ZusammenfassungDie finanziellen Ressourcen im deutschen Gesundheitssystem sind begrenzt. Diese Mittelknappheit führt im Rahmen der ärztlichen Tätigkeit zu medizinischen, ökonomischen, juristischen und ethischen Problemen, welche sich in den kommenden Jahren weiter verschärfen dürften. Aus ethischer Perspektive sind die Probleme einer gerechten Verteilung knapper Ressourcen sowie mögliche Rollen- oder Gewissenskonflikte der ärztlichen Profession besonders relevant. Mit Hilfe von qualitativen Interviewstudien lässt sich der aktuelle ärztliche Umgang mit der Mittelknappheit in der klinischen Versorgung in seiner Komplexität und seinen ethisch relevanten Aspekten untersuchen. An (...) fünf Kliniken mit unterschiedlichem Versorgungsauftrag wurden Tiefeninterviews mit fünfzehn leitenden Ärzten in den Bereichen Intensivmedizin und Kardiologie durchgeführt. Die auf Tonband aufgezeichneten Interviews wurden nach dem Verfahren der Grounded Theory ausgewertet. Die Ärzte berichten ein heterogenes Spektrum von Einflussfaktoren, Konsequenzen und Reaktionen im Zusammenhang mit ihrem Handeln bei Mittelknappheit. Zuteilungskriterien wie der medizinische Nutzen oder die Kosteneffektivität werden von den befragten Ärzten sehr unterschiedlich interpretiert und führen damit möglicherweise zu inkonsistenten Allokationsentscheidungen. Gleichzeitig bestätigen die Untersuchungen aber auch, dass die Ärzte nicht leichtfertig mit den Allokationsentscheidungen umgehen, im Gegenteil: Die Mittelknappheit und die dadurch hervorgerufenen Verteilungsprobleme können zu Gewissenskonflikten, emotionalem Stress und Gefühlen der Überforderung führen. Um Lösungskonzepte für ethische Probleme im Umgang mit der Mittelknappheit in der klinischen Praxis entwickeln und erfolgreich implementieren zu können, müssen die in dieser Arbeit systematisch zusammengestellten Verständnisweisen, Einflussfaktoren und Konsequenzen im Zusammenhang mit dem Kostendruck berücksichtigt werden. (shrink)

In this event-related potential study a masking technique that prevents conscious perception of words and non-words through attentional distraction was used to reveal the temporal dynamics of word processing under non-conscious and conscious conditions. In the non-conscious condition, ERP responses differed between masked words and non-words from 112 to 160 ms after stimulus-onset over posterior brain areas. The early onset of the word–non-word differences was compatible with previous studies that reported non-conscious access to orthographic information within this time period. Moreover, (...) source localisations provided evidence for automatic activation of prelexical phonological information, whereas no evidence for non-conscious semantic processing was found. When subjects were informed about the masking technique, lexical differences occurred at later time intervals, suggesting conscious access to additional word related information. These results indicate that early visual word processing does not depend entirely on attentional resources, but that non-conscious processing probably is restricted to rather lower-level linguistic information. (shrink)

In this volume, renowned experts in psychoanalysis reflect on the relationship between psychoanalysis and religion, in particular presenting various controversial interpretations of the question if and to what extent monotheism semantically and structurally fits psychoanalytic insights. Some essays augment traditional religious critiques of Freudianism with later religio-philosophical theories on, for example, femininity. Others explore the relation between psychopathology and morality from the Freudian premise that psychopathology shows in an excessive way aspects or mechanisms of the human psyche that constitute our (...) subjectivity, moral capacities, and behavior.Contributors: Andreas De Block, KU Leuven-University of Leuven; Fethi Benslama, University of Paris Diderot; Sergio Benvenuto, ISTC, Rome; Gohar Homayounpour, Shahid Beheshti University, Tehran; Felix de Mendelssohn, Sigmund Freud University, Vienna; Julia Kristeva, University of Paris Diderot; Lode Lauwaert, KU Leuven-University of Leuven; Siamak Movahedi, University of Massachusetts; Wolfgang Muller-Funk, University of Vienna; Gilles Ribault, University of Paris Diderot; Céline Surprenant, University of Sussex; Inge Scholz-Strasser, Sigmund Freud Foundation; Herman Westerink, University of Vienna; Joel Whitebook, Columbia University; Moshe Zuckermann, Tel Aviv University. (shrink)

Purpose: To explore the characteristics of the use of laughs and jokes during doctor-couple assisted reproductive technology visits.Methods: 75 videotaped doctor-couple ART visits were analyzed and transcribed in order to: quantify laugh and jokes, describing the contribution of doctors and couples and identifying the timing of appearance; explore the topic of laughs and jokes with qualitative thematic analysis.Results: On average, each visit contained 17.1 utterances of laughs and jokes. Patients contributed for 64.7% of utterances recorded. Doctor and women introduced the (...) majority of laughs and jokes. Visits with female physicians had significantly more laughs and jokes than visits with male doctors; no differences were found considering physicians’ age and years of experience, cause of infertility, and prognosis. Laughs and jokes were mainly recorded during history taking and information giving. Four core themes were identified, regarding the topic of laughs and jokes: health status, infertility treatment, organizational aspects, and doctor-patient interaction.Conclusion: Laughs and jokes are common in doctor-couple ART visits and are frequently used during the dialogue, covering a wide range of topics. Results seem to show that laughs and jokes are related to doctor’s personal characteristics, while are not associated with infertility aspects. Given the complexity of this communicative category, further studies are needed to explore the functions and the effects of laugh and jokes. (shrink)

Preterm discharge effects: Relationship between the maternal experience and newborn's psychobiological regulation The purpose of this study is to investigate how the past experiences of mothers and their potentially traumatic events during pregnancy may have influenced the processes of psychobiological self-regulation and cognitive development in a child born preterm. Eighty children who had a gestational age of < 32 weeks were examined at the 9th month of the corrected age. The mothers and children were divided in two groups: multipara mothers (...) and their children and the primipara mothers and their children. These children were examined on the basis of sleep disorders, nutritional problems and mental development. Perinatal data from clinical observations and data from standardized developmental tests were used to describe the differences. The children of primipara mothers who had unexpected preterm delivery presented major incidences of sleep disorders while the children of primipara mothers, who programmed preterm delivery, presented a major incidences of nutrition problems. The predictability of preterm delivery has a major influence on the capacity of newborns for self-regulation in the case of primipara mothers. (shrink)

Desde 1996 el Estado chileno ha desarrollado una política de incorporación progresiva de tecnologías al aula. Al mismo tiempo los jóvenes usan cada vez de forma más intensiva las TIC y en particular los servicios de la Web 2.0. Sin embargo, hay evidencia que el uso de las tecnologías desde una perspectiva didáctica y creativa no es habitual. La propuesta didáctico-pedagógica de Kelluwen busca articular el trabajo de aula con herramientas de la Web 2.0 a través del uso de Diseños (...) Didácticos Colaborativos para desarrollar competencias socio-comunicativas y contenidos disciplinares en los estudiantes. Este artículo sistematiza, expone y discute los resultados preliminares de una intervención educativa que ha consolidado una comunidad de estudiantes, profesores e investigadores centrada en construir, usar y compartir diseños didácticos colaborativos que utilizan la Web Social como espacio de mediación en el proceso de enseñanza y aprendizaje escolar. (shrink)

ORCA.IT, a new online test of online research and comprehension was developed for the Italian population. A group of 183 students attending various types of upper secondary schools in Northern Italy were tested with the new tool and underwent further cognitive and neuropsychological assessment. The different school types involved in the study are representative of the school population in the Italian system, but can also be easily compared with the educational systems of other countries. The new test turned out to (...) have good psychometric properties after accurate item construction and final selection. In particular, Version 1 showed better characteristics than Version 2. Subsequently, comparison with one-way ANOVAs were performed to test whether differences exist between different school types, between groups with and without reading difficulties, and between males and females. Such differences are sometimes reported in the literature, but many remain controversial. Further, Pearson’s bivariate correlations were calculated to analyze associations between scores on the ORCA.IT and cognitive/neuropsychological variables. Finally, a stepwise regression analysis was performed on aggregated scores to identify the predictors of performance on each of the two versions, The test, especially in the most complete version (Version 1), appears to accurately and reliably capture students’ web searching abilities and online reading comprehension. The tool could highlight differences in online search and comprehension ability between students with and without reading difficulties, not penalizing overall performance but allowing very specific weaknesses to be pointed out. Further, it seems to be able to capture differences due to both educational pathways (different school types) and social attitudes (differences between males and females). Most interesting, it shows to be clearly resting on specific cognitive and neuropsychological abilities, including language, memory and attentional skills, which explain a large portion of the total variance. Offline text reading comprehension is a crucial predictor of online reading performance, while decoding ability is not. Prior knowledge also influences the results, as expected. The new tool turns out to be rather independent from previous internet experience and to measure more cognitively grounded processes related to information gathering, processing and communicating. (shrink)

The paper presents and discusses the processes and the results of a Systematic Review of the scientific literature conducted with the aim to become aware of how the antisocial behaviour of adolescents are understood and educationally managed. The results show how the phenomenon is understood mainly through an explanatory and experimental epistemological and methodological approach. Such approach aims at identifying several risks and protection factors that determine/influence AB as well as at defining indications on the practices to be implemented for (...) the design of adequate prevention programmes. Based on these results, the paper proposes some critical reflections on a deterministic conception of AB. (shrink)

Recent studies reported the development of psychological distress symptoms in patients who recovered from COVID-19. However, evidence is still scarce and new data are needed to define the exact risk and protective factors that can explain the variability in symptoms manifestation. In this study, we enrolled 257 patients who recovered from COVID-19 and we evaluated the levels of psychological distress through the Symptoms Checklist-90-R scale. Data concerning illness-related variables were collected from medical records, while the presence of subjective cognitive difficulties, (...) both before and after the illness, as well as the level of the cognitive reserve, were assessed over a clinical interview. Results revealed that being female and reporting the presence of subjective cognitive difficulties after COVID-19 were associated with higher levels of psychological distress. At the same time, being admitted to the hospital and having a high CR were protective factors. Adding new information to this emerging research field, our results highlight the importance of a complete psychological and cognitive assessment in patients with COVID-19. (shrink)

BackgroundDefinition and concept of the ‘beginning of human life’ are weakened by co-existing contrasting hypotheses based on humanistic or religious beliefs rather than scientific foundations. This plethora of conceptually distant views have important common concerns in different fields of science and shape, in turn, several societal aspects including laws related, for instance, to inheritance eligibility or abortion, end-of-life care and euthanasia, and reproductive technology. Also, they are fundamental to evaluate opportunity for resuscitation vs. palliative care in extremely preterm infants. In (...) this article, we address one of the most common tenets in medicine: the acceptance that human life starts with first breath, even though several events are well-documented to take place before its occurrence.Main textSeveral studies show how pivotal physiological events take place before first breath. Evidence of a number of neurological events occurring before first breath opens the way to the primacy of the Central Nervous System, given its immediate extra-uterine activation at birth. This activation eventually sets specific physiological conditions that allow the complex sequence of events determining the muscle activity associated with the influx of air in the lung and the settling of a continuous and successful extra-uterine respiration. We would like to invite the scientific community to endorse a clear-cut position against the paradigm of ‘first breath’ as the beginning of life. Herein, we also assume how, a still undefined, yet possibly specific quid in the external environment triggers further physiological response in newborns. Better understanding of the critical events that occur at the beginning of human life is likely to cause great concern and expectations in scientists, researchers and physicians working in the domain of brain, and its physiology, and mental health.ConclusionsThe comparison between beliefs and evidence-based observations generates confusion, misperceptions and false expectations in society, hence, in the scientific and medical community. Different and more solid alternatives about the carachterization of the ‘beginning of human life’ are indeed available and require to be explored and defined. (shrink)

It is thought that just as hunger itself, the expectancy to eat impacts attention and cognitive control toward food stimuli, but this theory has not been extensively explored at a behavioral level. In order to study the effect of expectancy to eat on attentional and cognitive control mechanisms, 63 healthy fasting participants were presented with an affective priming spatial compatibility Simon task that included both food and object distracters. The participants were randomly assigned to two groups: an “immediate expectancy” group (...) made up of participants who expected to eat immediately after the task and a “delayed expectancy” cohort made up of individuals who expected to eat a few hours later. Slower reaction times toward the food and non-food distracters and a more pronounced effect on the RTs in the incompatible condition [i.e., the Simon effect ] were noted in both groups. The effect of the food and non-food distracters on the RTs was more pronounced in the immediate with respect to the delayed expectancy group. The magnitude of the SE for the food and the non-food distracters was also greater in the immediate with respect to the delayed expectancy group. These results seem to indicate that when the expectancy to eat is short, the RTs are delayed, and the SE is more pronounced when food and non-food distracters are presented. Instead, when the expectancy to eat is more distant, the distracters have less of an effect on the RTs and the correspondence effect is smaller. Our results suggest that the expectancy to eat can modulate both attention orienting and cognitive control mechanisms in healthy fasting individuals when distracting details are competing with information processing during goal directed behavior. (shrink)

ZusammenfassungDie Beschäftigung mit der ethischen Dimension des ärztlichen Handelns beruht auf der freiwilligen Einsicht in deren Notwendigkeit. Es stellte sich die Frage, ob die Anwesenheit von Studierenden, die nur durch den Zwang des Stundenplans Ethikseminare besuchen, die Qualität der Veranstaltungen messbar negativ beeinflusst. In einer über 2 Jahre umfassenden Umfrage zu Lernzielen, Unterrichtsatmosphäre, Moderation und Fächerwichtigkeiten wurden die Ethikseminare an der Universität Ulm evaluiert. Hierzu bekamen wir Fragebögen von 192 freiwillig Teilnehmenden des Jahrgangs 2001/2002 und von 293 Pflichtteilnehmern des Jahrgangs (...) 2002/2003 zurück. Überraschenderweise gab es bei keiner relevanten Frage oder Bewertung einen statistisch signifikanten Unterschied zwischen freiwilligen und Pflichtteilnehmern. Zum Teil deutliche Unterschiede zeigten sich zwischen männlichen und weiblichen Studierenden. Diese Unterschiede müssen aufgrund ihrer didaktischen und konzeptionellen Bedeutung weiterverfolgt werden. Das Umfrageergebnis lässt hoffen, dass das Unterrichtskonzept der fallorientierten Kleingruppenseminare die Lernziele bei allen Studierenden verwirklichen kann. (shrink)

Patientenselbstbestimmung und Patientenverfügungen haben zunehmende Bedeutung und Beachtung erfahren. In der vorliegenden qualitativen Studie wurden 15 Patientinnen und Patienten mit amyotropher Lateralsklerose —einer unheilbaren, chronisch-degenerativen Erkrankung mit vorhersehbarer Symptomatik—interviewt, um zu erfahren, welche Werte und Kriterien sie bei prospektiven Entscheidungen am Lebensende und bei der Abfassung von PV zugrunde legen. Die Auswertung erfolgte nach der Methode der „grounded theory“. Die befragten Patientinnen und Patienten befürworteten einen Verzicht auf lebenserhaltende Behandlungen, wenn sie keine hinreichenden Lebensmöglichkeiten mehr sahen, d. h. wenn sie (...) die aktuelle Lebensqualität für unzureichend erachteten und die Chance auf Besserung als gering einschätzten. Dem Patientenwillen sprachen sie bei der Entscheidungsfindung ein Vetorecht zu. Patientenverfügungen fassten sie erst ab, als sie keine Hoffnung mehr auf Besserung ihrer Erkrankung hatten. Sie verstanden diese als Instrumente zur vorsorglichen Erklärung ihres Wunsches, auf lebensverlängernde Maßnahmen zu verzichten, wenn die LM inakzeptabel geworden sind. Damit wollten sie sich gegenüber dem Arzt absichern, den sie in der Rolle eines Anwalts des Lebens sahen und mit dem sie daher ihre Behandlungswünsche nicht besprochen haben. Trotz vorhersehbarer Symptomatik legten sie in ihren PV keine spezifischen Behandlungswünsche nieder, sondern verwendeten allgemeine Formularmuster ohne konkreten Bezug zu ihrer Erkrankung. Daher bestehen auch bei dieser Patientengruppe Zweifel, ob die PV in einer konkreten Behandlungssituation hilfreich sind. (shrink)

Die geschichte der macht.--Ewige menschheit und wandel der reiche.--Ahnung der form.--Blick auf das werden.

Die Einführung der kostenkalkulierten und landesweit einheitlich bepreisten DRGs hat die Möglichkeiten gewinnorientierter Krankenhausträger, ehemals kommunale, defizitäre Krankenhäuser in die Gewinnzone zu führen, erschwert. Diese reagieren darauf mit dem Einsatz bisher nicht gekannter Werkzeuge wie beispielsweise der Steuerung von Patientenströmen, Anreizsystemen, Gründung von Privatkliniken sowie erlösorientierten Therapien und Abrechnungen. Mittlerweile bedienen sich auch andere Trägergruppen dieser Instrumente, so dass sich die Frage stellt, ob angesichts der Wettbewerbssituation nicht gewinnorientierte Träger eines besonderen wirtschaftlichen Schutzes bedürfen, damit die bisher im Krankenhaus gültigen (...) ethischen Prinzipien auch weiterhin Anwendung finden können. (shrink)

La poesía de Rodrigo Lira está marcada por el uso del humor negro y la polifonía, tanto para referirse a la voz poética como a su contexto literario, cultural, social y político. Estas estrategias para la configuración de su identidad y posicionamiento discursivo, de carácter fragmentario, se utilizan para conjurar su sentido de despertenencia, soledad y culpa de ser.

ZusammenfassungDer heutige Arbeitsalltag im medizinischen Betrieb ist durch verschiedene Belastungsfaktoren gekennzeichnet: 1) die Tempobeschleunigung und die Komplexitätssteigerung der medizinischen Entwicklung allgemein sowie 2) eine zunehmende moralische Verunsicherung des Personals in Bezug auf das Verhältnis von Möglichkeiten und Notwendigkeiten bestimmter therapeutischer Verfahren. Die in diesem Aufsatz vorgelegten Beobachtungen, die aus einem Projekt am Lehrstuhl für Ethik der Georg-August-Universität Göttingen resultieren, machen noch einen weiteren Punkt geltend, so dass 3) bereits die unterschiedliche Einschätzung rein sachlicher Fragen zu einem Dissens führen kann, der (...) als moralischer empfunden wird. Aus diesen drei Momenten erwächst ein allgemeiner Bedarf an ethischer Handlungsorientierung. Allerdings ist die Entlastung, die durch ethische Kommunikation, beispielsweise in klinischen Ethik-Komitees, erreicht wird, anderer Art als zunächst in der Regel erwartet. Denn die Leistung liegt nicht so sehr in der Lösung von Problemen als vielmehr in deren Beschreibung. (shrink)

El presente artículo aborda la estrategia escritural de Daniela Catrileo. Se propone revisar la elaboración del concepto de piñen examinando la relación entre lenguaje y colonialidad, para, de ese modo, subrayar el potencial político y reivindicativo que comporta en la novela del mismo nombre, Piñen (2019). Dicha hipótesis articulará el ejercicio de lectura aquí propuesto, atendiendo principalmente las estrategias narrativas empleadas –servirse de un polilingüismo que rompe estructuras gramaticales– para descentrar el lenguaje de su determinismo colonial. Así, interpretamos dicha (...) estrategia escritural en consonancia con las potencias micropolíticas y descolonizadoras del arte descritas por Suely Rolnik y, en consecuencia, apostando por la posibilidad de diagramar un devenir minoritario que dispute los imaginarios del inconsciente colonial-capital. (shrink)

Ist das Politische Macht? Ist es öffentliches Handeln oder die beste Gesellschaftsordnung? Daniela Hüttinger sucht dort nach einer Antwort, wo die historische Wurzel des Politischen vermutet wird: im Griechenland des 5. und 4.

Background Despite continuous performance improvements, especially in clinical contexts, a major challenge of Artificial Intelligence based Decision Support Systems (AI-DSS) remains their degree of epistemic opacity. The conditions of and the solutions for the justified use of the occasionally unexplainable technology in healthcare are an active field of research. In March 2024, the European Union agreed upon the Artificial Intelligence Act (AIA), requiring medical AI-DSS to be ad-hoc explainable or to use post-hoc explainability methods. The ethical debate does not seem (...) to settle on this requirement yet. This systematic review aims to outline and categorize the positions and arguments in the ethical debate. Methods We conducted a literature search on PubMed, BASE, and Scopus for English-speaking scientific peer-reviewed publications from 2016 to 2024. The inclusion criterion was to give explicit requirements of explainability for AI-DSS in healthcare and reason for it. Non-domain-specific documents, as well as surveys, reviews, and meta-analyses were excluded. The ethical requirements for explainability outlined in the documents were qualitatively analyzed with respect to arguments for the requirement of explainability and the required level of explainability. Results The literature search resulted in 1662 documents; 44 documents were included in the review after eligibility screening of the remaining full texts. Our analysis showed that 17 records argue in favor of the requirement of explainable AI methods (xAI) or ad-hoc explainable models, providing 9 categories of arguments. The other 27 records argued against a general requirement, providing 11 categories of arguments. Also, we found that 14 works advocate the need for context-dependent levels of explainability, as opposed to 30 documents, arguing for context-independent, absolute standards. Conclusions The systematic review of reasons shows no clear agreement on the requirement of post-hoc explainability methods or ad-hoc explainable models for AI-DSS in healthcare. The arguments found in the debate were referenced and responded to from different perspectives, demonstrating an interactive discourse. Policymakers and researchers should watch the development of the debate closely. Conversely, ethicists should be well informed by empirical and technical research, given the frequency of advancements in the field. (shrink)

For decades there has been a controversial debate over how far religious faith communities are specifically engaged in ecological practices (EP). Therefore we studied four Austrian and two German Benedictine monasteries religious ethics and spirituality as a means of a driving force for initiating EP. We draw upon theories of organizational learning processes and capacity-building of sustainability to interpret our empirical findings. The majority of monasteries are highly engaged in EP, initiated either as an outcome of individual activities or through (...) a specific mostly informally acting group, but rarely an organizationally or systematically integrated goal of the monasteries, or a focus of capacity building. Monasteries follow a technical and economic decision-making process in implementing EP. Spirituality plays a limited role in the initiation of EP. The environment of monasteries–acceptance or critique against ecological practices–influences the monasteries decisions. Institutionalization of ecological practices into the monasteries organizational structure is rare. (shrink)

Recent decades have seen the facilitation of unconventional or even extraordinary reproductive endeavours. Sperm has been harvested from dying or deceased men at the request of their wives; reproductive tissue has been surgically removed from children at the request of their parents; deceased adults’ frozen embryos have been claimed by their parents, in order to create grandchildren; wombs have been transplanted from mothers to their daughters. What is needed for requests to be honoured by healthcare staff is that they align (...) with widely shared expectations about what people’s reproductive potential ought to be, what marital relationships ought to result in, and which kinds of ties are desirable between parents and children. Costly and invasive technologies are not considered excessive when they are used to support the building of appropriate families. However, deviations from dominant reproductive norms, even if technologically simple and convenient to the participants, are unlikely to receive support. In this paper, we offer examples of such deviations and explore their implications. If reproduction is important as a way of creating genetic relationships, should reproductive material in storage be offered to genetic relatives other than the people from whom it originated? And if parents are allowed to have reproductive material collected from their offspring, or even to use it to create babies, should offspring likewise be allowed to use their parents’ reproductive material? We tackle these questions and suggest ways in which interests in genetic ties could be operationalised in a more coherent and less-invasive manner than they currently are. (shrink)

The production of easy-read and plain language is a challenging task, requiring well-educated experts to write context-dependent simplifications of texts. Therefore, the domain of easy-read and plain language is currently restricted to the bare minimum of necessary information. Thus, even though there is a tendency to broaden the domain of easy-read and plain language, the inaccessibility of a significant amount of textual information excludes the target audience from partaking or entertainment and restricts their ability to live life autonomously. Large language (...) models can solve a vast variety of natural language tasks, including the simplification of standard language texts to easy-read or plain language. Moreover, with the rise of generative models like GPT, easy-read and plain language may be applicable to all kinds of natural language texts, making formerly inaccessible information accessible to marginalized groups like, a.o., non-native speakers, and people with mental disabilities. In this paper, we argue for the feasibility of text simplification and generation in that context, outline the ethical dimensions, and discuss the implications for researchers in the field of ethics and computer science. (shrink)