RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

Governments are widely viewed by academics and practitioners as the key societal actors who are capable of compelling businesses to practice corporate social responsibility. Arguably, such government involvement could be seen as a technocratic device for encouraging ethical business behaviour. In this paper, we offer a more politicised interpretation of government engagement with CSR where “CSR” is not a desired form of business conduct but an element of discourse that governments can deploy in structuring their relationships with other social actors. (...) We build our argument through a historical analysis of government CSR discourse in the Russian Federation. Laclau and Mouffe's social theory of hegemony underpins our research. We find that “CSR” in the Russian government’s discourse served to legitimise its power over large businesses. Using this case, we contribute to wider academic debates by providing fresh empirical evidence that allows the development of critical evaluation tools in relation to governments’ engagement with “CSR”. We find that governments are capable of hijacking CSR for their own self-interested gain. We close the paper by reflecting on the merit of exploring the case of the Russian Federation. As a “non-core”, non-western exemplar, it provides a useful “mirror” with which to reflect on the more widely used test-bed of Western industrial democracies when scrutinising CSR. Based on our findings, we invite other scholars to adopt a more critical, politicised stance when researching the role of governments in relation to CSR in other parts of the world. (shrink)

This volume represents the first which interfaces with astronomy as the fulcrum of the sciences. It gives full expression to the human passion for the skies. Advancing human civilization has unfolded and matured this passion into the comprehensive science of astronomy. Advancing science’s quest for the first principles of existence meets the ontopoietic generative logos of life, the focal point of the New Enlightenment. It presents numerous perspectives illustrating how the interplay between human beings and the celestial realm has informed (...) civilizational trends. Scholars and philosophers debate in physics and biology, the findings of which are opening a more inclusive, wider picture of the universe. The different models of the universal order and of life here presented, all aiming at the first principles of existence—accord with the phenomenology/ontopoiesis of life within the logos-prompted primogenital stream of becoming and action, which points to a future of progressing culture. (shrink)

This paper argues that the function of moral education in the biomedical context should be exactly the same as in a general, philosophical framework: it should not provide ready-to-use kits of moral principles; rather, it must show the history, epistemology and conceptual structure of moral theories that would enable those who have to make decisions to be as informed and as responsible as possible. If this complexity cannot be attained, an incomplete product—i.e. bioethics or bioethical principles—should not be seen as (...) a viable substitute. This theoretical position is subsequently illustrated by a case study involving research ethics committees. It is argued that within these committees, that are carefully formed multidisciplinary bodies, what makes competent decision-making possible is not a bioethical theory, nor even a sound philosophical ethics, but the dynamics of the discussion of a number of experts coming from different disciplines. This multidisciplinary expertise is necessary and sufficient to undertake the challenges of complex decisions in the biomedical context. (shrink)

Binz et al. argue that meta-learned models offer a new paradigm to study human cognition. Meta-learned models are proposed as alternatives to Bayesian models based on their capability to learn identical posterior predictive distributions. In our commentary, we highlight several arguments that reach beyond a predictive distribution-based comparison, offering new perspectives to evaluate the advantages of these modeling paradigms.

In this third volume of a monumental four book survey of Phenome­ nology world-wide fifty years after the death of its chief founder, Edmund Husserl, we have a collection of studies which, in the first place, consider Husserl's legacy in the postmodern world. The extent of our indebtedness to the Master is shown in explora­ tions of the archeology of knowledge, hermeneutics, and critical studies of language by A. Ales Bello, P. Pefialver, P. Million, V. Martinez Guzman, H. Rodriguez Pifiero, (...) Y. Vlaisavlevich, and others. There follow calls for renewing the critique of reason by C. Schrag, F. Bosio, and J. Lerin Riera and discussion by D. Laskey, K. G6rniak-Kocikowska, M. R. Barral, Y. Park, and N. Delle Site on A-T. Tymieniecka's phe­ nomenology of life, which proposes a total reorientation of phenome­ nology by introducing a conception of the human condition in which the human creative act is the Archimedean point for philosophy. (shrink)

Contemporary theories of institutional group agency have focused on modeling democratically legitimate institutional group agents. Yet many countries in the world are democratic only on paper, with their governing structures relying, to a large extent, on informal power networks. I give a paradigmatic example of the governance in a de facto nondemocratic state based on sistema, and then explain how we can model something like a sistema- based group to reflect both its differences with widely theorized liberal-democratic groups and its (...) status with respect to its members. (shrink)

The present article analyses the research papers devoted to changes in industrial workers'states of Ukraine during 1905-1914. Current understanding of the basic principles of historiographical studies stipulates a many-sided approach to the studied problem. The analysis and generalization of extensive sweep of historical papers belonged to the historians of several generations outstand as an essential component. The presented article is devoted to presentation of the social and economic, political, ethnic changes in the environment of industrial workers of Ukraine in 1907-1914 (...) in the papers of pre-revolutionary, Soviet and modern historians. It is no coincidence that the workers of Ukraine came into view of the researchers- a change-over to capitalistic business model took place in consequence of economic growth and due to industrial advance of separate regions of Russian Empire in which there are two new classes: owners of enterprises - bourgeoisie and wage and salary workers - proletariat. A problem of the growth of a number of industrial workers in Ukraine in the period after revolution 1905-1907 in the terms of evolution of value judgments of this issue in the environment of historian was considered in the pages of the research. That fact that the overwhelming majority of industrial workers definitively severed ties with land and semi- agricultural sector was not remained out of view of the researchers. In the vast majority of papers there was traced the unified tendency- in estimating of the socio-economic state of industrial workers a salary level and unemployment index are considered. It should be emphasized that historians of the Soviet time pointed up the enterprises' drive against demonstration of labour solidarity, strike movements and trades unions. In contradistinction to them the modern researchers draw attention not to repressive-punitive measures of the government and enterprises but to democratic ways of search of understanding between two social classes. The foreign researchers do not leave aside the problems of the research of formation and development of industrial workers in the industrial regions of Russian Empire. They pointed out that progressive transformations were executed not through the capitalists' excessive jealousy for the state of wage workers and in the first instance for the purpose of increase in incomes by the intensive method of economy management. Consequently the following stages of research of changes in working environment in Ukraine during 1907-1914 can be distinguished in the following way - pre-revolutionary authors concerned themselves with accumulation of statistical data, reminiscences of parties involved in the events, descriptive materials which just stated the facts; the historians of the Soviet period gradually deviate from accumulation of information to its research, analysis, systematization and fusion that was most pronounced in the 70th -80th of the ХХ for a period of creation of collective papers; modern researchers basing on best practice of their predecessors consider transformation in the working environment in new perspective without ideological overrun of the Soviet period. At present there is necessity of creation of generalising historiographical papers the task of which consisted in systematization and generalization of the best practice of several generations of historians on the problem of industrial workers' state in Ukraine during 1907-1914. (shrink)

Using interactional sociolinguistics, I analyze two versions of a narrative chronicling the humorous antics of a prankster called Zimmerman who, along with the narrator, was a seminary student in the Midwestern United States in the 1950s. To explore the interactional function of telling stories about pranks, I compare two versions: one which is more performative, the other which feels more like a summary, calling attention to differences in narrative evaluation accomplished through use of such linguistic features as reference, deixis, and (...) contextualization cues. I argue that both versions accomplish moral positioning for the narrator, and work to construct and negotiate his identity as someone who values cleverness, finding humor in the playful defiance of authority. However, by contrasting a telling in which this evaluation is accomplished internally to one in which evaluation is largely external, I hope to highlight how evaluative devices contribute to meaning-making through narrative performance in the relatively understudied genre of prankster tales. (shrink)

This paper looks to evolve a discourse about the body in medieval women's mystical experience via an understanding of the life and work of Saint Catherine of Genoa as écriture-féminine. Drawing upon Catherine's resolution of binarism through the articulation of sexuality and textuality, I argue that the female mystic's experience of the body as site of struggle helps move beyond analysis of a binary experience to a politics of speaking the body directly.

Name der Zeitschrift: Millennium Jahrgang: 10 Heft: 1 Seiten: 331-348.

The article refers to Helena Eilstein’s views: her analysis of biblical contradictions and a limited moral relativism (similar observations made by Leszek Kołakowski are also evoked). It classifies the types of contradictions found in the Bible and suggests how to deal with them. At times the conceptual apparatus created in the philosophy of science is used and a connection to scientific cognition is made, for foundations of philosophy of science can influence the attitude towards biblical contradictions. It emphasizes the role (...) of individual attitudes and the psychological conditionality of taking moral decisions, as well as the importance of shaping moral sensitivity. Metaphors play a double role in the Bible. Firstly, metaphorical interpretations eliminate contradictions. Secondly, metaphors are useful for shaping moral sensitivity. (shrink)