Previous studies support the link of parental acculturation to their children’s academic achievement, identity, and family relations. Prior research also suggests that parental language proficiency is associated with children’s vocabulary knowledge. However, few studies have examined the links of parental acculturation to young children’s oral language abilities. As preschool oral language skills have been shown to predict future academic achievement, it is critical to understand the relations between parental acculturation and bilingual abilities with young immigrant children. Furthermore, few studies have (...) examined the links between parental acculturation and children’s bilingual ability among different immigrant groups who live in the same areas to understand possible similarities and differences. To address these gaps, this study examines these relations in two of the largest and fastest-growing immigrant populations in the United States, Chinese American and Mexican American families. A total of 119 dual language learners enrolled in Head Start programs in Northern California were recruited. DLLs were assessed on oral language measures in both their heritage language and English. Parental interviews were conducted to obtain parental acculturation and language proficiency. Results showed no significant group differences between Chinese American and Mexican American parents on the majority of their acculturation dimensions. Furthermore, there were no significant group differences in the bilingual abilities between Chinese American and Mexican American DLLs. Cluster analysis identified four groups of DLLs based on their bilingual ability: high language ability in both English and HL, low language ability in both, English-dominant, and HL-dominant. Results suggest that parental acculturation levels are more similar than different among the four groups. On average, parents in all four groups had stronger ties to their heritage culture and HL than to the American culture. Results also showed links between parental cultural identities and children’s language dominance. Parents of English-dominant children had significantly higher levels of American identity than the parents of children with high ability in both languages. Implications are discussed. (shrink)

We investigated the relationship between attentional resources and pedaling cadence using electroencephalography to measure P300 amplitudes and latencies. Twenty-five healthy volunteers performed the oddball task while pedaling on a stationary bike or relaxing. We set them four conditions, namely, performing only the oddball task, performing the oddball task while pedaling at optimal cadence, performing the oddball task while pedaling faster than optimal cadence, and performing the oddball task while pedaling slower than optimal cadence. P300 amplitudes at Cz and Pz electrodes (...) under optimal, fast, and slow conditions were significantly lower than those under control conditions. P300 amplitudes at Pz under fast and slow conditions were significantly lower than those under the optimal condition. No significant changes in P300 latency at any electrode were observed under any condition. Our findings revealed that pedaling at non-optimal cadence results in less attention being paid to external stimuli compared with pedaling at optimal cadence. (shrink)

Background Traditionally, palliative care has focused on patients suffering from life-threatening somatic diseases such as cancer or progressive neurological disorders. In contrast, despite the often chronic, severely disabling, and potentially life-threatening nature of psychiatric disorders, there are neither palliative care units nor clinical guidelines on palliative measures for patients in psychiatry. Main text This paper contributes to the growing literature on a palliative approach in psychiatry and is based on the assumption that a change of perspective from a curative to (...) a palliative approach could help promote patient-centeredness and increase quality of life for severely ill patients in psychiatry as well as in somatic medicine. To exemplify this, we offer three different clinical scenarios: severe and enduring anorexia nervosa, treatment-refractory schizophrenia, and chronic suicidality and persistent self-injury in borderline personality disorder. Conclusion We emphasize that many typical interventions for treatment-refractory psychiatric disorders may indeed be of a palliative nature. Furthermore, introducing traditional features of palliative care, e.g. so-called goals of care conversations, could aid even further in ensuring that caregivers, patients, and families agree on which treatment goals are to be prioritized in order to optimize quality of life in spite of severe, persistent mental disorder. (shrink)

Objectives To explore attitudes and reasoning among Swedish physicians and the general public regarding the withdrawal of life-sustaining treatment at a competent patient's request. Design A vignette-based postal questionnaire including 1202 randomly selected individuals in the county of Stockholm and 1200 randomly selected Swedish physicians with various specialities. The vignettes described patients requesting withdrawal of their life-sustaining treatment: (1) a 77-year-old woman on dialysis; (2) a 36-year-old man on dialysis; (3) a 34-year-old ventilator-dependent tetraplegic man. Responders were asked to classify (...) the act of terminating treatment and to prioritise arguments for/against. Results A majority in both groups prioritised arguments in favour of terminating treatment and classified the act as defensible in all vignettes. However, among the general public, 16% classified the act as euthanasia in all vignettes; among physicians this view was most expressed regarding ventilator treatment (26%). Some who classified the act as euthanasia prioritised arguments in favour of terminating treatment: among physicians 18% in vignette 1, 19% in vignette 2 and 34% in vignette 3; among the general public 35% in vignette 1, 20% in vignette 2 and 48% in vignette 3. Conclusion There is a widespread consensus regarding competent patients' right to abstain from life-sustaining treatment. An association between the hastening of death, caused by the withdrawal of life-sustaining treatment and the concept of euthanasia is proposed. The results also suggest that classifying the withdrawal of life-sustaining treatment as ‘euthanasia’ does not necessarily mean that the act is interpreted as ethically unacceptable. (shrink)

Psychiatry today is mainly practised within a curative framework. However, many mental disorders are persistent and negatively affect quality of life as well as life expectancy. This tension between treatment goals and the actual illness trajectory has evoked a growing academic interest in ‘palliative psychiatry’, namely the application of a palliative care approach in patients with severe persistent mental illness. Recently, Trachsel et al presented a working definition of palliative psychiatry. This first official attempt to capture the concept is based (...) on WHO’s widely accepted definition of palliative care but modified and limited to include only severe persistent psychiatric illness. While this is a welcome step in the discussion on palliative care approaches in psychiatry, it also opens up for new questions. One of the most evident is whether psychiatry actually needs its own definition of palliative care or, put differently, whether there is something about mental disorders that differs so radically from other medical conditions that it calls for a separate definition. We acknowledge the need to discuss the goals of psychiatric care in patients with severe persistent psychiatric illness. However, we question whether a separate definition of palliative care exclusive to psychiatry is the right way to go. In this paper, we discuss why. (shrink)

The Rule of Double Effect (RDE) holds that it may be permissible to harm an individual while acting for the sake of a proportionate good, given that the harm is not an intended means to the good but merely a foreseen side-effect. Although frequently used in medical ethical reasoning, the rule has been repeatedly questioned in the past few decades. However, Daniel Sulmasy, a proponent who has done a lot of work lately defending the RDE, has recently presented a reformulated (...) and more detailed version of the rule. Thanks to its greater precision, this reinvented RDE avoids several problems thought to plague the traditional RDE. Although an improvement compared with the traditional version, we argue that Sulmasy's reinvented RDE will not stand closer scrutiny. Not only has the range of proper applicability narrowed significantly, but, more importantly, Sulmasy fails to establish that there is a morally relevant distinction between intended and foreseen effects. In particular, he fails to establish that there is any distinction that can account for the alleged moral difference between sedation therapy and euthanasia. (shrink)

Background Physician-assisted suicide is a controversial issue and has sometimes raised emotion-laden reactions. Against this backdrop, we have analyzed how Swedish physicians are reasoning about physician-assisted suicide if it were to be legalized. Methods and participants We conducted a cross-sectional study and analyzed 819 randomly selected physicians’ responses from general practitioners, geriatricians, internists, oncologists, psychiatrists, surgeons, and all palliativists. Apart from the main questions about their attitude toward physician-assisted suicide, we also asked what would happen with the respondents’ own trust (...) in healthcare if physician-assisted suicide were legalized. Response options were that trust would decrease, not be influenced, or would increase. Results We identified a strong statistical association between on the one hand those whose own trust would increase and who were pro physician-assisted suicide, and on the other hand those who were against physician-assisted suicide and whose own trust would decrease [relative risk: 16.7 (95% confidence interval: 10.2–27.2)]. Among those whose own trust would not be influenced (n = 456), 60% were pro pysician-assisted suicide, 16% were against, and 24% were undecided. Of those whose trust would increase or not be influenced, a large majority supported autonomy-based arguments, whereas those whose trust would decrease supported non-maleficence-based arguments. Conclusion Analyzing the answers after having divided respondents into those whose own trust in healthcare would decrease or increase and not be influenced brings about interesting results such as how the three groups prioritize arguments for and against physician-assisted suicide. This way of analyzing the data seems to be a promising strategy when identifying value-impregnated factual claims. (shrink)

Previous research found that application of eyeshadow on the upper eyelids induces overestimation of eye size. The present study examined whether this eyeshadow illusion is dependent on or independent of viewpoint. We created a three-dimensional model of a female face and manipulated the presence/absence of eyeshadow and face orientation around the axis of yaw (Experiment 1) or pitch (Experiment 2) rotation. Using the staircase method, we measured perceived eye size for each face stimulus. Results showed that the eyeshadow illusion occurred (...) regardless of face orientation around axes of both yaw and pitch rotations. Crucially, the illusion’s magnitude did not vary across face orientations; lack of interaction between the illusion’s magnitude and face orientation was confirmed by small values of Bayes factors. These findings ruled out the hypothesis that eyeshadow serves as a depth cue and leads to overestimation of eye size due to size-distance scaling. Alternatively, the present findings suggest that the eyeshadow illusion can be well explained by the assimilation between the eyes and eyeshadow, which also facilitates assimilation between the eyes and eyebrows. Practical implications and the present findings’ generalizability are also discussed. (shrink)

Two questionnaires directed to Swedish physicians and a sample of the Swedish population investigated attitudes towards physician-assisted suicide (PAS). The aim of the present work was to analyse qualitative data from these questionnaires in order to explore how respondents reason about PAS. Data were analysed in two steps. First, we categorized different kinds of responses and identified pro and con arguments. Second, we identified general conclusions from the responses. The data reflect the differences in attitudes towards PAS among the public (...) and physicians, with the former mainly in favour of PAS and the latter mainly against. There was, however, considerable agreement about what requirements must be met before PAS could be considered ethical. Many arguments against PAS concerned the professional role of physicians, which indicates that it may not be assisted suicide as such that many PAS opponents disagree with, but rather that it is handled by physicians in the regular health-care system. (shrink)

AimsTo examine attitudes towards physician-assisted suicide (PAS) among physicians in Sweden and compare these with the results from a similar cross-sectional study performed in 2007.ParticipantsA random selection of 250 physicians from each of six specialties (general practice, geriatrics, internal medicine, oncology, surgery and psychiatry) and all 127 palliative care physicians in Sweden were invited to participate in this study.SettingA postal questionnaire commissioned by the Swedish Medical Society in collaboration with Karolinska Institute in Stockholm. ResultsThe total response rate was 59.2%. Slightly (...) fewer than half [47.1% (95% CI 43.7–50.5)] of the respondents from the six specialties accepted PAS, which is significantly more than accepted PAS in the 2007 study [34.9% (95% CI 31.5–38.3)]. Thirty-three percent of respondents were prepared to prescribe the needed drugs. When asked what would happen to the respondent’s own trust in healthcare, a majority [67.1% (95% CI 63.9–70.3)] stated that legalizing PAS would either not influence their own trust in healthcare, or that their trust would increase. This number is an increase compared to the 2007 survey, when just over half [51.9% (95% CI 48.0–55.2)] indicated that their own trust would either not be influenced, or would increase.ConclusionsThe study reveals a shift towards a more accepting attitude concerning PAS among physicians in Sweden. Only a minority of the respondents stated that they were against PAS, and a considerable proportion reported being prepared to prescribe the needed drugs for patient self-administration if PAS were legalized. (shrink)

RATIONALE, AIM AND OBJECTIVE: Factors influencing doctors in prescribing of drugs have mostly been studied in primary care. Studies performed in hospital care have primarily focused on new drugs, not prescribing in general. An in-depth understanding of the prescribing process in the more specialized secondary care is not only important for secondary care itself, but because it also influences prescribing in primary care. The aim of this study is therefore to identify factors that secondary care doctors believe influence them in (...) prescribing drugs, using a qualitative approach. (shrink)

Background Despite its negative impact on patients and nurses, the use of restraint in somatic health care continues in many settings. Understanding the reasons and justifications for the use of restraint among nurses is crucial in order to manage this challenge. Aim To understand nurses’ justifications for restraint use in neurosurgical care. Research design A qualitative, descriptive design was used. Data were analysed with inductive qualitative content analysis. Participants and research context Semi-structured interviews with 15 nurses working in three neurosurgical (...) departments in Sweden. Ethical considerations Approved by The Regional Ethics Committee, Stockholm, Sweden. Findings The analysis resulted in three categories. The category Patient factors influencing restraint use describes patient factors that trigger restraint, such as a diminished decision-making competence, restlessness, and need for invasive devices. The category Specific reasons for justifying restraint describes reasons for restraining patients, such as restraint being used for the sake of the patient or for the sake of others. The category General reasoning in justifying restraint describes how nurses reason when using restraint, and the decision to use restraint was often based on a consequentialist approach where the nurses’ weighed the pros and cons of different alternatives. Discussion Nurses with experience of restraint use were engaged in a constant process of justifying and balancing different options and actions. Restraint was considered legitimate if the benefit exceeded the suffering, but decisions on which restraint measures to use and when to use them depended on the values of the individual nurse. Conclusion How nurses reason when justifying restraint, why they use restraint, and who they use restraint on must be considered when creating programs and guidelines to reduce the use of restraint and to ensure that when it is used it is used carefully, appropriately, and with respect. (shrink)

Aim To examine the hypothesis that knowledge about physician-assisted suicide (PAS) and euthanasia is associated with a more restrictive attitude towards PAS. Design A questionnaire about attitudes towards PAS, including prioritisation of arguments pro and contra, was sent to Swedish veterinary surgeons. The results were compared with those from similar surveys of attitudes among the general public and physicians. Participants All veterinary surgeons who were members of the Swedish Veterinary Association and had provided an email address (n=2421). Main outcome measures (...) Similarities or differences in response pattern between veterinary surgeons, physicians and the general public. Results The response pattern among veterinary surgeons and the general public was almost similar in all relevant aspects. Of the veterinarians 75% (95% CI 72% to 78%) were in favour of PAS, compared with 73% (95% CI 69% to 77%) among the general public. Only 10% (95% CI 5% to 15%) of the veterinary surgeons were against PAS, compared with 12% (95% CI 5% to 19%) among the general public. Finally, 15% (95% CI 10% to 21%) of veterinarians were undecided, compared with 15% (95% CI 8% to 22%) among the general public. Physicians had a more restrictive attitude to PAS than the general public. Conclusions Since veterinary surgeons have frequent practical experience of euthanasia in animals, they do have knowledge about what euthanasia really is. Veterinary surgeons and the general public had an almost similar response pattern. Accordingly it seems difficult to maintain that knowledge about euthanasia is unambiguously associated with a restrictive attitude towards PAS. (shrink)

We present a perspective of the national transplant program based on organizational theory and complexity theory, framing the system’s allocation of donor organs as an interorganizational directed multiplex of agents with diverse belief formation in a cooperative-competitive environment. Simulation and analysis of this macroscale complexity may help explain known behavioural variations across member organizations. However, the transplant community still relies on system-scale simulations since effective macroscale methodologies are not well established. Therefore, we offer this perspective of the national transplant program (...) as a means to stimulate new methods that capture macroscale impacts of policy development for deceased donor organ allocation. (shrink)

Restraint is regularly used in somatic healthcare settings, and countries have chosen different paths to regulate restraint in somatic healthcare. One overarching problem when regulating restraint is to ensure that patients with reduced decision-making capacity receive the care they need and at the same time ensure that patients with a sufficient degree of decision-making capacity are not forced into care that they do not want. Here, arguments of justice, trust in the healthcare system, minimising harm and respecting autonomy are contrasted (...) with different national regulations. We conclude that a regulation that incorporates an assessment of patients’ decision-making capacity and considers the patient’s best interests is preferable, in contrast to regulations based on psychiatric diagnoses or regulations where there are no legal possibilities to exercise restraint at all in somatic care. (shrink)

Quantum theory of Lorentz invariant local scalar fields without restrictions on 4-momentum spectrum is considered. The mass spectrum may be both discrete and continues and the square of mass as well as the energy may be positive or negative. One may assume the existence of such fields only if they interact with ordinary fields very weakly. Generalization of Kallen-Lehmann representation for propagators of these fields is found. The considered generalized fields may violate CPT-invariance. Restrictions on mass-spectrum of CPT-violating fields are (...) found. Local fields that annihilate vacuum state and violate CPT-invariance are constructed in this scope. Correct local relativistic generalization of Lindblad equation for density matrix is written for such fields. This generalization is particularly needed to describe the evolution of quantum system and measurement process in a unique way. Difficulties arising when the field annihilating the vacuum interacts with ordinary fields are discussed. (shrink)

Text on fundamentals of Vedanta philosophy; includes Sanskrit commentary with Hindi Translation and English explanation.

We consider the problem of measurement using the Lindblad equation, which allows the introduction of time in the interaction between the measured system and the measurement apparatus. We use analytic results, valid for weak system-environment coupling, obtained for a two-level system in contact with a measurer (Markovian interaction) and a thermal bath (non-Markovian interaction), where the measured observable may or may not commute with the system-environment interaction. Analysing the behavior of the coherence, which tends to a value asymptotically close (...) to zero, we obtain an expression for the time of measurement which depends only on the system-measurer coupling, and which does not depend on whether the observable commutes with the system-bath interaction. The behavior of the coherences in the case of strong system-environment coupling, found numerically, indicates that an increase in this coupling decreases the measurement time, thus allowing our expression to be considered the upper limit for the duration of the process. (shrink)

In 2003 Japanese folk horror game Fatal Frame II: Crimson Butterfly directed by Makoto Shibata, the protagonist bears witness to an ancient tradition of a community linked to the ritual sacrifice of twins, which results in the female victim becoming a malevolent spirit. Gradually the player, as Mio, equipped with the Camera Obscura, transitions from observer to participant in the cycle of events that results in sacrificing their own twin sister. This article focuses on establishing the game within the folk (...) horror subgenre, before examining three female characters: Mio, the protagonist, who shifts from witness/voyeur to participant; Mayu, their twin, who transitions from unwilling to willing sacrifice; and Sae, the victim of the original ritual and antagonist. In Fatal Frame II, the Camera Obscura, which captures the supernatural world, is the lens through which past and present blur as the player is confronted by the twisted beliefs of the village. Through analysis of the game’s narrative, ludic elements, and visual aesthetics, I examine how these roles fit within the context of folk horror, gender and Japanese folklore. (shrink)

Standard quantum theory is inadequate to explain the mechanisms by which potential becomes actual. It is inadequate and therefore unable to describe generation of events. Niels Bohr emphasized long ago that the classical part of the world is necessary. John Bell stressed the same point: that “measurement≓ cannot even be defined within the standard quantum theory, and he sought a solution within hidden variable theories and his concept of “beables.≓Today it is customary to try to explain emergence of the classical (...) world through a decoherence mechanism due to “environment.≓ But, we believe, as it was with the concept of measurement, “environment≓ itself cannot be defined within the standard quantum theory.We have proposed a semiphenomenological solution to this problem by introducing explicitly, from the very beginning, classical degrees of freedom, and by coupling these degrees of freedom, through a Lindblad type coupling, to the quantum world. The resulting theory, we call “event-enhanced quantum theory.≓ EEQT allows us to describe an event-generating mechanism for individual quantum systems under continuous observation. The objections of John Bell are met and precise definitions of an “experiment≓ and of a “measurement≓ have been given within EEQT. However EEQT is, essentially, a nonrelativistic theory.In the present paper we extend the ideas of L. P. Horwitz and C. Piron and we propose a relativistic version of EEQT, with an event-generating algorithm for spin one-half particle detectors. The algorithm is based on proper time formulation of the relalivistic quantum theory. Although we use indefinite metric, all the probabilities controlling the random process of the detector clicks are nonnegative. (shrink)