OBJECTIVES: Cognitive and sensory difficulties frequently jeopardize informed consent of frail elderly patients This study is the first to test whether preliminary research experience could enhance geriatric patients' capacity to consent. DESIGN/SETTING: A step-wise consent procedure was introduced in a study on fluid balance in geriatric patients. Eligible patients providing verbal consent participated in a try-out of a week, during which bioelectrical impedance and weight measurements were performed daily. Afterwards, written informed consent was requested. Comprehension, risk and inconvenience scores (ranges: (...) 0-10) were obtained before and after the try-out by asking ten questions about the study's essentials and by asking for a risk and inconvenience assessment on a ten-points rating scale. SUBJECTS AND RESULTS: Seventy of the 78 eligible subjects started the try-out and 53 (68%) provided written consent. The comprehension score increased from 5.0 (+/- 2.3) to 7.0 (+/- 1.9) following the try-out (P < 0.001). The number of subjects capable of weighing risks and inconveniences increased from 32 to 48 (P < 0.001). CONCLUSIONS: Research experience improved the capacity to consent, still enabling an acceptable participation rate. Therefore, experienced consent seems a promising tool to optimize informed consent in frail elderly subjects. (shrink)

Vladimir Solov'ev (1853-1900- is regarded as the most original and systematic of the Russian philosophers in the 19th century. He has once again become the subject of international scholarly attention both in Slavic countries and the West. This volume contains selected papers presented at the international conference on Vladimir Solov'ev held at Nijmegen University, the Netherlands, in September 1998. The scope of this conference was wide-ranging, dealing with theological, metaphysical, philosophical and historical themes. Though Solov'ev's broad intellectual activity defies any (...) strict attempt at categorisation, the editors have classified its major themes under the dual characteristic of reconciliation and polemics. Solov'ev was passionately committed to the reconciliation of all beings under the idea of all-unity, which he attemted to achieve by engaging in uncompromising polemics with his contemporaries, The thirty contributors to this volume are specialists from Russia, Ukraine, Bulgaria, Western Europe and the United States. The volume makes a significant contribution to the intellectual reassesment of Vladimir Solov'ev since the rediscovery of his philosophical heritage in his own homeland in the 1980s. (shrink)

The first quodlibetal question by William of Alnwick is a reply to John Duns Scotus' Quaestio de Formalitatibus, where the latter clarified his understanding of the formal distinction: ‘formal non-identity’ of the personal properties in God (and of the divine attributes) does not preclude a formal distinction if the latter is conceived as a distinction weakened by the modifier ‘formal’. Whereas Scotus' Quaestio has been subjected to a detailed analysis by Stephen Dumont, “Duns Scotus’ Parisian Question”, there is as yet (...) no such analysis of Alnwick's response. In the present paper his position is explained in detail. Alnwick rejects Scotus' view of ‘formal’ as a weakening modifier; he argues that the formal distinction necessarily is unqualified and may still import too much of unwanted realism in the matter at hand. Both Scotus and Alnwick acknowledge that the formal non-identity reflects the nature of things without falling back to a real distinction. But for Alnwick the right kind of distinction is a qualified distinction that is not a formal distinction. (shrink)

A theory of the joint measurement of quantum mechanical observables is generalized in order to make it applicable to the measurement of the local observables of field theory. Subsequently, the property of local commutativity, which is usually introduced as a postulate, is derived by means of the theory of measurement from a requirement of mutual nondisturbance, which, for local observables performed at a spacelike distance from each other, is interpreted as a requirement of macrocausality. Alternative attempts at establishing a deductive (...) relationship between relativistic causality and local commutativity are reviewed, but found wanting, either because of the assumption of an unwarranted objectivity of the object system (algebraic approach) or because of the use of a projection postulate (operational approach). Finally, the quantum mechanical nonobjectivity is related to certain features of nonlocality which are present in the formalism of quantum mechanics. (shrink)

This paper investigates the state of the art with respect to sustainability reporting, its linkages with the corporations, internal measurement and monitoring systems and their combined impact on the quality of contemporary sustainability benchmarks, developed by SRI analysts and so-called rating and screening agencies. This research originated from the EU-funded research initiative to create a new generation management framework for corporate sustainability and responsibility (CS-R). The aim of it is to develop a coherent set of assessment -, measurement - and (...) monitoring tools. The sustainability benchmark tool should align the interests of corporations implementing CS-R and various organizations supporting SRI, such as fund managers, analysts and screening agencies. This paper show the essentials features of an actual sustainability benchmark which is currently under construction. This approach will have significance impact on the further development of SRI and CS-R practices, as well as support the development of sustainability reporting standards. (shrink)

BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were (...) asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

BackgroundWith advances in sequencing technologies, increasing numbers of people are being informed about a genetic disease identified in their family. In current practice, probands are asked to inform at-risk relatives about the diagnosis. However, previous research has shown that relatives are sometimes not informed due to barriers such as family conflicts. Research on family communication in genetic diseases aims to explore the difficulties encountered in informing relatives and to identify ways to support probands in this.Main bodyResearch on family communication may (...) also reveal that participants did not inform their relatives about the risk of a serious genetic condition, even when preventive and treatment options are available. Researchers may then face a dilemma: Do they need to warn at-risk relatives about the finding? Or do they keep silent due to prior confidentiality agreements with study participants?ConclusionsWe believe that the absolute confidence promised to research participants outweighs the interests of their relatives, even though it can be claimed that relatives at risk of a genetic disease do, in principle, have a right to know information collected about their health. Not respecting confidentiality agreements could cause distrust between researchers and research participants and possibly harm the relationship between probands and relatives. Relatives' health interests can still be taken into account without jeopardizing participant trust, by considering alternative scenarios, including sharing general study findings on the barriers participants experience with their healthcare professionals and by offering participants psychosocial support for family communication. (shrink)

Lee and Schwarz interpret meta-analytic research and replication studies as providing evidence for the robustness of cleansing effects. We argue that the currently available evidence is unconvincing because publication bias and the opportunistic use of researcher degrees of freedom appear to have inflated meta-analytic effect size estimates, and preregistered replications failed to find any evidence of cleansing effects.

Vaccination programmes against infectious diseases aim to protect individuals from serious illness but also offer collective protection once a sufficient number of people have been immunized. This so-called ‘herd immunity’ is important for individuals who, for health reasons, cannot be immunized or who respond less well to vaccines. For these individuals, it is pivotal that others establish group protection. However, herd immunity can be compromised when people deliberately decide not to be immunized and benefit from the herd’s protection. These agents (...) are often referred to as free riders: their omissions are deemed to be unfair to those who do contribute to the collective’s health. This article addresses the unfairness of such ‘free riding’. An argument by Garett Cullity is examined, which asserts that the unfairness of moral free riding lies neither in one’s intentions, nor in one’s reluctance to embrace a public good. This argument offers a strong basis for justifiably arguing that free riding is unfair. However, it is then argued that other considerations also need to be taken into account before simply holding free riding against non-compliers. (shrink)

Background:Women's health has received renewed attention in the last few years including health rehabilitation options for women affected by breast cancer. Dancing has often been regarded as one attractive option for supporting women's well-being and health, but research with women recovering from breast cancer is still in its infancy. Dancing with Health is multi-site pilot study that aimed to evaluate a dance programme for women in recovery from breast cancer across five European countries.Methods:A standardized 32 h dance protocol introduced a (...) range of Latin American dances presented within a sports and exercise framework with influences from dance movement therapy. Fifty-four women (M age 53.51; SD 7.99) participated in the study who had a breast cancer diagnosis 6 weeks, no indication of metastasis, or scheduled surgery/chemotherapy/radiation treatment for the duration of the intervention. Primary outcome data was collected for anthropometric and fitness measures next to cancer-related quality of life.T-tests and Wilcoxon signed ranked tests were used to establish differences pre and post intervention. Cohen's d was also calculated to determine the effect size of the intervention.Results:Statistically significant changes were found for: (i) weight, right and left forearm circumference and hip; (ii) 6 min walking, right and left handgrip, sit-to-stand and sit-and-reach; (iii) the EORTC-QLQ C30 summary score as well as the subscales of emotional and social functioning and symptoms. In all cases the direction of change was positive, while Cohen's d calculated showed that the effect of the intervention for these parameters ranged from intermediate to large.Conclusion:Changes on the above anthropometric, fitness and quality of life measures suggest that the intervention was of value to the participating women recovering from breast cancer. Results also advocate collaborative efforts across countries to further research. (shrink)

Within current debates about the future impact of Artificial Intelligence on human society, roughly three different perspectives can be recognised: the technology-centric perspective, claiming that AI will soon outperform humankind in all areas, and that the primary threat for humankind is superintelligence; the human-centric perspective, claiming that humans will always remain superior to AI when it comes to social and societal aspects, and that the main threat of AI is that humankind’s social nature is overlooked in technological designs; and the (...) collective intelligence-centric perspective, claiming that true intelligence lies in the collective of intelligent agents, both human and artificial, and that the main threat for humankind is that technological designs create problems at the collective, systemic level that are hard to oversee and control. The current paper offers the following contributions: a clear description for each of the three perspectives, along with their history and background; an analysis and interpretation of current applications of AI in human society according to each of the three perspectives, thereby disentangling miscommunication in the debate concerning threats of AI; and a new integrated and comprehensive research design framework that addresses all aspects of the above three perspectives, and includes principles that support developers to reflect and anticipate upon potential effects of AI in society. (shrink)

The COVID-19 pandemic has forced developmental researchers to rethink their traditional research practices. The growing need to study infant development at a distance has shifted our research paradigm to online and digital monitoring of infants and families, using electronic devices, such as smartphones. In this practical guide, we introduce the Experience Sampling Method – a research method to collect data, in the moment, on multiple occasions over time – for examining infant development at a distance. ESM is highly suited for (...) assessing dynamic processes of infant development and family dynamics, such as parent-infant interactions and parenting practices. It can also be used to track highly fluctuating family dynamics and routines. The aim of the current paper was to provide an overview by explaining what ESM is and for what types of research ESM is best suited. Next, we provide a brief step-by-step guide on how to start and run an ESM study, including preregistration, development of a questionnaire, using wearables and other hardware, planning and design considerations, and examples of possible analysis techniques. Finally, we discuss common pitfalls of ESM research and how to avoid them. (shrink)

Theurgy, the ritual practice intended to free the descended soul from the body, has been considered an irrational and hence uninteresting part of late Neoplatonism. In this chapter, the author vindicates theurgy by showing that for Proclus there is an intimate relation between philosophy and theurgy. More specifically, he discusses the relevance of theurgy in Proclus’ metaphysics of causation, psychology, theology, and ethics. Theurgical symbols work because they are in fact low immanent forms. We need them, because our souls are (...) entirely descended, and theurgical excellence is the highest virtue. After a discussion of the role of theurgy in Proclus’ reading of the myth of the winged charioteer, the limits of theurgy, and the theurgical practices of purifying the soul from the body and of contemplation, the author ends with a short discussion of hymns as ‘theurgy in action’. (shrink)

In our daily lives, we continuously evaluate feedback information, update our knowledge, and adapt our behavior in order to reach desired goals. This ability to learn from feedback information, however, declines with age. Previous research has indicated that certain higher-level learning processes, such as feedback evaluation, integration of feedback information, and updating of knowledge, seem to be affected by age, and recent studies have shown how the adaption of choice behavior following feedback can differ with age. The neural mechanisms underlying (...) this age-related change in choice behavior during learning, however, remain unclear. The aim of this study is therefore to investigate the relation between learning-related neural processes and choice behavior during feedback learning in two age groups. Behavioral and fMRI data were collected, while a group of young and older adults performed a probabilistic learning task consisting of 10 blocks of 20 trials each. On each trial, the participants chose between a house and a face, after which they received visual feedback. In each block, either the house or the face image had a higher probability of yielding a reward. Participants were instructed to try to maximize their gains. Our results showed that less successful learning in older adults, as indicated by a lower learning rate, corresponded with a higher tendency to switch to the other stimulus option, and with a reduced adaptation of this switch choice behavior following positive feedback. At the neural level, activation following positive and negative feedback was found to be less distinctive in the older adults, due to a smaller feedback-evaluation response to positive feedback in this group. Furthermore, whereas young adults displayed increased levels of knowledge updating prior to adapting choice behavior, we did not find this effect in older adults. Together, our results suggest that diminished learning performance with age corresponds with diminished evaluation of positive feedback and reduced knowledge updating related to changes in choice behavior, indicating how such differences in feedback processing at the trial level in older adults might lead to reduced learning performance across trials. (shrink)

This paper studies moral education in Proclus and Iamblichus. The first section analyses Proclus’ theory of moral education and its psychological underpinnings. Especially important in this context is the identification of the faculty of choice with the passive or teachable intellect. The second section investigates the implementation of this theory into practice with the help of Iamblichus’ Letter to Sopater: On Bringing up Children. The final section demonstrates how Proclus’ famous tripartite division of poetry should be understood in the context (...) of his program of moral education. (shrink)

This paper investigates the state of the art with respect to sustainability reporting, its linkages with the corporations, internal measurement and monitoring systems and their combined impact on the quality of contemporary sustainability benchmarks, developed by SRI analysts and so-called rating and screening agencies. This research originated from the EU-funded research initiative to create a new generation management framework for corporate sustainability and responsibility (CS-R). The aim of it is to develop a coherent set of assessment –, measurement – and (...) monitoring tools. The sustainability benchmark tool should align the interests of corporations implementing CS-R and various organizations supporting SRI, such as fund managers, analysts and screening agencies. This paper show the essentials features of an actual sustainability benchmark which is currently under construction. This approach will have significance impact on the further development of SRI and CS-R practices, as well as support the development of sustainability reporting standards. (shrink)

How can new drug lead suggestions beinferred from neurophysiological models? This paperaddresses this question based on a case study ofresearch into Parkinson''s disease at the GroningenUniversity Department of Pharmacy. It is argued thatneurophysiological box-and-arrow models can beunderstood as qualitative differential equationmodels. An inference task is defined to helpunderstand and possibly aid the discovery andexplanation of new drug lead suggestions.

Aneuploidy, an aberrant number of chromosomes in a cell, is a feature of several syndromes associated with cognitive and developmental defects. In addition, aneuploidy is considered a hallmark of cancer cells and has been suggested to play a role in neurodegenerative disease. To better understand the relationship between aneuploidy and disease, various methods to measure the chromosome numbers in cells have been developed, each with their own advantages and limitations. While some methods rely on dividing cells and thus bias aneuploidy (...) rates to that population, other, more unbiased methods can only detect the average aneuploidy rates in a cell population, cloaking cell‐to‐cell heterogeneity. Furthermore, some techniques are more prone to technical artefacts, which can result in over‐ or underestimation of aneuploidy rates. In this review, we provide an overview of several “traditional” karyotyping methods as well as the latest high throughput next generation sequencing karyotyping protocols with their respective advantages and disadvantages. (shrink)

Cet article examine les opinions des néoplatoniciens tardifs sur le phénomène social de la philotimia (« amours des honneurs » ; « ambition »). Sur la base du Commentaire de l’Alcibiade de Proclus, on montre que la philotimia est une émotion qui résulte d’une compréhension imparfaite de la vraie nature de l’honneur et du pouvoir. La mauvaise philotimia pousse les ambitieux à poursuivre une carrière politique en quête de pouvoir mondain et de prestige au prix de l’étude de la philosophie. (...) La bonne philotimia, au contraire, peut les pousser à rechercher ce qui est véritablement bien et donc les mettre sur la voie de la philosophie. L’histoire fournit maints exemples de bonne et de mauvaise philotimia. Damascius, dans sa Vie d’Isidore, mobilise des théories de la bonne et de la mauvaise philotimia pour éloigner ses lecteurs de l’arène politique et les conduire vers la poursuite de la philosophie. (shrink)

Background Implementing person-centred care (PCC) in nursing homes is challenging due to a gap between theory and practice. Bridging this gap requires suitable education, which focuses on learning how to attune care to the values and preferences of residents and take moral, relational, and situational aspects into account. Staff’s stories about the care they provide (i.e. caring stories) may deliver valuable insights for learning about these aspects. However, there is limited research on using staff's narratives for moral learning. Objective This (...) study aims to provide insight into the perspectives of nursing staff on using their caring stories to learn about PCC. Research design In this qualitative research, we conducted two rounds of interviews with 17 participants working in nursing homes. We wanted to obtain nursing staff’s perceptions of working with their caring stories and the impact on PCC. Ethical considerations Participation was voluntary, and participants provided written consent. The study protocol is approved by The Institutional Review Board of the Medical Ethical Committee Leiden-Den Haag-Delft. Findings Working with caring stories enables nursing staff to provide PCC and improves job satisfaction. It increases awareness of what matters to residents, fosters information rich in context and meaning, and enhances voice and vocabulary. Through in-depth team reflections, nursing staff discussed the significant moments for residents, which centralizes the discussions on the moral quality of care. Discussion Working with caring stories fosters dialogue on PCC and enhances reflection on ethical situations in daily encounters, contributing to the moral development of nursing staff. Putting nursing staff’s narratives at the centre of learning suits their daily practice and intrinsic motivation. Therefore, the outcomes of this study are an addition to the existing literature about using narratives in long-term care. Conclusion Using nursing staff's narratives contributes to PCC and positively impacts nursing staff. We recommend using staff's caring stories as a vehicle for moral learning in the transition to PCC. (shrink)

In their introduction to the recent excellent volume Plato & Hesiod, the editors G.R. Boys-Stones and J.H. Haubold observe that when we think about the problematic relationship between Plato and the poets, we tend to narrow this down to that between Plato and Homer. Hesiod is practically ignored. Unjustly so, the editors argue. Hesiod provides a good opportunity to start thinking more broadly about Plato's interaction with poets and poetry, not in the least because the ‘second poet’ of Greece represents (...) a different type of poetry from Homer's heroic epics, that of didactic poetry. What goes for Plato and Hesiod goes for Proclus and Hesiod. Proclus , the productive head of the Neoplatonic school in Athens, took a great interest in poetry to which he was far more positively disposed than Plato had ever been. He wrote, for example, two lengthy treatises in reaction to Socrates' devastating criticism of poetry in the Republic as part of his commentary on that work in which he tries to keep the poets within the Platonic pale. This intriguing aspect of Proclus' thought has, as one might expect, not failed to attract scholarly attention. In Proclus' case too, however, discussions tend to concentrate on his attitude towards Homer . To some extent this is only to be expected, since much of the discussion in the Commentary on the Republic centres on passages from Homer. Proclus did not, however, disregard Hesiod: we still possess his scholia on the Works and Days, now available in a recent edition by Patrizia Marzillo. (shrink)