This article examines whether the likelihood and amount of firm charitable giving in response to catastrophic events are related to firm advertising intensity, and whether industry competition level moderates this relationship. Using data on Chinese firms’ philanthropic response to the 2008 Sichuan earthquake, we find that firm advertising intensity is positively associated with both the probability and the amount of corporate giving. The results also indicate that this positive advertising intensity-philanthropic giving relationship is stronger in competitive (...) industries, and firms in competitive industries are more likely to donate. This study thus provides evidence suggesting that even in the wake of catastrophic events, corporate philanthropic giving is strategic. (shrink)

Background Levels of care deemed as inappropriate generate moral distress among nurses and other intensive care professionals. Inappropriate levels of care and related moral distress are frequently broached as individual and psychological phenomena, reduced to how individuals feel and think about specific cases. However, this tends to obscure the complex context in which these situations occur, and on which healthcare professionals can act. There is thus a need for a more contextual and team-level lens on inappropriate levels of care. (...) Research objective This study aims to explore and understand the issue of inappropriate levels of care in an intensive care unit (ICU) through a contextual and team-level lens. Research design Semi-structured interviews were conducted with nurses, respiratory therapists, and intensivists. Thematic analysis focused on understanding the causes and consequences of inappropriate levels of care, as well as potential avenues for improvement. This study is part of a 5-phase participatory living lab project on inappropriate levels of care conducted in the ICU of a Montreal (Quebec, Canada) hospital. This paper relates the initial phases of the project, focusing on understanding the issue, with reported events spanning from June 2022 to May 2023. Ethical considerations Ethics approval was sought and granted by the Research Ethics Board of the CIUSSS de l’Est-de-l’Île-de-Montréal. Findings/Discussion Five broad themes intrinsically related to the phenomenon of inappropriate levels of care were explored with and by participants: (1) the process of determining levels of care, (2) the distinction between appropriate and inappropriate levels of care, (3) causes of inappropriate levels of care, (4) consequences of inappropriate levels of care and (5) potential avenues for improvement. Conclusion This research provides a comprehensive understanding of inappropriate levels of care in the ICU and emphasizes the relevance of team-level explorations of complex ethical issues. (shrink)

Decades of research conducted in Western, Educated, Industrialized, Rich, & Democratic (WEIRD) societies have led many scholars to conclude that the use of mental states in moral judgment is a human cognitive universal, perhaps an adaptive strategy for selecting optimal social partners from a large pool of candidates. However, recent work from a more diverse array of societies suggests there may be important variation in how much people rely on mental states, with people in some societies judging accidental harms just (...) as harshly as intentional ones. To explain this variation, we develop and test a novel cultural evolutionary theory proposing that the intensity of kin-based institutions will favor less attention to mental states when judging moral violations. First, to better illuminate the historical distribution of the use of intentions in moral judgment, we code and analyze anthropological observations from the Human Area Relations Files. This analysis shows that notions of strict liability—wherein the role for mental states is reduced—were common across diverse societies around the globe. Then, by expanding an existing vignette-based experimental dataset containing observations from 321 people in a diverse sample of 10 societies, we show that the intensity of a society's kin-based institutions can explain a substantial portion of the population-level variation in people's reliance on intentions in three different kinds of moral judgments. Together, these lines of evidence suggest that people's use of mental states has coevolved culturally to fit their local kin-based institutions. We suggest that although reliance on mental states has likely been a feature of moral judgment in human communities over historical and evolutionary time, the relational fluidity and weak kin ties of today's WEIRD societies position these populations' psychology at the extreme end of the global and historical spectrum. (shrink)

Suffering repeated experiences of moral distress in intensive care units due to applications of futility reflects on nurses’ patient care negatively, increases their burnout, and reduces their job satisfaction. This study was carried out to investigate the levels of job satisfaction and exhaustion suffered by intensive care nurses and the relationship between them through the futility dimension of the issue. The study included 138 intensive care nurses. The data were obtained with the futility questionnaire developed by the researchers, Maslach Burnout (...) Inventory and Minnesota Satisfaction Questionnaire. It was determined that nurses who agreed to the proposition that the application of futility demoralizes health-care professionals had low levels of job satisfaction but high levels of depersonalization. It was determined that nurses had moderate levels of job satisfaction, emotional exhaustion, and personal achievements but high levels of sensitivity. Nurses’ job satisfaction and sensitivities are positively affected when they consider that futility does not contradict the purposes of medicine. (shrink)

This study integrates the resource dependence perspective and the stakeholder perspective to analyze local Chinese suppliers’ environment strategies in response to environmental requirements of different types of customers. With a sample of 1,215 local Chinese manufacturing suppliers, we examine the impact of export intensity and environmental requirements of multinational enterprises on local Chinese suppliers’ environment strategies. The results show that local Chinese suppliers with high levels of export intensity are more likely to adopt positive environment strategies to reduce (...) environmental risks. In addition, local Chinese suppliers respond actively to environmental requirements of MNE customers but not to those of local customers. The linkage between MNE customers’ environmental requirements and local Chinese suppliers’ environment strategies remains significant, even after we control for the impact of export intensity. Implications of the findings conclude the article. (shrink)

Suffering repeated experiences of moral distress in intensive care units due to applications of futility reflects on nurses’ patient care negatively, increases their burnout, and reduces their job satisfaction. This study was carried out to investigate the levels of job satisfaction and exhaustion suffered by intensive care nurses and the relationship between them through the futility dimension of the issue. The study included 138 intensive care nurses. The data were obtained with the futility questionnaire developed by the researchers, Maslach Burnout (...) Inventory and Minnesota Satisfaction Questionnaire. It was determined that nurses who agreed to the proposition that the application of futility demoralizes health-care professionals had low levels of job satisfaction but high levels of depersonalization. It was determined that nurses had moderate levels of job satisfaction, emotional exhaustion, and personal achievements but high levels of sensitivity. Nurses’ job satisfaction and sensitivities are positively affected when they consider that futility does not contradict the purposes of medicine. (shrink)

Although research has generated a wealth of information on cultural influences on emotion judgements, the information we have to date is limited in several ways. This study extends this literature in two ways, first by obtaining judgements from people in two cultures of expressions portrayed at different intensity levels, and second by incorporating individual level measures of culture to examine their contribution to observed differences. When judging emotion categories in low intensity expressions, American and Japanese judges see (...) the emotion intended at above-chance rates, albeit lower than when judging high intensity faces. Also, American and Japanese intensity ratings of external displays and internal experiences differ dramatically for low intensity expressions compared to high intensity faces. Finally, the two cultural dimensions measured in this study—individualism versus collectivism (IC) and status differentiation (SD)—accounted for almost all of the variance in the observed differences. These findings are discussed in terms of their underlying possible mechanisms, and future research possibilities. (shrink)

Research on the relationship between religious commitment and business ethics has produced widely varying results and made the impact of such commitment unclear. This study presents an empirical investigation based on a questionnaire survey of business managers and professionals in the United States yielding a database of 1234 respondents. Respondents evaluated the ethical acceptability of 16 business decisions. Findings varied with the way in which the religion variable was measured. Little relationship between religious commitment and ethical judgment was found when (...) responses were compared on the basis of broad faith categories – Catholic, Protestant, Jewish, other religions, and no religion. However, respondents who indicated that religious interests were of high or moderate importance to them demonstrated a higher level of ethical judgment (less accepting of unethical decisions) than others in their evaluations. Evangelical Christians also showed a higher level of ethical judgment. (shrink)

Caring for a child in a pediatric intensive care unit is emotionally and physically challenging and often leads to conflict. Skilled mediators may not always be available to aid in conflict resolution. Careproviders at all levels of training are responsible for managing difficult conversations with families and can often prevent escalation of conflict. Bioethics mediators have acknowledged the important contribution of mediation training in improving clinicians’ skills in conflict management. Familiarizing careproviders with basic mediation techniques is an important step towards (...) preventing escalation of conflict. While training in effective communication is crucial, a sense of fairness and justice that may only come with the introduction of a skilled, neutral third party is equally important. For intense conflict, we advocate for early recognition, comfort, and preparedness through training of clinicians in de-escalation and optimal communication, along with the use of more formally trained third-party mediators, as required. (shrink)

Background: Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess moral distress (...) suffered by nurses nor a study conducted on the issue. Aim/objective: The study aims to (a) validate the Turkish version of the Moral Distress Scale–Revised to be used in intensive care units and to examine the validity and reliability of the Turkish version of the scale, and (b) explore Turkish intensive care nurses’ moral distress level. Method: The sample of this methodological, descriptive, and cross-sectional design study comprises 200 nurses working in the intensive care units of internal medicine and surgical departments of four hospitals in three cities in Turkey. The data were collected with the Socio-Demographic Characteristics Form and The Turkish Version of Moral Distress Scale–Revised. Ethical considerations: The study proposal was approved by the ethics committee of the Faculty of Medicine, Cumhuriyet University. All participating nurses provided informed consent and were assured of data confidentiality. Results: In parallel with the original scale, Turkish version of Moral Distress Scale–Revised consists of 21 items, and shows a one-factor structure. It was determined that the moral distress total and item mean scores of the nurses participating in the study were 70.81 ± 48.23 and 3.36 ± 4.50, respectively. Conclusion: Turkish version of Moral Distress Scale–Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by nurses working in intensive care units in Turkey. In line with our findings, it can be said that nurses suffered low level of moral distress. However, factors which caused the nurses in our study to experience higher levels of moral distress are inadequate communication within the team, working with professionals they considered as incompetent, and futile care. (shrink)

Digital piracy as a continuing problem significantly impacts various stakeholders, including consumers, enterprises, and countries. This study develops a three-level mechanism of determinants of consumer digital piracy behavior, with personal risk as an individual factor, susceptibility to interpersonal influence as an inter-personal factor, and moral intensity as a broad societal factor. Further, it explores the role of rationalization and future piracy intent as outcomes of past piracy behaviors. The authors use survey data from four countries in the European (...) Union to test the system of structural relationships. With an exception of the effect of consumers’ susceptibility to interpersonal influence on piracy behavior, the conceptual model receives remarkably consistent support across the four countries. Specifically, perception of personal risk and moral intensity negatively affected the reported piracy behavior in all four countries. The results further support the negative influence of moral intensity and the positive influence of past digital piracy behavior on consumers’ use of rationalization. Lastly, personal risk, rationalization, and past digital piracy behavior directly influenced consumers’ intention to engage in digital piracy in the future. The study also discusses implications of the findings and identifies areas of future research. (shrink)

Background Moral distress is a major issue in intensive care units that requires immediate attention since it can cause nurses to burnout. Given the special conditions of patients in intensive care units and the importance of the mental health of nurses, the present study was designed to systematically review the factors affecting moral distress in nurses working in intensive care units. Methods PubMed, EMBASE, Web of Science, Scopus, and Science Direct were systematically searched for papers published between 2009 and 2019. (...) Original articles from quantitative and qualitative studies were reviewed. The CONSORT and STROBE checklists were used to assess the quality of the quantitative papers. The JBI checklist was applied for qualitative studies. Results Factors affecting moral distress in nurses include lack of nursing staff, nurses with inadequate experience, lack of support from organizations and colleagues, inadequate education and lack of knowledge of nurses, poor collaboration of physicians with nurses, ethical insensitivity and lack of teamwork, heavy workload, poor quality of care and moral violence and they are considered as risk factors for moral distress. Conclusion Many of the related causes are due to the nature of nurses’ work and it is necessary to manage the underlying conditions of this phenomenon so that it can be effectively prevented from spreading. Levels of moral distress require more attention of authorities in the use of prevention strategies and the reduction of effective factors in distress. (shrink)

In this qualitative study, we aimed to identify and compare the ethical problems perceived by physicians and nurses in intensive care units at Baskent University hospitals in Turkey. A total of 21 physicians and 22 nurses were asked to describe ethical problems that they frequently encounter in their practice. The data were analyzed using an interactive model. The core problem for both physicians and nurses was end-of-life decisions (first level). In this category, physicians were most frequently concerned with euthanasia (...) while nurses were more concerned with do-not-resuscitate orders (second level). At the third level, we saw that almost all of the participants’ responses related to negative perceptions about euthanasia. Communication and hierarchical problems were the second most reported main category. Nurses were more likely to cite problems with hierarchy than physicians. At the third level, a large percentage of nurses described communication problems with authority and hierarchical problems with physicians. In the same category, physicians were most often concerned with communication problems with patients’ relatives. The ethical problems were reported at different frequencies by physicians and nurses. We asked the participants about ethical decision-making styles. The results show that nurses and physicians do not follow a systematic pattern of ethical decision making. (shrink)

The Belgian Act on Euthanasia came into force on 23 September 2002, making Belgium the second country—after the Netherlands—to decriminalize euthanasia under certain due-care conditions. Since then, Belgian nurses have been increasingly involved in euthanasia care. In this paper, we report a qualitative study based on in-depth interviews with 18 nurses from Flanders (the Dutch-speaking part of Belgium) who have had experience in caring for patients requesting euthanasia since May 2002 (the approval of the Act). We found that the care (...) process for patients requesting euthanasia is a complex and dynamic process, consisting of several stages, starting from the period preceding the euthanasia request and ending with the aftercare stage. When asked after the way in which they experience their involvement in the euthanasia care process, all nurses described it as a grave and difficult process, not only on an organizational and practical level, but also on an emotional level. “Intense” is the dominant feeling experienced by nurses. This is compounded by the presence of other feelings such as great concern and responsibility on the one hand, being content in truly helping the patient to die serenely, and doing everything in one’s power to contribute to this; but also feeling unreal and ambivalent on the other hand, because death is arranged. Nurses feel a discrepancy, because although it is a nice death, which happens in dignity and with respect, it is also an unnatural death. The clinical ethical implications of these findings are discussed. (shrink)

While research has focused on why certain entrepreneurs elect to create innovative solutions to social problems, very little is known about why some social entrepreneurs choose to scale their solutions while others do not. Research on scaling has generally focused on organizational characteristics often overlooking factors at the individual level that may affect scaling decisions. Drawing on the multidimensional construct of moral intensity, we propose a theoretical model of ethical decision making to explain why a social entrepreneur’s perception (...) of moral intensity of the social problem, coupled with their personal desire for control, can significantly influence scaling decisions. Specifically, we propose that higher levels of perceived moral intensity will positively influence the likelihood of scaling through open as opposed to closed modes in order to achieve greater speed and scope of social impact. However, we also propose this effect will be negatively moderated by a social entrepreneur’s higher levels of desire for control. Our model has implications for research and practice at the interface of ethics and social entrepreneurship. (shrink)

Intensive care units are challenging and technologically advanced environments. Dealing with situations that have an ethical dimension is an intrinsic part of working in such a milieu. When a moral dilemma emerges, it can cause anxiety and unease for all staff involved with it. Theoretical and abstract papers reveal that having to confront situations of ethical difficulty is a contributory factor to levels of poor morale and burnout among critical care staff. Despite this, there is a surprising dearth of published (...) nursing research in the UK that investigates how staff deal with ethical issues in intensive care units. The purpose of this paper is to explore and discuss the development of a research framework designed to explore how staff deal with moral dilemmas in a British inten sive care unit. (shrink)

Background: Ethical conflict is a barrier to decision-making process and is a problem derived from ethical responsibilities that nurses assume with care. Intensive care unit nurses are potentially exposed to this phenomenon. A deep study of the phenomenon can help prevent and treat it. Objectives: This study was aimed at determining the frequency, degree, level of exposure, and type of ethical conflict among nurses working in the intensive care units. Research design: This was a descriptive cross-sectional research. Participants and (...) research context: In total, 382 nurses working in the intensive care units in Iranian hospitals were selected using the random sampling method. Data were collected using the Ethical Conflict in Nursing Questionnaire-Critical Care Version (Persian version). Ethical considerations: This study was approved by the Medical Research Ethics Committee. Ethical considerations such as completing the informed consent form, ensuring confidentiality of information, and voluntary participation were observed. Findings: The results showed that the average level of exposure to ethical conflict was 164.39 ± 79.06. The most frequent conflict was related to “using resources despite believing in its futility,” with the frequency of at least once a week or a month (68.6%, n = 262). The most conflictive situation was violation of privacy (76.9%, n = 294). However, the level of exposure to ethical conflict according to the theoretical model followed was the situation of “working with incompetent staff.” The most frequently observed type of conflict was moral dilemma. Conclusion: The moderate level of exposure to ethical conflict was consistent with the results of previous studies. However, the frequency, degree, and type of ethical conflict were different compared to the results of other studies. Recognizing ethical conflict among intensive care unit nurses can be useful as it allows to consolidate those measures that favor low levels of ethical conflict, design appropriate strategies to prevent ethical conflicts, and improve the nursing work environment. (shrink)

Transcranial magnetic stimulation can be used to mask visual stimuli, disrupting visual task performance or preventing visual awareness. While TMS masking studies generally fix stimulation intensity, we hypothesized that varying the intensity of TMS pulses in a masking paradigm might inform several ongoing debates concerning TMS disruption of vision as measured subjectively versus objectively, and pre-stimulus versus post-stimulus TMS masking. We here show that both pre-stimulus TMS pulses and post-stimulus TMS pulses could strongly mask visual stimuli. We found (...) no dissociations between TMS effects on the subjective and objective measures of vision for any masking window or intensity, ruling out the option that TMS intensity levels determine whether dissociations between subjective and objective vision are obtained. For the post-stimulus time window particularly, we suggest that these data provide new constraints for models of vision and visual awareness. Finally, our data are in line with the idea that pre-stimulus masking operates differently from conventional post-stimulus masking. (shrink)

Background In neonatal intensive care, a child's death is often preceded by a medical decision. Nurses, social workers and pastors, however, are often excluded from ethical case deliberation. If multiprofessional ethical case deliberations do take place, participants may not always know how to perform to the fullest. Setting A level-IIID neonatal intensive care unit of a paediatric teaching hospital in the Netherlands. Methods Structured multiprofessional medical ethical decision-making (MEDM) was implemented to help overcome problems experienced. Important features were: all (...) professionals who are directly involved with the patient contribute to MEDM; a five-step procedure is used: exploration, agreement on the ethical dilemma/investigation of solutions, analysis of solutions, decision-making, planning actions; meetings are chaired by an impartial ethicist. A 15-item questionnaire to survey staff perceptions on this intervention just before and 8 months after implementation was developed. Results Before and after response rates were 91/105 (87%) and 85/113 (75%). Factor analysis on the questionnaire suggested a four-factor structure: participants' role; structure of MEDM; content of ethical deliberation; and documentation of decisions/conclusions. Effect sizes were 1.67 (p<0.001), 0.69 (p<0.001) and 0.40 (p<0.01) for the first three factors respectively, but only 0.07 (p=0.65) for the fourth factor. Nurses' perceptions of improvement did not significantly exceed those of physicians. Conclusion Professionals involved in ethical case deliberation perceived that the process of decision-making had improved; they were more positive about the structure of meetings, their own role and, to some extent, the content of ethical deliberation. Documentation of decisions/conclusions requires further improvement. (shrink)

Data on farming systems in Petén, Guatemala, were used to develop an agricultural intensity index. The index can be used to assign an intensity “score” to a given farming system based on the array of practices used by the farmer, each practice’s contribution to production intensity, and the scale at which these practices are used. The scores assigned to 118 farmers in three study areas in Petén were analyzed through analysis of variance (ANOVA) to identify the factors (...) that account for the variation in intensity levels, as measured through the index. The analyses reveal that the factors influencing agricultural intensity in Petén vary greatly from one study area to the next. This is due to differences in livelihood opportunities and strategies that, in turn, affect how agriculture fits into the local economy and how and why intensification is pursued. Variation in intensity levels can best be understood by considering the factors at the household and sub-regional scales that influence (a) whether farmers feel a need to intensify, (b) whether they see some benefit in doing so, and (c) whether they have the resources required to intensify production through particular strategies. Close attention must be paid to these factors by conservation and development organizations seeking to influence land use patterns and conserve forest in Petén. (shrink)

For a number of years, the debate in evolutionary biology over the ’levels of selection’ has attracted intense interest from philosophers of science. The main question concerns the level of the biological hierarchy at which natural selection occurs. Does selection act on organisms, genes, groups, colonies, demes, species, or some combination of these? According to traditional Darwinian theory the answer is the organism -- it is the differential survival and reproduction of individual organisms that drives the evolutionary process. But (...) there are alternative views too, including pluralist views which say that the choice between different levels of selection is often a matter of perspective, not empirical fact. (shrink)

Abstract:Because the demand for intensive care unit (ICU) beds exceeds the supply in general, and because of the formidable costs of that level of care, clinicians face ethical issues when rationing this kind of care not only at the point of admission to the ICU, but also after the fact. Under what conditions—if any—may patients be denied admission to the ICU or removed after admission? One professional medical group has defended a rule of “first come, first served” in ICU (...) admissions, and this approach has numerous moral considerations in its favor. We show, however, that admission to the ICU is not in and of itself guaranteed; we also show that as a matter of principle, it can be morally permissible to remove certain patients from the ICU, contrary to the idea that because they were admitted first, they are entitled to stay indefinitely through the point of recovery, death, or voluntary withdrawal. What remains necessary to help guide these kinds of decisions is the articulation of clear standards for discontinuing intensive care, and the articulation of these standards in a way consistent with not only fiduciary and legal duties that attach to clinical care but also with democratic decision making processes. (shrink)

Transcranial magnetic stimulation studies have demonstrated increased cortical facilitation and reduced inhibition following aerobic exercise, even when examining motor regions separate to the exercised muscle group. These changes in brain physiology following exercise may create favorable conditions for adaptive plasticity and motor learning. One candidate mechanism behind these benefits is the increase in brain-derived neurotropic factor observed following exercise, which can be quantified from a venous blood draw. The aim of this study was to investigate changes in motor cortex excitability (...) and inhibition of the upper limb, and circulating BDNF, following high-intensity interval training on a stationary bicycle. Nineteen sedentary adults participated in a randomized crossover design study involving a single bout of high-intensity interval cycling for 20 min or seated rest. Venous blood samples were collected, and transcranial magnetic stimulation was used to stimulate the extensor carpi radialis, where motor evoked potentials were recorded pre- and post-condition. Following exercise, there was a significant increase in corticospinal excitability measured at 120% of resting motor threshold and a reduction in short-interval cortical inhibition. There was a non-significant 23.6% increase in BDNF levels. Collectively, these results reflect a net reduction in gamma aminobutyric acid ergic synaptic transmission and increased glutamatergic facilitation, resulting in increased corticospinal excitability. This study supports the notion that acute high-intensity exercise provides a potent stimulus for inducing cortical neuroplasticity, which may support enhanced motor learning. (shrink)

Binaural pitch fusion is the perceptual integration of stimuli that evoke different pitches between the ears into a single auditory image. This study was designed to investigate how steady background noise can influence binaural pitch fusion. The binaural fusion ranges, the frequency ranges over which binaural pitch fusion occurred, were measured with three signal-to-noise ratios of the pink noise and compared with those measured in quiet. The preliminary results show that addition of an appropriate amount of noise can reduce binaural (...) fusion ranges, an effect called stochastic resonance. This finding increases the understanding of how specific noise levels can sharpen binaural pitch fusion in normal hearing individuals. Furthermore, it elicits more pathways for research to explore how this benefit can practically be used to help improve binaural auditory perception. (shrink)

What makes some firms more innovative than others and what determines the source of these innovations are questions that are still not adequately answered due to the complex, often esoteric, nature of the innovation process. This paper considers the effect of one externally oriented strategy (extent of formal inter-organizational linkages) and one internally oriented strategy (degree of knowledge intensity) on overall levels of innovativeness and the source of these innovations. Using data collected from firms operating in the bioscience-technology industries (...) in both New York and Utah, our results suggest that both of these strategies have a significant effect upon innovation levels and the source of innovation (internally versus externally stimulated). Interestingly, there were few firms that undertook both of these strategies simultaneously and thus the proposed interaction effect where increased absorptive capacity (on the basis of knowledge intensity) would make external linkages even more valuable could not be discerned. (shrink)

The aim of the paper is to investigate the effects of the corporate governance model on social and environmental disclosure (SED). We analyze the disclosures of the 100 U.S. Best Corporate Citizens in the period 2005–2007, and we posit a series of simultaneous relationships between different attributes of the governance system and a multidimensional construct of corporate social performance (CSP). We consider both the extent and the quality of SED, with the purpose of identifying increasing levels of corporate commitment to (...) stakeholders and shedding some light on whether SED is used as a signal or rather as a legitimacy tool. Our empirical evidence shows that the stakeholders’ orientation of corporate governance is positively associated with CSP and SED. On the other hand, we do not find support for the monitoring intensity of corporate governance being negatively associated with social performance. We also find that CSP in the “product” dimension is positively associated with the extent and quality of SED whilst CSP in the “people” dimension is negatively associated with the extent and quality of SED. At a time when shareholders and stakeholders share more common aspects in their relationships with firms, this is a significant area to explore and this research fills an important lacuna in this respect. (shrink)

Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying (...) ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1) Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9); 2) Deputy chief provincial coroners (N = 5); 3) Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12). Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia. (shrink)

It is still a controversial issue whether Reichenbach’s Principle of the Common Cause (RPCC) is a sound method for causal inference. In fact, the status of the principle has been a subject of intense philosophical debate. An extensive literature has been thus generated both with arguments in favor and against the adequacy of the principle. A remarkable argument against the principle, first proposed by Elliott Sober (Sober, 1987, 2001), consists on a counterexample which involves corelations between bread prices in Britain (...) and sea levels in Venice. The aim of this paper is to put into perspective criticisms to RPCC of the kind of Sober’s in the light of recent formal results regarding the so-called extendability and common cause completability. (shrink)

Background Ethical decision making in intensive care is a demanding task. The need to proceed to ethical decision is considered to be a stress factor that may lead to burnout. The aim of this study is to explore the ethical problems that may increase burnout levels among physicians and nurses working in Portuguese intensive care units . A quantitative, multicentre, correlational study was conducted among 300 professionals.Results The most crucial ethical decisions made by professionals working in ICU were related to (...) communication, withholding or withdrawing treatments and terminal sedation. A positive relation was found between ethical decision making and burnout in nurses, namely, between burnout and the need to withdraw treatments , to withhold treatments and to proceed to terminal sedation . This did not apply to physicians. Emotional exhaustion was the burnout subdimension most affected by the ethical decision. The nurses' lack of involvement in ethical decision making was identified as a risk factor. Nevertheless, in comparison with nurses , it was the physicians who more keenly felt the need to proceed to ethical decisions in ICU.Conclusions Ethical problems were reported at different levels by physicians and nurses. The type of ethical decisions made by nurses working in Portuguese ICUs had an impact on burnout levels. This did not apply to physicians. This study highlights the need for education in the field of ethics in ICUs and the need to foster inter-disciplinary discussion so as to encourage ethical team deliberation in order to prevent burnout. (shrink)

Background: Despite the progress made in recent decades on the phenomenon of futility in adult intensive care, recognizing it during clinical care practice remains a complex and sensitive process, during which questions are often raised for which concrete answers are difficult to find. Aims: To analyze the frequency with which futile nursing interventions are implemented in critically ill patients admitted to adult intensive care in specific situations and how often futile autonomous and interdependent nursing interventions are implemented in the same (...) population, as perceived by adult intensive care nurses. Research design: Cross-sectional, quantitative, and descriptive study, which employed a questionnaire constructed specifically for this research to assess the perception of therapeutic futility in nursing in adult intensive care. Following an evaluation of the psychometric properties, the questionnaire was made available in an electronic format on the EUSurvey platform between August and October 2024. The data was analyzed between November 2023 and March 2024 using the statistical software packages SPSS and R. Participants and research context: A simple random sample of nurses working in level II and level III intensive care units in Portugal. Ethical considerations: Research ethical approvals were obtained, and the participants provided informed consent. Findings/results: Four hundred and fourteen valid questionnaires were obtained. The results allow the identification of thirty-three statistically significant associations, the inference of intervals for the mean and median for the perception of futility of nursing interventions with a 95% confidence interval, and enable the hierarchization of nursing interventions implemented in critically ill patients admitted to adult intensive care units according to the nurses’ perception of their futility. Conclusion: There is a balance in nurses' perception of the futility of their interventions in the specific situations analyzed. There is statistically significant evidence that interdependent nursing interventions are, in general, more frequently perceived as futile when compared to autonomous nursing interventions. (shrink)

Background Intensive care nurses frequently encounter ethical issues with potentially severe consequences for nurses, patients, and next of kin. Therefore, ethical issues in intensive care units (ICU) should be recognized and managed. Research objectives To analyze ethical issues reported by intensive care nurses and how reported issues were managed within the organization using register data from the HaiPro critical incident reporting system (CIRS), and to explore the suitability of this system for reporting and managing ethical issues. Research design This was (...) a retrospective descriptive register study. CIRS reports on ethical issues in adult ICUs ( n = 12) in one hospital district in Finland over 25 months (2019–2021) were analyzed through inductive content analysis and descriptive quantification. The CIRS’s suitability for reporting and managing ethical issues was evaluated through a strengths, weaknesses, opportunities, and threats (SWOT) analysis. Ethical considerations The study was approved by the University Ethics Committee, and permission to conduct the research was granted before data collection within the organization. Results CIRS reports on ethical issues ( n = 35) made by nurses were found in seven of the 12 ICUs. The CIRS managers of these units managed these reports. The ethical issues described by the nurses were divided into four main categories: nature, situational information, consequences, and contributing factors. Management of reported ethical issues was divided into three main categories: preventive actions proposed by nurses, proposals for actions by CIRS managers, and actions taken by CIRS managers. Conclusions Systematic register data broadly describe ethical issues and their management, indicating that the CIRS could be suitable for reporting and managing ethical issues, thereby enabling the monitoring and development of ethical quality at the unit and organizational levels. (shrink)

You have not opened the wrong journal!The police have a duty to protect the public and to investigate any, and all, serious crimes. The article by Lynøe and Leijonhufvud raises important issues about the interaction between hospital staff and police in cases in which suggested medical negligence crosses into the arena of serious legal offences, which range from murder and homicide to serious assault.1Although arising in Sweden, the issues raised in this case are generalisable. While our understanding is limited to (...) the journal article there seem several uncontested facts: a children's intensive care doctor was arrested, charged and acquitted of the mercy killing of an infant in a Swedish hospital. The baby had sustained severe brain injury prior to this clinician's involvement, either due to birth asphyxia or to an accidental overdose of salt. The baby died after withdrawal of life-sustaining treatment with parental agreement. At a later stage, the family asked the police to investigate the initial salt incident. Despite the team attending the baby after WLST stating that only a morphine infusion was administered, a 25-day postmortem femoral artery sample showed ‘an extremely high level of thiopentone’ , although no control sample was analysed.Healthcare staff are subject to the laws of their country. However, Lynøe and Leijonhufvud raise the issue of a conflict between what they term ‘soft law’—the rules, regulations and ethics of healthcare practice and the law of the land. …. (shrink)

Construal-level theory emphasizes that representing events at greater spatial, temporal, social, or hypothetical distance results in processing information at high construal levels (more conceptual, abstract). We posit that psychological distance and construal level are somewhat separable constructs, and can have different effects on emotion, and therefore, emotion regulation. We argue that psychological distance influences emotional appraisal, such that increasing distance results in lower emotion intensity, which can be leveraged to down-regulate emotions. However, we consider construal level (...) a mindset, which can occur with either high or low psychological distance. Furthermore, we argue that compared with psychological distance, construal level has a more nuanced relationship with emotion, and changing construal level for the purpose of changing emotion also requires considering the construal level of one's emotion-regulation goals. (shrink)

Previous research has demonstrated that regular exercise modulates motor cortical plasticity and cognitive function, but the influence of short-term high-intensity interval training remains unclear. In the present study, the effect of short-term HIIT on neuroplasticity and executive function was assessed in 32 sedentary females. Half of the participants undertook 2 weeks of HIIT. Paired-pulse transcranial magnetic stimulation was used to measure motor cortical plasticity via short intracortical inhibition and intracortical facilitation. We further adapted the Stroop task using functional near-infrared (...) spectroscopy to evaluate executive function in the participants. The results indicated that, compared with the control group, the HIIT group exhibited decreased ICF. In the Stroop task, the HIIT group displayed greater activation in the left dorsolateral prefrontal cortex and left orbitofrontal cortex even though no significant difference in task performance was observed. These findings indicate that short-term HIIT may modulate motor cortical plasticity and executive function at the neural level. (shrink)

Background and purpose: The functional understanding and examination of competitive anxiety responses as temporal events that unfold as time-to-competition moves closer has emerged as a topical research area within the domains of sport psychology. However, little is known from an inclusive and interaction oriented perspective. Using the multidimensional anxiety theory as a framework, the present study examined the temporal patterning of competitive anxiety, focusing on the dimensions of intensity, direction, and frequency of intrusions in athletes across gender and skill (...) level. Methods: Elite and semi-elite Table Tennis athletes from the Ghanaian league (N= 90) completed a modified version of Competitive State Anxiety Inventory-2 (CSAI-2) with the inclusion of the directional and frequency of intrusion scales at three temporal phases (7 days, two days and 1 hour) prior to a competitive fixture. Results: MANOVA repeated measures with follow-up analyses revealed significant interactions for between-subjects factors on all anxiety dimensions (intensity, direction and frequency). Notably, elite (international) female athletes were less cognitively anxious, showed more facilitative interpretation towards somatic anxiety symptoms and experienced less frequency of somatic anxiety symptoms than their male counterparts. However, both elite groups displayed appreciable level of self-confidence. For time-to-event effects, both cognitive and somatic anxiety intensity fluctuated whereas self-confidence showed a steady rise as competition neared. Somatic anxiety debilitative interpretation slightly improved 1 hour before competition whereas cognitive anxiety frequencies also increased progressively during the entire preparatory phase. Conclusions: Findings suggest a more dynamic image of elite athletes’ pre-competitive anxiety responses than suggested by former studies, potentially influenced by cultural differences. The use of psychological skills interventions that require effective structure, content, and timing in a composite manner is suggested. (shrink)

The metaphysics underlying differences in degree of qualitative intensity was widely debated in the medieval period. Medieval Aristotelians agreed that subjects possess qualities in virtue of inherent accidental forms. Yet, there was considerable disagreement about what happens at the level of form when a quality increases or decreases in its intensity. For instance, what happens when a pot of water on the stove gets hotter? Is the water’s previous form of heat replaced by a new one, or (...) does the same form of heat persist? Does the form of heat itself undergo a change, or does only the water undergo a change? While there have been several important studies on the medieval debate about the “intension and remission of forms,” little attention has been paid to Thomas Aquinas’s intriguing theory. Aquinas claims that a subject’s quality increases in intensity in virtue of the subject “participating” more perfectly in an invariable form. This paper examines Aquinas’s conception of the participation relationship between a substance and its accidental forms; and his metaphysical analysis of changes of intensification. (shrink)

Pain is commonly explained in terms of the perceptual activity of a distinct sensory modality, the function of which is to enable us to perceive actual or potential damage to the body. However, the characterization of pain experience in terms of a distinct sensory modality with such content is problematic. I argue that pain is better explained as occupying a different role in relation to perception: to indicate when the stimuli that are sensed in perceiving anything by means of a (...) sensory modality exceed a significant level of intensity. Viewing the system underlying pain experience as an integral and functionally integrated feature of all the senses provides a new perspective on the diverse forms of pain, what it is like to experience pain and the contrasting natures of pain and pleasure. (shrink)

Quite a few recent models are rapidly introducing new concepts describing different levels of consciousness. This situ- ation is getting confusing because some theorists formulate their models without making reference to existing views, redun- dantly adding complexity to an already difficult problem. In this paper, I present and compare nine neurocognitive models to highlight points of convergence and divergence. Two aspects of consciousness seem especially important: perception of self in time and complexity of self-representations. To this I add frequency of (...) self-focus, amount of self-related informa- tion, and accuracy of self-knowledge. Overall, I conclude that many novel concepts (e.g., reflective, primary, core, extend- ed, recursive, and minimal consciousness) are useful in helping us distinguish between delicate variations in consciousness and in clarifying theoretical issues that have been intensely debated in the scientific literature—e.g., consciousness in rela- tion to mirror self-recognition and language. (shrink)

Drawing on the behavioral theory, this study examines how the misalignment between a firm's environmental effort and the level of subsidies received from the government in affecting the firm's investment in non-environmental R&D. Based on a sample of Chinese A-share listed firms from 2008 to 2019 and using polynomial regression techniques, our findings reveal that firms in the “low effort-high subsidies” group exhibit lower non-environmental R&D intensity compared to firms in the “high effort-low subsidies” group. This study contributes (...) to the literature by shedding light on the interplay between corporate environmental efforts, government subsidies, and non-environmental R&D investment. The findings suggest the importance of aligning the environmental efforts of firms with subsidy levels from the government to effectively allocate resources for different types of R&D. The implications of this research suggest that firms should carefully consider aligning their environmental efforts with government subsidies to optimize their investment in non-environmental R&D and overall innovation strategy. Furthermore, the study indicates that firms and governments should prudently balance the relationship between environmental R&D and non-environmental R&D to avoid any negative impact on the latter. (shrink)

Definition of the problem The research and regulatory levels for data-intensive research in medicine are divergent. This results in a heterogeneous global field of regulating institutions with regionally unequal regulations, both in terms of the depth and restrictiveness of regulations. Despite or precisely because of the lack of globally binding regulation, nonbinding or only partially binding normative guidelines can also serve as orientation. But how should such normative regulation be designed in view of data-intensive research in medicine and what should (...) it be based on? Arguments The question of how concrete and in detail such research should be regulated can only be answered on a case-by-case basis for specific situations and institutions. Whether new norms or weightings of norms should be introduced, or whether the norms and their weightings should remain in place, can only be answered with reference to strong normative arguments. So far, there is a lack of compelling arguments in favour of new standards in view of data-intensive medical research. However, it is always necessary to translate norms, whether new or old, and apply them to a new method or technology. As in the past, both established and transparently communicated standards and an independent judgement on the application of these standards are therefore required. Conclusion In view of their particular suitability for this task, ethics committees should continue to be required and qualified as a procedural authority in the approval of data-intensive research in medicine; as an independent institution, they should make a judgement appropriate to the individual case on the basis of existing norms and standards. However, the changing practices of data-intensive research projects can also be reflected in new demands on research ethics committees, which should be addressed with reforms of their operating mode. (shrink)

This study investigates the association of a broad set of variables with the ethical decision making of management accountants in Libya. Adopting a cross-sectional methodology, a questionnaire including four different ethical scenarios was used to gather data from 229 participants. For each scenario, ethical decision making was examined in terms of the recognition, judgment and intention stages of Rest’s model. A significant relationship was found between ethical recognition and ethical judgment and also between ethical judgment and ethical intention, but ethical (...) recognition did not significantly predict ethical intention—thus providing support for Rest’s model. Organizational variables, age and educational level yielded few significant results. The lack of significance for codes of ethics might reflect their relative lack of development in Libya, in which case Libyan companies should pay attention to their content and how they are supported, especially in the light of the under-development of the accounting profession in Libya. Few significant results were also found for gender, but where they were found, males showed more ethical characteristics than females. This unusual result reinforces the dangers of gender stereotyping in business. Personal moral philosophy and moral intensity dimensions were generally found to be significant predictors of the three stages of ethical decision making studied. One implication of this is to give more attention to ethics in accounting education, making the connections between accounting practice and Islam. Overall, this study not only adds to the available empirical evidence on factors affecting ethical decision making, notably examining three stages of Rest’s model, but also offers rare insights into the ethical views of practising management accountants and provides a benchmark for future studies of ethical decision making in Muslim majority countries and other parts of the developing world. (shrink)

To elucidate the distinct effects of relationship conflict and task conflict, we investigated the intensity of the two types of conflict on emotional exhaustion and work engagement. Furthermore, we examined how cooperative vs. competitive conflict-handling styles moderate the relationship between the two types of conflict and emotional exhaustion and work engagement. We also examined the role of emotion regulation as a covariate to control its effects on the study variables. Utilizing two separate 2 × 2 between-subject experimental designs, we (...) recruited 120 employees from several companies in Austria. The results suggest that higher levels of both RC and TC are positively related to emotional exhaustion and negatively to work engagement. A cooperative conflict management style moderated the effects of both RC and TC on work engagement. The results suggest decoupling RC and TC and examining the interplay between the intensity of intragroup conflict types and conflict management styles provides insights into the connection between the levels of conflict, conflict management, emotional exhaustion, and work engagement. Additionally, it supports the usage of distraction as a viable regulation strategy for managing the effects of high levels of RC on emotional exhaustion. (shrink)

Background Intensive and critical care nurses need to demonstrate ethical sensitivity especially in recognizing and dealing with ethical dilemmas particularly as they often care for patients living with life-threatening conditions. Theories suggest that there is a convergence between nurses’ empathy and ethical sensitivity. Evidence in the literature indicates that nurses’ emotional, demographic, and work characteristics are associated with their level of empathy and ethical sensitivity. Aim To investigate the relationship between nurses’ empathy and ethical sensitivity, considering their emotional states (...) (depression, anxiety, and stress), demographic and work characteristics, and test an empirical model describing potential predictors of empathy (as a mediator) and ethical sensitivity using path analysis. Research design Using a cross-sectional design, the philosophical theory of care ethics and empathy was extended and adopted as a conceptual framework for this study and tested by path analysis. Participants and research context Data were collected from 347 intensive care nurses recruited by ten educational-medical hospitals in Iran using a questionnaire between February and March 2021. Ethical considerations The study was reviewed by the Ethical Advisory Board in Iran and conducted according to the Declaration of Helsinki. Findings Study participants demonstrated a mild level of stress, anxiety, and depression, alongside a relatively high level of empathy and ethical sensitivity. Nurses with good socioeconomic status had higher empathetic behavior with patients than those with weak status. Nurses aged over 40 who had received ethics training and had higher work experience were associated with higher ethical sensitivity compared to nurses under 20 years of age. Empathy directly affected ethical sensitivity; however, anxiety had an indirect effect on ethical sensitivity through empathy. Among demographic factors, age had a positive direct effect on ethical sensitivity. Conclusions Less anxiety and a high level of empathy contribute to higher levels of ethical sensitivity among intensive and critical care nurses. (shrink)

Background: Nursing is a profession that has always been accompanied with common ethical concerns. There are some evidences which indicate that narrative writing on traumatic experiences may improve an individual’s emotional health. Objective: This study aimed to determine the effectiveness of narrative writing on moral distress of nurses working in intensive care unit. Research design: This study was a clinical trial with pre- and post-test design. The frequency and intensity of moral distress was measured by a valid and reliable (...) questionnaire (Corely) at baseline and after 8 weeks. The intervention group was asked to write about their deepest emotions and stressful experiences in the intensive care unit for 8 weeks. Participants and research context: Using consensus sampling, 120 nurses of intensive care unit and neonatal intensive care unit of the teaching hospitals (in Iran) were invited to and were randomly allocated into the intervention and control groups. Ethical considerations: Participation was voluntary, data were anonymized, and the confidentiality of the participating nurses and their institutions maintained. The ethical approval was obtained from an IRB or research ethics committee. Findings: In total, 106 nurses completed the trial consisting of 87.75% females. The mean work experience of nurses in the intervention and control groups was 7.21 ± 4.96 and 8.28 ± 5.45 years, respectively. Independent t-test showed no statistical difference neither in the intensity of moral distress ( P = 0.8), nor in its frequency ( P = 0.5) between the two groups. Discussion: As nurses constantly face ethical tensions, moral distress is a phenomenon that results from the different situations of critical care units. Their concern about receiving negative feedback from the managerial level may have influenced the outcome of the intervention. Conclusion: Narratives writing by the nurses showed no effect on reducing the intensity and frequency of moral distress. It seems that due to the intensity of moral distress in clinical settings, we need to test variety solutions to reduce the problem. (shrink)