such studies. Ethical issues raised by the harms are discussed in relation to the benefits of the study. Practical suggestions for reducing harm to patients are proposed. A secondary consideration, discomfort to the researcher, is also identified and suggestions made to reduce its effect. Finally, the role of research questionnaires as a study intervention is discussed. (shrink)