Most models of patient-physician communication take decision-making as a central concept. However, we found that often the treatment course of metastatic cancer patients is not easy to describe in straightforward terms used in decision-making models but is instead frequently more erratic. Our aim was to analyse these processes as trajectories. We used a longitudinal case study of 13 patients with metastatic colorectal and pancreatic cancer for whom palliative chemotherapy was a treatment option, and analysed 65 semi-structured interviews. We analysed three (...) characteristics of the treatment course that contributed to the ‘erraticness’ of the course: (1) The treatment (with or without chemotherapy) contained many options; (2) these options were not stable entities to be decided upon, but changed identity over the course of treatment, and (3) contrary to the closure (option X means no option Y, Z, etc.) a decision implies, the treatment course was a continuous process in which options instead remained open. When the treatment course is characterised by these many and changeable options that do not result in closure, the shared decision-making model should take these into account. More attention needs to be paid to the erratic character of the process in which the doctor has to provide continuous information that is related to the changing situation of the patient; also, flexibility in dealing with protocols is warranted, as is vigilance about the overall direction of the process. (shrink)

This empirical study concerns the authorship credit decision-making processes and outcomes that occur among coauthors in cases of multiauthored publications. The 2002 American Psychological Association (APA) Ethics Code offers standards for determining authorship order; however, little is known about how these decisions are made in actual practice. Results from a survey of 109 randomly selected authors indicated that most authors were satisfied with the decision-making process and outcome with few disagreements. Participants reported cases of both undeserved authorship being given and (...) omission of deserving contributors' names as coauthors. Some factors associated with authorship decisions included "sense of loyalty or obligation," "publish or perish pressures," and "power differentials." Authors who used APA standards were significantly more satisfied with both the process and outcome of authorship credit decisions. (shrink)

This paper reports a study of planning processes in the five-disc Tower of London (TOL) task in 20 younger and 20 older adult participants. A concurrent direct ''think-aloud'' method was used to obtain data on planning processes prior to moving discs in the TOL. A check was made of the effects of verbalising by comparing performance data from the experimental groups with data from control groups who did not verbalise during planning or moving. Verbalising slowed down planning and moving but (...) did not appear to distort the participants' approaches to the task. Older and younger participants did not differ in average moves taken to solve the tasks. However, older participants' planning was less complete and more error-prone than that of younger participants. The planning processes were characterised as showing a means-ends ''goal selection'' strategy. In this strategy participants (1) identify a single active goal disc at the start, (2) select moves and move sequences to enable the placing of the current goal disc in its target position, and (3) continue in this way until all discs are in their target positions. Age differences were found in the planning stage, during which there was no stimulus support and hence a substantial working memory load. During the move phase there was stimulus support and hence little loading of working memory. Age differences in moves required were not found in the move phase. As older participants tend to have depleted working memory capacity the present results suggest that working memory is heavily loaded in TOL planning but less so in the move phase of TOL. (shrink)

Anna J Dare,1 Anthony RJ Phillips,1–3 Michael Chu,1 Anthony JR Hickey,2 Adam SJR Bartlett1–31Department of Surgery, 2Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand; 3New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New ZealandBackground: Hepatic steatosis is increasingly encountered among organ donors. Currently, there is no consensus guideline as to the type or degree of donor steatosis considered acceptable for liver transplantation, and little is known about local practices in this area. The aim of this (...) survey was to evaluate current clinical practices amongst liver transplant surgeons in Australia and New Zealand in the evaluation and use of steatotic donor livers in LT.Methods: An anonymous online twelve-question survey was emailed to all practicing LT surgeons in ANZ in January 2010.Results: The response rate was 83%. Estimated prevalence of steatosis in donor livers was between 40% and 60%. In determining suitability for LT, 90% of respondents reported rejecting organs with "severe" steatosis based on visual and palpation grounds alone. A total of 68% sought further histological assessment if the donor liver looked bad and there were risk factors for steatosis. The majority of respondents performed only one biopsy of the liver, using hematoxylin and eosin staining for fat assessment. There was wide variation in the upper limit of steatosis considered to be acceptable for LT. A total of 21% of respondents still considered microvesicular steatosis a risk factor for primary graft nonfunction.Conclusion: This survey highlights the significant variation in the appraisal and use of steatotic grafts by LT surgeons in ANZ. Accurate evaluation and judicious use of mild and moderately steatotic grafts is required if we are to utilize the available donor pool best.Keywords: liver transplantation, steatosis, fatty liver, organ donors. (shrink)

The almost 300 articles contain not only historical accounts but also some indication of the state of present day study in classical philosophy.

: The transplantation of adult human neural stem cells into prenatal non-humans offers an avenue for studying human neural cell development without direct use of human embryos. However, such experiments raise significant ethical concerns about mixing human and nonhuman materials in ways that could result in the development of human-nonhuman chimeras. This paper examines four arguments against such research, the moral taboo, species integrity, "unnaturalness," and human dignity arguments, and finds the last plausible. It argues that the transfer of human (...) brain or retinal stem cells to nonhuman embryos would not result in the development of human-nonhuman chimeras that denigrate human dignity, provided such stem cells are dissociated. The article provides guidelines that set ethical boundaries for conducting such research that are consonant with the requirements of human dignity. (shrink)

Combat deployments put health care providers in ethically compromising and morally challenging situations. A sample of recently deployed nurses and physicians provided narratives that were analyzed to better appreciate individual perceptions of moral dilemmas that arise in combat. Specific questions to be answered by this inquiry are: 1) How do combat deployed nurses and physicians make sense of morally injurious traumatic exposures? and 2) What are the possible psychosocial consequences of these and other deployment stressors? This narrative inquiry involves analysis (...) of ten deployed military nurses’ and physicians’ aversive or traumatic experiences. Burke’s dramatist pentad is used for structural narrative analysis of stories that confirm and illuminate the impact of war zone events such as betrayal, disproportionate violence, incidents involving civilians, and within-rank violence on military health care provider narrators. Results indicate cognitive dissonance and psychosocial sequelae related to moral and psychological stressors faced by military medical personnel. Discussion addresses where healing efforts should be focused. (shrink)

In this paper, I critique two conceptions of mechanisms, namely those put forth by Stuart Glennan (Erkenntnis 44:49–71, 1996; Philosophy of Science 69:S342–S353, 2002) and Machamer et al. (Philosophy of Science 67:1–25, 2000). Glennan’s conception, I argue, cannot account for mechanisms involving negative causation because of its interactionist posture. MDC’s view encounters the same problem due to its reificatory conception of activities—this conception, I argue, entails an onerous commitment to ontological dualism. In the place of Glennan and MDC, I propose (...) a “modified conception” of mechanisms, which (a) obviates the problem of negative causation by reinterpreting MDC’s activities according to a “descriptivist” account, and (b) avoids MDC’s problem by postulating a monistic ontology of entities. Thus, by solving these problems, my modified conception offers a cogent, more adequate alternative to Glennan’s and MDC’s conceptions of mechanisms. (shrink)

The book examines the emerging approach of using qualitative methods, such as interviews and field observations, in the philosophy of science. Qualitative methods are gaining popularity among philosophers of science as more and more scholars are resorting to empirical work in their study of scientific practices. At the same time, the results produced through empirical work are quite different from those gained through the kind of introspective conceptual analysis more typical of philosophy. This volume explores the benefits and challenges of (...) an empirical philosophy of science and addresses questions such as: What do philosophers gain from empirical work? How can empirical research help to develop philosophical concepts? How do we integrate philosophical frameworks and empirical research? What constraints do we accept when choosing an empirical approach? What constraints does a pronounced theoretical focus impose on empirical work? Nine experts discuss their thoughts and empirical results in the chapters of this book with the aim of providing readers with an answer to these questions. (shrink)

Classical education includes an apprenticeship in the art of rhetoric. It also gives a central place to the study of major works of literature, philosophy, and theology. There is often, however, an assumed disconnection between the art of rhetoric and the study of great texts. This disconnection undermines students’ ability to hear the voices of these texts as conversation partners in ongoing debates. This article illustrates how historically-based rhetorical-poetic reading enables us to hear the voices in a given text and (...) to consider how they work together. The argument first outlines some modern assumptions about the relation between poetry and rhetoric. The second part explains what rhetorical-poetic reading involves when approaching John Milton’s epic, Paradise Lost. The final section focuses on the second book of Milton’s poem, establishing how layered persuasive purposes constitute the fabric of the work and what the poem reveals through its curious dramatization of demonic deliberation. (shrink)

The Relevance Criterion of confirmation gained prominence as the underlying principle of the class-size approach (CSA) to Hempel's paradoxes of confirmation. The CSA, however, yields counter-intuitive results for (c) instances, and this failing cast serious doubt on the acceptability of the Relevance Criterion. In this paper an attempt is made to rescue the Relevance Criterion from this embarrassment. This is done by incorporating that criterion into a new resolution of the paradoxes, a resolution based on a theory of selective confirmation (...) and a distinction between mere confirmation in principle and evaluative confirmation (E-confirmation). (shrink)

Today, an increased impact of information and communication technologies in the society at large has lead teachers to engage in professional development activities related to the use of ICT. Even though this development has been prominent for more than two decades, its long term effects seem complex to determine. This paper is based on interviews with twelve Swedish teachers who participated in a national program for promoting school development and use of ICT in 2000-2001. The program was aligned with the (...) pedagogical approaches set out in the national Swedish curriculum, such as a shift from teaching to learning and giving pupils more responsibility, introducing interdisciplinary approaches to teaching in teams, and a problem based pupils-oriented pedagogy. The analysis of the interviews show that teachers still feel a high degree of appreciation for the program, and that they share a relative agreement of the importance of the program for their teaching with ICT in the last decade. The general intentions of the program to be more concerned with school development and pedagogy rather than technology and ICT seem also to be present today as a long term effect. (shrink)

BackgroundBayesian estimation with informative priors permits updating previous findings with new data, thus generating cumulative knowledge. To reduce subjectivity in the process, the present study emphasizes how to systematically weigh and specify informative priors and highlights the use of different aggregation methods using an empirical example that examined whether observed mother-adolescent positive and negative interaction behavior mediate the associations between maternal and adolescent internalizing symptoms across early to mid-adolescence in a 3-year longitudinal multi-method design.MethodsThe sample consisted of 102 mother-adolescent dyads. (...) Mothers and adolescents reported on their internalizing symptoms and their interaction behaviors were observed during a conflict task. We systematically searched for previous studies and used an expert-informed weighting system to account for their relevance. Subsequently, we aggregated the priors using three methods: linear pooling, logarithmic pooling, and fitting a normal distribution to the linear pool by means of maximum likelihood estimation. We compared the impact of the three differently specified informative priors and default priors on the prior predictive distribution, shrinkage, and the posterior estimates.ResultsThe prior predictive distributions for the three informative priors were quite similar and centered around the observed data mean. The shrinkage results showed that the logarithmic pooled priors were least affected by the data. Most posterior estimates were similar across the different priors. Some previous studies contained extremely specific information, resulting in bimodal posterior distributions for the analyses with linear pooled prior distributions. The posteriors following the fitted normal priors and default priors were very similar. Overall, we found that maternal, but not adolescent, internalizing symptoms predicted subsequent mother-adolescent interaction behavior, whereas negative interaction behavior seemed to predict subsequent internalizing symptoms. Evidence regarding mediation effects remained limited.ConclusionA systematic search for previous information and an expert-built weighting system contribute to a clear specification of power priors. How information from multiple previous studies should be included in the prior depends on theoretical considerations, and may also be affected by pragmatic considerations regarding the impact of the previous results at hand. (shrink)

Edward S. Casey offers a phenomenology of memory and imagination in his book Spirit and Soul, which provides a unique opportunity for thinking about the very ethereal and aqueous activity of sailing. Imagination and memory are as much a part of everyday life as most forms of mentation; but sailing, as much as it is a physical activity, is just as much a suitable analogy for engaging with these particular psychic forms. In their collaboration, memory and imagination are a means (...) for balancing the sails with the wind just as much as they provide equilibrium to the temporal expanse of conscious unification. But perhaps mostimportantly, in their spiritual and soulful employment, imagination and memory provide a place and a home for dwelling and sailing. (shrink)

Edward S. Casey offers a phenomenology of memory and imagination in his book Spirit and Soul, which provides a unique opportunity for thinking about the very ethereal and aqueous activity of sailing. Imagination and memory are as much a part of everyday life as most forms of mentation; but sailing, as much as it is a physical activity, is just as much a suitable analogy for engaging with these particular psychic forms. In their collaboration, memory and imagination are a means (...) for balancing the sails with the wind just as much as they provide equilibrium to the temporal expanse of conscious unification. But perhaps mostimportantly, in their spiritual and soulful employment, imagination and memory provide a place and a home for dwelling and sailing. (shrink)

Authenticity in Culture, Self, and Society addresses the problems surrounding the concept of authenticity by offering its first sociological analysis. Compiled by a team of experts from a variety of disciplinary backgrounds, it provides readers with a survey of original empirical studies focused on its experience, negotiation, and social relevance at the levels of self, culture, and specific social settings.

This article provides a framework by way of introduction to the special section, ‘The Urban Problematic II’. It introduces a new selection of papers contributing to the continuing project of interrogating concepts, processes and practices associated with contemporary forms of urban life. The article focuses in particular on the problem of infrastructure in relation to questions of urban politics and especially remarks on the emergence of a kind of thinking in which the separation of notions of material infrastructure from those (...) of the social or cultural sphere can no longer be usefully maintained. The essays in the section cumulatively address the issue of an emergent hybridity of urban elements: the virtual and the material, the social and the technical, the political and the instrumental, the vertical and the horizontal. The spectacle of contemporary political activism and dissent emerges in the transformation of social and urban space. (shrink)

Henry Sheffer’s 1908 Harvard Ph.D. thesis contains an interesting appendix on a central feature of the logical work of his thesis advisor, Josiah Royce. This is the claim in Royce’s 1905 article “The Relations of the Principles of Logic to the Foundations of Geometry” that an unsymmetric ordering relation can be defined on the single symmetric O-relation for which he gives postulates in that paper. Sheffer criticizes Royce’s specific definition from the point of view of the evolving twentieth century conception (...) of axiomatic method and also shows more generally that an unsymmetric1 order relation cannot be defined in the system of the 1905 paper based on the O-relation. In this article I wish to consider the nature.. (shrink)