The decision-making environment in intensive care units (ICUs) is influenced by the transformation of intensive care medicine, the staffing situation and the increasing importance of patient autonomy. Normative implications of time in intensive care, which affect all three areas, have so far barely been considered. The study explores patterns of decision making concerning the continuation, withdrawal and withholding of therapies in intensive care. A triangulation of qualitative data collection methods was chosen. Data were collected through non-participant observation on a surgical (...) ICU at an academic medical centre followed by semi-structured interviews with nurses and physicians. The transcribed interviews and observation notes were coded and analysed using qualitative content analysis according to Mayring. Three themes related to time emerged regarding the escalation or de-escalation of therapies: influence of time on prognosis, time as a scarce resource and timing in regards to decision making. The study also reveals the ambivalence of time as a norm for decision making. The challenge of dealing with time-related efforts in ICU care results from the tension between the need to wait to optimise patient care, which must be balanced against the significant time pressure which is characteristic of the ICU setting. (shrink)

BackgroundClinical ethics case consultations (CECCs) provide a structured approach in situations of ethical uncertainty or conflicts. There have been increasing calls in recent years to assess the quality of CECCs by means of empirical research. This study provides detailed data of a descriptive quantitative and qualitative evaluation of a CECC service in a department of cardiology and intensive care at a German university hospital.MethodsSemi-structured document analysis of CECCs was conducted in the period of November 1, 2018, to May 31, 2020. (...) All documents were analysed by two researchers independently.ResultsTwenty-four CECCs were requested within the study period, of which most (n = 22; 92%) had been initiated by physicians of the department. The patients were an average of 79 years old (R: 43–96), and 14 (58%) patients were female. The median length of stay prior to request was 12.5 days (R: 1–65 days). The most frequent diagnoses (several diagnoses possible) were cardiology-related (n = 29), followed by sepsis (n = 11) and cancer (n = 6). Twenty patients lacked decisional capacity. The main reason for a CECC request was uncertainty about the balancing of potential benefit and harm related to the medically indicated treatment (n = 18). Further reasons included differing views regarding the best individual treatment option between health professionals and patients (n = 3) or between different team members (n = 3). Consensus between participants could be reached in 18 (75%) consultations. The implementation of a disease specific treatment intervention was recommended in five cases. Palliative care and limitation of further disease specific interventions was recommended in 12 cases.ConclusionsTo the best of our knowledge, this is the first in-depth evaluation of a CECC service set up for an academic department of cardiology and intensive medical care. Patient characteristics and the issues deliberated during CECC provide a starting point for the development and testing of more tailored clinical ethics support services and research on CECC outcomes. (shrink)

Dynamical Grammar explores the consequences for language acquisition, language evolution, and linguistic theory of taking the underlying architecture of the language faculty to be that of a complex adaptive dynamical system. It contains the first results of a new and complex model of language acquisition which the authors have developed to measure how far language input is reflected in language output and thereby get a better idea of just how far the human language faculty is hard-wired.

The text introduces a translation of Ilyenkov’s famous text “On the State of Philosophy,” which was meant as a letter to the Central Committee of the CPSU and expressed his exasperation with the development of Soviet philosophy. In our introduction, we describe the historical context of the emergence of the letter, including the main changes in Soviet philosophy in the 1960s (esp. rise in popularity of cybernetics), and the institutional details of Ilyenkov’s biography. We point to the contemporary relevance of (...) the letter by emphasizing how Ilyenkov’s dialectical account of science can enrich contemporary discussions in the sociology of science and STS. (shrink)

We present a dynamical model of interaction between recognition memory and affect, focusing on the phenomenon of “warm glow of familiarity.” In our model, both familiarity and affect reflect quick monitoring of coherence in an attractor neural network. This model parsimoniously explains a variety of empirical phenomena, including mere-exposure and beauty-in-averages effects, and the speed of familiarity and affect judgments.

Zusammenfassung Hintergrund Advance Care Planning (ACP) wird auch in Deutschland zunehmend praktiziert. Aus klinisch-ethischer Perspektive bietet ACP eine Möglichkeit, Vorausverfügungen zu konkretisieren und auf diese Weise die Entscheidungsfindung bei fehlender Selbstbestimmungsfähigkeit von Patient:innen zu unterstützen. Während es für Gesprächsangebote im Sinne des ACP in Pflegeeinrichtungen und Einrichtungen der Eingliederungshilfe seit 2015 Finanzierungsmöglichkeiten gibt und erste Studien zu Angeboten veröffentlich wurden, fehlt es in Deutschland bisher an publizierten Evaluationsstudien zu ACP-Angeboten im Krankenhaus. Intervention und Methoden Im vorliegenden Beitrag erfolgt die strukturierte (...) Darstellung von ACP als ein Element des klinisch-ethischen Unterstützungsangebotes am Universitätsklinikum Halle (Saale) (UKH). Es erfolgte eine quantitative Inhaltsanalyse der schriftlichen Dokumentation von durchgeführten ACP-Gesprächsprozessen für den Zeitraum der Pilotphase von 01/2020 bis 08/2021 (20 Monate). Ergebnisse Im Zeitraum wurden 93 ACP-Gespräche angefragt. Mit 79 Patient:innen konnten 110 Gespräche geführt werden. 46 % der Anfragen kamen von Palliative Care betreuten Patient:innen. Im Durchschnitt dauerten die Beratungen 45 min. Der Gesprächsprozess zur Erstellung einer Patientenverfügung benötigte durchschnittlich 122 min und 2,5 Gespräche. Bei 23 % der Patient:innen endete der ACP-Prozess nach dem Erstgespräch. Die Inhalte der ACP-Prozesse tangierten verschiedene Bereiche anderer Professionen im Krankenhaus, insbesondere die Entscheidungsfindung über aktuelle Diagnostik und Therapie zwischen Ärzt:innen und Patient:innen. Diskussion Die Einführung eines ACP-Angebotes im Krankenhaus zeigt neben einer Vielzahl an Chancen auch Herausforderungen auf, welche es im gemeinsamen Diskurs zu bewältigen gilt. Bei der Einbettung eines ACP-Angebots im Krankenhaus müssen die Besonderheiten der Klinik und insbesondere die Abgrenzung von ACP zu anderen Arbeitsfeldern der Ethikberatung, wie beispielsweise die Ethikfallberatung, bedacht werden. (shrink)

The outbreak of the COVID-19 pandemic had an impact on the global economy, including the provision of health services, with medical facilities and patients cancelling or postponing medical appointments. An alternative to in-person appointments was through the available forms of telemedicine. Scientific reports around the world have suggested that the accessibility and quality of health services declined. The aim of this study was to investigate the accessibility and quality of health services in Poland and to verify whether there were differences (...) between men and women in this respect. The study was based on the authors’ own survey questionnaire filled in by 265 respondents, including 181 women, 82 men, and 2 persons without a defined gender. The study revealed that during the COVID-19 pandemic, the accessibility and quality of health services declined. Additionally, women were more likely to use general and specialist health services than men, but a comparison of changes in the assessment of accessibility and quality of services by gender revealed no differences in the assessment of accessibility and quality. (shrink)

Many psychological studies have shown that human‐generated sequences are hardly ever random in the strict mathematical sense. However, what remains an open question is the degree to which this (in)ability varies between people and is affected by contextual factors. Herein, we investigated this problem. In two studies, we used a modern, robust measure of randomness based on algorithmic information theory to assess human‐generated series. In Study 1 (), in a factorial design with task description as a between‐subjects variable, we tested (...) the effects of context and mental fatigue on human‐generated randomness. In Study 2 (), in online research, in experimental design, we further investigated the effect of mental fatigue on the randomness of human‐generated series and the relationship between the need for cognition (NFC) and the ability to produce random‐like series. Results of Study 1 show that the activation of the ability to produce random‐like series depends on the relevance of the contextual cues (), whether they activate known representations of a random series generator and consequently help to avoid the production of trivial sequences. Our findings from both studies on the effect of mental fatigue (Study 1 – ; Study 2 – ) and cognitive motivation () demonstrate that regardless of the context or task's novelty people quickly lose interest in the random series generation. Therefore, their performance decreases over time. However, people high in the NFC can maintain the cognitive motivation for a longer period and consequently on average generate more random series. In general, our results suggest that when contextual cues and intrinsic constraints are in optimal interaction people can temporarily escape the structured and trivial patterns and produce more random‐like sequences. (shrink)

To deal with syntactic structure, one needs to go beyond a simple model based on associative structures, and to adopt a dynamical systems perspective, where each phrase and sentence of a language is represented as a trajectory in a syntactic phase space. Neural assemblies could possibly be used to produce dynamics that in principle could handle syntax along these lines.

Quality is usually considered to be an attribute of an object, its degree of excellence or, more subjectively, fitness for use. Stemming from this point of view, the goal of most ranking systems is to find efficient ways of discovering, or rather uncovering, the quality of specific products or services. However, from a social psychological perspective it seems that the notion of quality belongs predominantly to the realm of social relationships. We argue that quality exists mainly between the users of (...) an object, not within the object itself, and its functions are predominantly social, i.e. promoting interactions, creating a shared reality, or building social relationships. Quality is constructed in social interactions and used as a token therein. In the present paper we outline the social functions of quality, and discuss the implications of this perspective for designing more useful recommendation systems. (shrink)

"Der vorliegende Band geht auf logikbezogene Spurensuche und vereinigt durchdachte, hochintelligente und zahlreiche neue Einsichten versprechende Texte. Wer sich ernsthaft mit Musik beschäftigt, sollte sich diesen Band nicht entgehen lassen." (bs, Musica sacra 4/2015) Texte zur Praxis, Theorie und Ästhetik der Musik beanspruchen den Begriff ›musikalische Logik‹, wobei die Vorstellungen über Geltung, Inhalt und Umfang dieses Begriffes weit divergieren. Im vorliegenden Buch wird eine problemgeschichtliche Klärung unternommen. Musikalische Logik erweist sich als Inbegriff der Bedingungen, unter welchen Musik als in sich (...) selbst begründeter Prozess erscheinen kann. Sie besteht in einem musikalischen Denken, dessen Zusammenhang generiert wird durch Differenzierung von Klangrelationen und Zeitmaßen, durch Bildung von Verknüpfungsweisen und Verlaufsformen, durch den variativen Gebrauch der resultierenden Modelle sowie durch Aufhebung und Neubildung der Konstituenten; als produktives Denken lässt sich das musikalische Denken die Wege nicht festlegen, die sich für seine Ausdrucks- und Kommunikationsweise bewährt haben. Musikalische Logik kann sich in voraushörbarer Konsequenz zeigen, aber auch und besonders in der Art, wie sich ein nicht zu antizipierender Prozess als in sich begründet erweist. Die Vielfalt der Möglichkeiten spricht nicht gegen die Erwartung von Logik in der Musik, sondern erfüllt die Eigenart des Logischen im Bereich des Schaffens gegenüber dem Logischen im Bereich des Erkennens. Die historische Darstellung führt von der Spätantike bis in die Mitte des 20. Jahrhunderts. Texts on the practice, theory and aesthetics of music make use of the term ‘musical logic’, although conceptions of the application, content and scope of the term differ greatly. This book attempts to solve this historical problem. Musical logic proves to be the embodiment of the conditions under which music can appear as a process founded in itself. It consists of musical thinking with ist context generated by the differentiation of relationships between sounds and of tempi, by the creation of forms of connection and progression, by the variational use of the resulting models and the suspension and re-creation of the constituent parts; as a form of productive thinking, music cannot define proven means for ist own expression and communication. Musical logic can manifest itself in consequences that can be aurally predicted, but also, and especially, in the ways in which a process that cannot be anticipated proves to be founded in itself. The range of possibilities does not contradict the expectation of logic in music but conforms to the peculiarity of logic in the sphere of creation as opposed to logic in the sphere of cognition. The historical presentation ranges from late antiquity to the mid 20th century. (shrink)

Autor artykułu przedstawia w syntetycznym skrócie zasady kształtowania się dwóch podstawowych form wypowiedzi literacko-muzycznej w antycznym świecie cywilizacji greckiej i hellenistycznej. Pokrótce omawia sposoby przejawiania się muzyki, traktowanej jako ważny element obiegu kulturowego w ówczesnej rzeczywistości. Archetypiczne wzorce hymnu i peanu - podstawowych form literacko-muzycznych kultury greckiej - zostały omówione według charakterystycznych cech oraz poparte konkretnymi przykładami literackimi. Wskazano, że synkretyzm form literacko-muzycznych, charakterystyczny dla antycznej kultury śródziemnomorskiej, był powiązany z elementami kultu religijnego. Wymiar religijny stanowił ważne uzupełnienie praktycystycznego sposobu (...) traktowania muzyki w świecie cywilizacji antycznej, niekiedy wysuwające się na pierwszy plan. Szczególnie widoczne było to w przypadku wczesnochrześcijańskiej twórczości hymnograficznej, opartej na syntezie tradycji hellenistyczno-rzymskiej i judeochrześcijańskiej. (shrink)

Moje zainteresowanie pracami i dziełem Michaiła Bachtina oraz Eugena Rosenstocka-Huessy bierze swój początek z odkrycia, ze obaj myśliciele zgodnie twierdzili, iż religijna moc języka oraz mowy wyrasta z różnorodnych kryzysów życiowych. Theoria przez nich stworzona zbudowana jest na gruncie praxis i czerpie swą siłę ze zderzenia doświadczeń duchowych i intelektualnych obu filozofów z rewolucyjnym wrzeniem otaczającej ich współczesności. Wykład niniejszy to próba nawiązania dialogu z osobami podzielającymi podobne zainteresowania i troski. Pisząc go kierowałem się także pragnieniem zaabsorbowania uwagi moich słuchaczy (...) przedstawione w nim istoty metalingwistyki głoszonej przez „nieortodoksyjnego" prawosławnego teoretyka literatury i filozofa języka, Michaiła Bachtina, oraz znaczeniem metanomiki opracowanej przez „rewolucyjnie konserwatywnego" chrześcijańskiego myśliciela mowy i filozofa społecznego, Eugena Rosenstocka-Huessy. Zamiarem moim jest przedstawienie roli, jaką społeczno-religijne modele filozofii i socjologii oparte na mowie i języku mogą^ odegrać w dążeniach do zaprowadzenia pokojowego współistnienia na całej naszej planecie. Ten właśnie obszar zainteresowań został określony przez Williama Jamesa, amerykańskiego filozofa pragmatyzmu, mianem „moralnego równoważnika wojny”. Przywołując na pamięć ogromną rzeszę myślicieli, których prace odnoszą się bezpośrednio do wyznaczonego tu obszaru – a w pewnych przypadkach noszą znamiona dzieła prekursorskiego – nie możemy poprzestać na wymienieniu tylko nazwiska Williama Jamesa. Inne wielkie postaci to: Charles Sanders Pierce, George Herbert Mead, a także myśliciele podejmujący zagadnienia, które później stały się treścią filozofii Rosenstocka-Huessy, tj. Giovanni Battista Vico, J. G. Hamann, Comte de Saint-Simon oraz Giuseppe Ferrari. (shrink)

Close relationships are described in terms of the temporal coordination of behavior based on the similarity of partners’ internal states. Coupled nonlinear dynamical systems were used to model the emergence, maintenance, and disruption of coordination in such relationships. For each system, there was a control parameter corresponding to an internal state and a dynamical variable corresponding to behavior. Computer simulations investigated how the temporal coordination of behavior in a relationship reflects the similarity of partners’ control parameters and the strength of (...) coupling. Several types of coordination were observed, with in-phase synchronization occurring for strong coupling and similarity in internal states. In a variation of the model, each system could adjust its own control parameter to synchronize its dynamics with that of the other system. Simulation results provide insight into several topics in the study of close relations and group dynamics. (shrink)