Making good decisions in extremely complex and difficult processes and situations has always been both a key task as well as a challenge in the clinic and has led to a large amount of clinical, legal and ethical routines, protocols and reflections in order to guarantee fair, participatory and up-to-date pathways for clinical decision-making. Nevertheless, the complexity of processes and physical phenomena, time as well as economic constraints and not least further endeavours as well as achievements in medicine and healthcare (...) continuously raise the need to evaluate and to improve clinical decision-making. This article scrutinises if and how clinical decision-making processes are challenged by the rise of so-called artificial intelligence-driven decision support systems (AI-DSS). In a first step, this article analyses how the rise of AI-DSS will affect and transform the modes of interaction between different agents in the clinic. In a second step, we point out how these changing modes of interaction also imply shifts in the conditions of trustworthiness, epistemic challenges regarding transparency, the underlying normative concepts of agency and its embedding into concrete contexts of deployment and, finally, the consequences for (possible) ascriptions of responsibility. Third, we draw first conclusions for further steps regarding a ‘meaningful human control’ of clinical AI-DSS. (shrink)

Artificial intelligence (AI) systems are increasingly being used in healthcare, thanks to the high level of performance that these systems have proven to deliver. So far, clinical applications have focused on diagnosis and on prediction of outcomes. It is less clear in what way AI can or should support complex clinical decisions that crucially depend on patient preferences. In this paper, we focus on the ethical questions arising from the design, development and deployment of AI systems to support decision-making around (...) cardiopulmonary resuscitation and the determination of a patient’s Do Not Attempt to Resuscitate status (also known as code status). The COVID-19 pandemic has made us keenly aware of the difficulties physicians encounter when they have to act quickly in stressful situations without knowing what their patient would have wanted. We discuss the results of an interview study conducted with healthcare professionals in a university hospital aimed at understanding the status quo of resuscitation decision processes while exploring a potential role for AI systems in decision-making around code status. Our data suggest that (1) current practices are fraught with challenges such as insufficient knowledge regarding patient preferences, time pressure and personal bias guiding care considerations and (2) there is considerable openness among clinicians to consider the use of AI-based decision support. We suggest a model for how AI can contribute to improve decision-making around resuscitation and propose a set of ethically relevant preconditions—conceptual, methodological and procedural—that need to be considered in further development and implementation efforts. (shrink)

The present two-study paper examined the role of communication strategies that athletes use to develop their coach-athlete relationship. Study 1 examined the mediating role of motivation, support and conflict management strategies between the quality of the coach-athlete relationship and athletes’ perceptions of sport satisfaction. Study 2 examined the longitudinal and mediational associations of communication strategies and relationship quality across two time points, over a six-week period. Within both studies, data were collected through multi section questionnaires assessing the studies’ variables. For (...) study 1, structural equation modelling highlighted significant indirect effects for motivation and support strategies between the quality of the coach-athlete relationship and athletes’ experiences of sport satisfaction. For study 2, significant indirect effects were found for the athletes’ perceptions of the quality of the coach-athlete relationship at time 2 between athletes’ use of communication strategies at time point 1 and time point 2. Together these findings provide support for the practical utility of communications strategies in enhancing the quality of the coach-athlete relationship and athlete’s experiences of sport satisfaction. In addition, the findings provide evidence to highlight the potential cyclical relationship between communication and relationship quality across time. (shrink)

Contemporary organizations often reciprocate to society for using resources and for affecting stakeholders by engaging in corporate social responsibility. It has been shown that CSR has a positive impact on employee attitudes. However, not all employees may react equally strongly to CSR practices. Based on socio-emotional selectivity theory, we contend that the effect of CSR on employee satisfaction will be more pronounced for older than for younger employees, because CSR practices address those emotional needs and goals that are prioritized when (...) people’s future time perspective decreases. In one multi-source field study and one experimental study, we demonstrate that CSR indeed has a stronger positive effect on employee satisfaction for older relative to younger employees. Accordingly, engaging in CSR can be an attractive tool for organizations that aim to keep their aging workforce satisfied with their job. (shrink)

Interdisciplinary research needs innovation. As an action-oriented intervention, this Manifesto begins from the authors’ experiences as social scientists working within interdisciplinary science and technology collaborations in agriculture and food. We draw from these experiences to: 1) explain what social scientists contribute to interdisciplinary agri-food tech collaborations; (2) describe barriers to substantive and meaningful collaboration; and (3) propose ways to overcome these barriers. We encourage funding bodies to develop mechanisms that ensure funded projects respect the integrity of social science expertise and (...) incorporate its insights. We also call for the integration of social scientific questions and methods in interdisciplinary projects from the outset, and for a genuine curiosity on the part of STEM and social science researchers alike about the knowledge and skills each of us has to offer. We contend that cultivating such integration and curiosity within interdisciplinary collaborations will make them more enriching for all researchers involved, and more likely to generate socially beneficial outcomes. (shrink)

While many theories exist to explain the complexity of environmental behaviour, the role of individuals' relationship with nature has not yet been fully clarified. This paper attempts to operationalise human-nature relationships. It expands upon a scale assessed by an iterative process of mixed methods in the US and Europe. This scale is then used to assess individuals' relationship with nature, and whether such relationships correlate with environmental behaviour. The value scale of Schwartz's Theory of Basic Values is used to validate (...) the results. The results verify that people hold multiple human-nature relationships, confirm strong correlations between human-nature relationships and values, and reveal that individuals' behaviour is connected to the relationship they have with nature. (shrink)

BackgroundThe need for an ethical debate about the use of coercion in intensive care units (ICU) may not be as obvious as in other areas of medicine, such as psychiatry. Coercive measures are often necessary to treat critically ill patients in the ICU. It is nevertheless important to keep these measures to a minimum in order to respect the dignity of patients and the cohesion of the clinical team. A deeper understanding of what patients and their relatives perceive during their (...) ICU stay will shed different light on intensive care management. Patients' experiences of loss of control, dependency and abandonment may lead to a new approach towards a broader approach to the concept of coercion in intensive care. The aim of our research is to explore the experiences of patients and relatives in the ICU and to determine when it might be possible to reduce feelings and memories of coercion.MethodsWe conducted and analysed 29 semi-structured interviews with patients and relatives who had been in the ICU a few months previously. Following a coding and categorisation process in MAXQDA™, a rigorous qualitative methodology was used to identify themes relevant to our research.ResultsFive main themes emerged: memory issues; interviewees’ experiences of restricting measures and coercive treatment; patients’ negative perception of situational and relational dependency with the risk of informal coercion; patients’ perceptions of good care in a context of perceived dependency; progression from perception of coercion and dependency to respect for the person. All patients were grateful to have survived. However, coercion in the form of restraint, restriction of movement, and coercive treatment in the ICU was also acknowledged by patients and relatives. These included elements of informal coercion beyond restraints, such as a perceived negative sense of dependence, surrender, and asymmetrical interaction between the patient and health providers.ConclusionsTo capture the full range of patients' experiences of coercion, it is necessary to expand the concept of coercion to include less obvious forms of informal coercion that may occur in dependency situations. This will help identify solutions to avoid or reduce negative recollections that may persist long after discharge and negatively affect the patients' quality of life. (shrink)

The aim of this study was to investigate the consistency between the self-reports and teacher ratings of students’ emotional and social inclusion at school as well as for their academic self-concept. The German version of the Perceptions of Inclusion Questionnaire (PIQ) was administered to 329 grade 8 students (50.8% female, Mage = 14.5 years, SDage = 0.5 years) and their teachers. First, the three-dimensional structure of both PIQ versions was confirmed by confirmatory item factor analysis. The  and  coefficients (...) demonstrated good reliability for all scales. Second, a correlated trait-correlated method minus one model provided evidence that the method-specificity of teacher ratings was larger than the consistency between the self-reports and teacher ratings. Third, the results of a latent difference model indicated that general method effects can partly be explained by a student’s gender or special educational needs. Finally, the low consistency between self-reports and teacher rating is discussed. (shrink)

The tenascins are a growing family of extracellular matrix proteins of typical multidomain structure. The prototype to be discovered was tenascin‐C. It shows a highly regulated expression pattern during embryonic development and is often transiently associated with morphogenetic tissue interactions during organogenesis. In the adult organism reexpression of tenascin‐C occurs in tumors and many other pathological conditions. Tenascin‐C expression can be regulated by many different growth factors and hormones. Furthermore, mechanical strain exerted by fibroblasts seems to induce the expression of (...) tenascin‐C. This could represent a mechanism of translating mechanical forces into protein patterns, a step of potential relevance in the organization of embryogenesis. Tenascin‐C as well as tenascin‐R are believed to counteract the cell adhesion and spreading activity of fibronectin, thereby facilitating cell movement. (shrink)

This study investigated the effect of stroking vs. simple human presence on later reactions of dairy cows to routine veterinary handling. While in two groups of cows the experimenter stroked the ventral part of the neck or the withers for three consecutive weeks, the third group was exposed to close visual presence. After the treatment period the cows were subjected to rectal palpation. The three groups differed significantly in stepping during rectal palpation, which occurred less often in Neck- and Withers-animals (...) than in control animals. Heart rate increase was significantly higher in the control group than in the two stroking groups. Previous stroking led to fewer stress reactions during the rectal palpation, possibly due to a combined effect of improved relationship towards and thus perception of humans and lasting anti-stress effects of tactile stimulation. (shrink)

The phenomenon of perceptual persistence after the motion stops in shape-from-motion displays was used to study the influence of prior knowledge on the maintenance of a percept in awareness. In SFM displays an object composed of discontinuous line segments are embedded in a background of randomly oriented lines. The object only becomes perceptible when the line segments that compose the object and the lines that compose the background move in counterphase. Critically, once the movement of the line segments stops, the (...) percept of the object persists for a short period of time. In the present study, perceptual persistence for digits exceeded that reported for nonsense shapes composed of the same line segments. This result is taken as evidence that the processes involved in the persistence of SFM, and therefore sustained perception, are sensitive to top-down influences. (shrink)

Die Sprachlichkeit des Glaubens ist von Anfang an zentrales Thema protestantischer Theologie. Der Glaube, als Vertrauen auf das biblisch bezeugte und lebendig gepredigte Evangelium, lebt in der Sprache, weil er aus dem Horen kommt: Er vollzieht sich im Modus des Verstehens. Seit jeher sind daher theologische Hermeneutik und Homiletik Orte, an denen die Sprachlichkeit des Glaubens reflektiert wird. Diese Reflexion setzen die Beitrage des vorliegenden Bandes in je unterschiedlicher Facherperspektive fort.

The current informal practice of pharmacometrics as a combination art and science makes it hard to appreciate the role that informatics can and should play in the future of the discipline and to comprehend the gaps that exist because of its absence. The development of pharmacometric informatics has important implications for expediting decision making and for improving the reliability of decisions made in model-based development. We argue that well-defined informatics for pharmacometrics can lead to much needed improvements in the efficiency, (...) effectiveness, and reliability of the pharmacometrics process. The purpose of this paper is to provide a description of the pervasive yet often poorly appreciated role of informatics in improving the process of data assembly, a critical task in the delivery of pharmacometric analysis results. First, we provide a brief description of the pharmacometric analysis process. Second, we describe the business processes required to create analysis-ready data sets for the pharmacometrician. Third, we describe selected informatic elements required to support the pharmacometrics and data assembly processes. Finally, we offer specific suggestions for performing a systematic analysis of existing challenges as an approach to defi ning the next generation of pharmacometric informatics. (shrink)

BackgroundRich in different kind of potent cells, embryos are used in modern regenerative medicine and research. Neurobiologists today are pushing the boundaries for what can be done with embryos existing in the transitory margins of medicine. Therefore, there is a growing need to develop conceptual frameworks for interpreting the transformative cultural, biological and technical processes involving these aborted, donated and marginal embryos. This article is a contribution to this development of frameworks.MethodsThis article examines different emotional, cognitive and discursive strategies used (...) by neurobiologists in a foetal cell transplantation trial in Parkinson’s disease research, using cells harvested from aborted embryos. Two interviews were analysed in the light of former observations in the processing laboratories, using the anthropologist Mary Douglas’s concept of pollution behaviour and the linguist, philosopher, psychoanalyst and feminist Julia Kristeva’s concept of the abjective to explain and make sense of the findings.ResultsThe findings indicate that the labour performed by the researchers in the trial work involves transforming the foetal material practically, as well as culturally, from trash to treasure. The transformation process contains different phases, and in the interview material we observed that the foetal material or cells were considered objects, subjects or rejected as abject by the researchers handling them, depending on what phase of process or practice they referred to or had experience of. As demonstrated in the analysis, it is the human origin of the cell that makes it abjective and activates pollution discourse, when the researchers talk of their practice.ConclusionsThe marginal and ambiguous status of the embryo that emerges in the accounts turns the scientists handling foetal cells into liminal characters in modern medicine. Focusing on how practical as well as emotional and cultural strategies and rationalizations of the researchers emerge in interview accounts, this study adds insights on the rationale of practically procuring, transforming and utilizing the foetal material to the already existing studies focused on the donations. We also discuss why the use and refinement of a tissue, around which there is practical consensus but cultural ambiguity, deserves further investigation. (shrink)

ZusammenfassungIm Rahmen des Modellvorhabens „Patienten als Partner—Tumorpatienten und ihr Mitwirken bei medizinischen Entscheidungen“ wurden zwischen März 2002 und August 2003 272 palliativ behandelte Tumorpatienten nach ihrer Einstellung zur Patientenverfügung und zur gewünschten Beteiligung an medizinischen Entscheidungen befragt. Von den Befragten kannten 30% Patientenverfügungen nicht, darunter signifikant mehr Befragte mit formal niedrigerem Bildungsabschluss. Es hatten bereits 11% eine Patientenverfügung abgeschlossen, 22% wollten wahrscheinlich eine abschließen, und 30% wollten keine abschließen. Es fand sich ein statistisch signifikanter Zusammenhang zwischen dem Abschluss einer Patientenverfügung (...) und dem Wunsch nach mehr eigener Entscheidungsverantwortung. Die Einstellung zur Patientenverfügung und der Wunsch nach partizipativer Entscheidungsfindung stehen in keinem statistisch signifikanten Zusammenhang. Patienten mit schriftlichen Vorausverfügungen haben einen erhöhten Kommunikations- und Rückkopplungsbedarf, auf den Ärzte sensibel eingehen sollten. Bei der Information über Patientenverfügungen sollten Menschen mit niedrigerem Bildungsstand mehr als bisher berücksichtigt werden. (shrink)

Human–robot interactions are often affected by error situations that are caused by either the robot or the human. Therefore, robots would profit from the ability to recognize when error situations occur. We investigated the verbal and non-verbal social signals that humans show when error situations occur in human–robot interaction experiments. For that, we analyzed 201 videos of five human–robot interaction user studies with varying tasks from four independent projects. The analysis shows that there are two types of error situations: social (...) norm violations and technical failures. Social norm violations are situations in which the robot does not adhere to the underlying social script of the interaction. Technical failures are caused by technical shortcomings of the robot. The results of the video analysis show that the study participants use many head movements and very few gestures, but they often smile, when in an error situation with the robot. The results suggest that participants do not see the robot as a social interaction partner with comparable communication skills. Our findings have implications for builders and evaluators of human–robot interaction systems. The builders need to consider including modules for recognition and classification of head movements to the robot input channels. The evaluators need to make sure that the presence of an experimenter does not skew the results of their user studies. (shrink)

This study investigated the effect of stroking vs. simple human presence on later reactions of dairy cows to routine veterinary handling. While in two groups of cows the experimenter stroked the ventral part of the neck or the withers for three consecutive weeks, the third group was exposed to close visual presence. After the treatment period the cows were subjected to rectal palpation. The three groups differed significantly in stepping during rectal palpation, which occurred less often in Neck- and Withers-animals (...) than in control animals. Heart rate increase was significantly higher in the control group than in the two stroking groups. Previous stroking led to fewer stress reactions during the rectal palpation, possibly due to a combined effect of improved relationship towards and thus perception of humans and lasting anti-stress effects of tactile stimulation. Keywords: cattle; tactile stimulation; human–animal relationship; animal welfare. (shrink)

L(ow) tone in Mandarin Chinese causes both downstep and post-low-bouncing. Downstep refers to the lowering of a H(igh) tone after a L tone, which is usually measured by comparing the H tones in a “H…HLH…H” sentence with a “H…HHH…H” sentence (cross-comparison), investigating whether downstep sets a new pitch register for the scaling of subsequent tones. Post-low-bouncing refers to the raising of a H tone after a focused L tone. The current study investigates how downstep and post-low-bouncing interact with focus and (...) phrasing in Mandarin Chinese. In the experiment, we systematically manipulated (a) the tonal environment by embedding two syllables with either LH or HH tone (syllable X and Y) sentence-medially in the same carrier sentences containing only H tones; (b) boundary strength between X and Y by introducing either a syllable boundary or a phonological phrase boundary; and (c) information structure by either placing a contrastive focus in the HL/HH word (XF), syllable Y (YF), or the sentence-final word (ZF). A wide-focus condition served as the baseline. With systematic control of focus and boundary strength around the L tone, the current study shows that the downstep effect in Mandarin is quite robust, lasting for 3–5 H tones after the L tone, but eventually levelling back again to the register reference line of a H tone. The way how focus and phrasing interact with the downstep effect is unexpected. Firstly, sentence-final focus has no anticipatory effect on shortening the downstep effect; instead, it makes the downstep effect lasts longer as compared to the wide focus condition. Secondly, the downstep effect still shows when the H tone after the L tone is on-focus (YF), in a weaker manner than the wide focus condition, and is overridden by the post-focus-compression. Thirdly, the downstep effect gets greater when the boundary after the L tone is stronger, because the L tone is longer and more likely to be creaky. We further analyzed downstep by measuring the F0 drop between the two H tones surrounding the L tone (sequential-comparison). Comparing it with F0 drop in all-H sentences (i.e., declination), it showed that the downstep effect was much greater and more robust than declination. However, creaky voice in the L tone was not the direct cause of downstep. At last, when the L tone was under focus (XF), it caused a post-low-bouncing effect, which is weakened by a phonological phrase boundary. Altogether, the results showed that although intonation is largely controlled by informative functions, the physical-articulatory controls are relatively persistent, varying within the pitch range of 2.5 semitones. Downstep and post-low-bouncing in Mandarin Chinese thus seem to be mainly due to physical-articulatory movement on varying pitch, with the gradual tonal F0 change meeting the requirement of smooth transition across syllables, and avoiding confusion in informative F0 control. (shrink)

BackgroundParental reflective functioning refers to parents’ mental capacity to understand their own and their children’s behaviors in terms of envisioned mental states. As part of a broader concept of parental mentalization, PRF has been identified as one of the central predictors for sensitive parenting. However, the unique contribution of PRF to the quality of various parenting behaviors has not yet been addressed systematically. Thus, the present article provides a systematic overview of current research on the associations between PRF or its (...) sub-dimensions and observed parenting behaviors in infancy and early childhood, while considering the influence of contextual factors.MethodsThe review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Systematic searches were carried out in five electronic databases. The eligibility and methodological quality of the identified studies were assessed using pre-defined criteria and a standardized checklist.ResultsSixteen studies with moderate to high quality on a total of 15 parenting behaviors were included, the majority of which examined positive parenting behaviors, while negative parenting behaviors were rarely investigated. Most of the associations indicated a positive effect of PRF on parenting behavior, with mostly small-sized effects. The strength and direction of the associations varied depending on the dimensionality of PRF, observation settings, sample types, socioeconomic factors, and cultural background. Moreover, five assessment instruments for PRF and 10 observation instruments for parenting behaviors were identified.ConclusionIn summary, PRF has shown a positive association with parenting quality. However, its complex interaction with further contextual factors emphasizes the need for differentiation of PRF dimensions and the consideration of the observation settings, assessment time points, psychosocial risks, and sample types in observational as well as intervention studies. Further high-quality studies with multivariate analyses and diverse study settings are required. (shrink)

Cofactor squelching is the term used to describe competition between transcription factors (TFs) for a limited amount of cofactors in a cell with the functional consequence that TFs in a given cell interfere with the activity of each other. Since cofactor squelching was proposed based primarily on reporter assays some 30 years ago, it has remained controversial, and the idea that it could be a physiologically relevant mechanism for transcriptional repression has not received much support. However, recent genome‐wide studies have (...) demonstrated that signal‐dependent TFs are very often absent from the enhancers that are acutely repressed by those signals, which is consistent with an indirect mechanism of repression such as squelching. Here we review these recent studies in the light of the classical studies of cofactor squelching, and we discuss how TF cooperativity in so‐called hotspots and super‐enhancers may sensitize these to cofactor squelching. (shrink)

This book offers a new account of what it is to act for a normative reason. The first part of the book examines the problems of causal accounts of acting for reasons and suggests to solve them by a dispositional approach. The author argues for a dispositional account which unites epistemic, volitional, and executional dispositions in a complex normative competence. This ‘Normative Competence Account’ allows for more and less reflective ways of acting for normative reasons. The second part of the (...) book clarifies the relation between the normative reason that an agent acts for and his or her motivating reasons. It refutes the widely held ‘identity view’ that acting for a normative reason requires the normative reason to be identical with a motivating reason. The author describes how normative reasons are related to motivating reasons by a relation of correspondence, and proposes a new understanding of how normative reasons explain those actions that are performed for them. Determined by Reasons engages with current debates from a wide range of different philosophical areas, including action theory, metaethics, moral psychology, epistemology, and ontology, to develop a new account of acting for normative reasons. (shrink)

In this article I advocate a worldly account of normative reasons according to which there is an ontological gap between these and the premises of practical thought, i.e. motivating considerations. While motivating considerations are individuated fine-grainedly, normative reasons should be classified as coarse-grained entities, e.g. as states of affairs, in order to explain certain necessary truths about them and to make sense of how we count and weigh them. As I briefly sketch, acting for normative reasons is nonetheless possible if (...) the connection between normative reasons and motivating considerations is a competence-based correspondence. (shrink)

On March 11, 2020 the World Health Organization classified COVID‐19, caused by Sars‐CoV‐2, as a pandemic. Although not much was known about the new virus, the first outbreaks in China and Italy showed that potentially a large number of people worldwide could fall critically ill in a short period of time. A shortage of ventilators and intensive care resources was expected in many countries, leading to concerns about restrictions of medical care and preventable deaths. In order to be prepared for (...) this challenging situation, national triage guidance has been developed or adapted from former influenza pandemic guidelines in an increasing number of countries over the past few months. In this article, we provide a comparative analysis of triage recommendations from selected national and international professional societies, including Australia/New Zealand, Belgium, Canada, Germany, Great Britain, Italy, Pakistan, South Africa, Switzerland, the United States, and the International Society of Critical Care Medicine. We describe areas of consensus, including the importance of prognosis, patient will, transparency of the decision‐making process, and psychosocial support for staff, as well as the role of justice and benefit maximization as core principles. We then probe areas of disagreement, such as the role of survival versus outcome, long‐term versus short‐term prognosis, the use of age and comorbidities as triage criteria, priority groups and potential tiebreakers such as ‘lottery’ or ‘first come, first served’. Having explored a number of tensions in current guidance, we conclude with a suggestion for framework conditions that are clear, consistent and implementable. This analysis is intended to advance the ongoing debate regarding the fair allocation of limited resources and may be relevant for future policy‐making. (shrink)

This book presents a study of human intelligence beginning with a semantic theory and leading into a critique of music.

In this article, we inquire into Maxine Sheets-Johnstone and Michele Merritt’s descriptions and use of dance improvisation as it relates to “thinking in movement.” We agree with them scholars that improvisational practices present interesting cases for investigating how movement, thinking, and agency intertwine. However, we also find that their descriptions of improvisation overemphasize the dimension of spontaneity as an intuitive “letting happen” of movements. To recalibrate their descriptions of improvisational practices, we couple Ezequiel Di Paolo, Thomas Buhrmann, and Xabier E. (...) Barandiaran’s enactive account of the constitution of agency with case studies of two expert performers of improvisation: a dancer and a musician. Our analyses hereof show that their improvisations unfold as a sophisticated oscillation of agency between specialized forms of mental and bodily control and, indeed, a more spontaneous “letting things happen.” In all, this article’s conclusions frame thinking in movement concerning improvisational practices as contextually embedded, purposively trained, and inherently relational. (shrink)