The advent of personal genomics companies offering direct translation of scientific data into personal health information, calls into question traditional policies to refuse disclosure of such scientific data to research participants. This seems especially true for population biobanks, as they collect not only genotype information but also associated phenotype information, and thus may be in a unique position to translate their scientific findings into personal health information for their participants. Disclosure of such information seems mandated by the expectations raised by (...) biobanks ('to help bring about the era of personalized medicine') and their participants' rights to know health information, to know clinical research results, to life and health and particularly their right to benefit. Refusals to disclose such information can be grounded in the lack of analytical validity and/or clinical utility of most findings, the need to avoid the therapeutic misconception, the complexity and costs involved in translation and disclosure and the disproportionate burden resulting from the obligation to respect participants' right not to know before any disclosure can be made. Currently, any demands by participants in population biobanks for full disclosure of all pertinent personal health information potentially resulting from the biobank's scientific findings are unlikely to be granted by a Dutch court under Dutch and international law. As the law stands now, a population biobank is neither a doctor nor a personal genomics company. However, in view of the rapid scientific, medical, technological, commercial and social developments, population biobanks must prepare to take more care of their participants' legitimate interest in receiving as much validated personal health information as reasonably possible, in a timely fashion, by developing appropriate translation and disclosure mechanisms. This paper examines whether population biobank participants have the right, under Dutch civil law and international law, to full disclosure, i.e. to all information generated by the biobank that is pertinent to their present and future health. It pioneers the format of a hypothetical court case to elucidate the legal and policy arguments" for and against full disclosure. (shrink)

Introduction: Uncertainty is omnipresent in cancer care, including the ambiguity of diagnostic tests, efficacy and side effects of treatments, and/or patients' long-term prognosis. During second opinion consultations, uncertainty may be particularly tangible: doubts and uncertainty may drive patients to seek more information and request a second opinion, whereas the second opinion in turn may also affect patients' level of uncertainty. Providers are tasked to clearly discuss all of these uncertainties with patients who may feel overwhelmed by it. The aim of (...) this study was to explore how oncologists communicate about uncertainty during second opinion consultations in medical oncology.Methods: We performed a secondary qualitative analysis of audio-recorded consultations collected in a prospective study among cancer patients who sought a second opinion in medical oncology. We purposively selected 12 audio-recorded second opinion consultations. Any communication about uncertainty by the oncologist was double coded by two researchers and an inductive analytic approach was chosen to allow for novel insights to arise.Results: Seven approaches in which oncologists conveyed or addressed uncertainty were identified: specifying the degree of uncertainty, explaining reasons of uncertainty, providing personalized estimates of uncertainty to patients, downplaying or magnifying uncertainty, reducing or counterbalancing uncertainty, and providing support to facilitate patients in coping with uncertainty. Moreover, oncologists varied in their choice of words/language to convey uncertainty.Discussion: This study identified various approaches of how oncologists communicated uncertain issues during second opinion consultations. These different approaches could affect patients' perception of uncertainty, emotions provoked by it, and possibly even patients' behavior. For example, by minimizing uncertainty, oncologists may consciously steer patients toward specific medical decisions). Future research is needed to examine how these different ways of communicating about uncertainty affect patients. This could also facilitate a discussion about the desirability of certain communication strategies. Eventually, practical and evidence-based guidance needs to be developed for clinicians to optimally inform patients about uncertain issues and support patients in dealing with these. (shrink)

BackgroundDespite its ubiquity in academic research, the phrase ‘ethical challenge(s)’ appears to lack an agreed definition. A lack of a definition risks introducing confusion or avoidable bias. Conceptual clarity is a key component of research, both theoretical and empirical. Using a rapid review methodology, we sought to review definitions of ‘ethical challenge(s)’ and closely related terms as used in current healthcare research literature.MethodsRapid review to identify peer-reviewed reports examining ‘ethical challenge(s)’ in any context, extracting data on definitions of ‘ethical challenge(s)’ (...) in use, and synonymous use of closely related terms in the general manuscript text. Data were analysed using content analysis. Four databases (MEDLINE, Philosopher’s Index, EMBASE, CINAHL) were searched from April 2016 to April 2021.Results393 records were screened, with 72 studies eligible and included: 53 empirical studies, 17 structured reviews and 2 review protocols. 12/72 (17%) contained an explicit definition of ‘ethical challenge(s), two of which were shared, resulting in 11 unique definitions. Within these 11 definitions, four approaches were identified: definition through concepts; reference to moral conflict, moral uncertainty or difficult choices; definition by participants; and challenges linked to emotional or moral distress. Each definition contained one or more of these approaches, but none contained all four. 68/72 (94%) included studies used terms closely related to synonymously refer to ‘ethical challenge(s)’ within their manuscript text, with 32 different terms identified and between one and eight different terms mentioned per study.ConclusionsOnly 12/72 studies contained an explicit definition of ‘ethical challenge(s)’, with significant variety in scope and complexity. This variation risks confusion and biasing data analysis and results, reducing confidence in research findings. Further work on establishing acceptable definitional content is needed to inform future bioethics research. (shrink)

For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients (or their proxies) over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based (...) on the well-documented tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed "medically inappropriate" will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience. (shrink)

The “binding problem” has been a central question in vision science for some 30 years: When encoding multiple objects or maintaining them in working memory, how are we able to represent the correspondence between a specific feature and its corresponding object correctly? In this letter we argue that the boundaries of this research program in fact extend far beyond vision, and we call for coordinated pursuit across the broader cognitive science community of this central question for cognition, which we dub (...) “Binding Problem 2.0”. (shrink)

The question, “Why has Harriet Taylor MM appeared in the history of philosophy as she has?” has several answers. The answers intertwine the personality and polities of Harriet, the sexism of those who wrote of her, misunderstandings of the means and meaning of her collaboration with John Stuart Mill, and the disturbing challenge of her questioning.

This study investigated the relationship between supervisor personality and subordinate reports of exposure to bullying and harassment at work. Three research questions were examined: Is there a direct relationship between supervisor personality and reports of workplace bullying? Is there an interaction between supervisor personality and supervisors’ perceived stress as predictors of workplace bullying? Will subordinates who experience bullying at their workplace rate their supervisor’s personality more negatively? The sample consisted of 207 supervisors and employees within 70 Norwegian restaurants. Supervisors low (...) on conscientiousness, high on neuroticism and portraying high levels of exposure to stress were the subject of significantly more reports from subordinates of exposure to workplace bullying. An interaction between agreeableness and stress was found showing that agreeableness is related to bullying under low levels of stress. In addition, subordinates who perceived their supervisor as being low on agreeableness and high on introversion reported significantly more workplace bullying, supporting a negative halo effect hypothesis. (shrink)

In this article, I address the question of the apportionment of the consequences of organizational misconduct to individual members of the organizational elite. I argue that this process can be best understood by marrying the behavioral aspects of stigma theory to the economic mechanisms of ex post settling up. Viewed in conjunction with stigmatization, ex post settling up following organizational misconduct can be seen as the result of attempts to avoid stigma by association. Efforts at stigma avoidance on the parts (...) of various stakeholders produce the diminished social interaction associated with ex post settling up: departure from the focal firm, and loss of seats on other boards. This also suggests that the process of stigmatization, and hence ex post settling up, can be influenced by characteristics of social interaction unrelated to the misconduct itself. (shrink)

Times of crisis bring about increased demands on businesses as shortages, or unexpected but significant, business costs are encountered. Passing on such costs to consumers is a challenge. When faced with a retail price increase, consumers may rely on cues as to the motive behind the increase. Such cues can raise suspicion of alternative motive (e. g., taking advantage of the consumer) affecting consumers' judgments of price fairness. This research investigates two triggers of suspicion: salience of alternative motives, and behavior (...) judged to be out-of-character for the business. Results of the two studies within crisis contexts indicate that suspicion is created when alternative motives are salient and when a retailer acts out-of-character. Multiple group analyses revealed that suspicion induced negative affect and subsequent perceptions of price fairness. When suspicion was present, more negative feelings toward the retailer and judgments of price unfairness resulted. (shrink)

It is well established that math anxiety has a negative relationship with math performance. A few theories have provided explanations for this relationship. One of them, the Attentional Control Theory, suggests that anxiety can negatively impact the attentional control system and increase one's attention to threat-related stimuli. Within the ACT framework, the math anxiety —working memory relationship is argued to be critical for math performance. The present meta-analyses provides insights into the mechanisms of the MA—MP relation and the mediating role (...) of WM. Through database searches with pre-determined search strings, 1,346 unique articles were identified. After excluding non-relevant studies, data from 57 studies and 150 effect sizes were used for investigating the MA—MP correlation using a random-effects model. This resulted in a mean correlation of r = −0.168. The database search of WM as a mediator for the MA—MP relation revealed 15 effects sizes leading to a descriptive rather than a generalizable statistic, with a mean indirect effect size of −0.092. Overall, the results confirm the ACT theory, WM does play a significant role in the MA—MP relationship. (shrink)

Walt Disney’s movie, The Pagemaster (1994) begins on a dark and stormy night, with a young boy stumbling into an immense, gothic-styled library for refuge from the rain. Once inside, he is soon carried away by a tumultuous river of coloured paints, transformed into an animated characterization of himself, and thrust into an animated world of literature, where he battles Captain Hook, flees Moby Dick, and participates in other classic tales of adventure, horror, and fantasy. -/- Adults might understand the (...) film as a fanciful description of how they feel when reading a lively book. Although they would probably not imagine themselves tagging along with the animated characters like a 4th musketeer, they might very well claim that they enter a fiction through the viewpoint of one or more of the characters, experiencing, imaginatively, mental images of the sights, sounds, smells, and movements that the character would experience. Under this description, the reader would be forming multi- modal images that would correspond directly to what the literary characters are doing, thinking, and experiencing. When a fictional hero whips out his sword and slashes a rope in half, the reader might form a visual image of the hero’s determined face, an auditory image of the sound of the whizzing sword, and a motor image of an extended arm movement. I call such an imitative participation, by use of mental images in any modality, a simulation. -/- I suggest that this imitative experiencing of a fiction through the production of multi-modal imagery - a simulation - is not the only way in which readers might engage a literary text. In this paper I explore the hypothesis that readers might use their own bodily processes - those of the somato-viscero-motor system (SVM) for a non-imitative activity that I call a reinterpretation and that the reinterpretation might make a distinctive contribution to the reading process. As an example of a simulation and a reinterpretation, take the SVM experience of the reader’s breathing. A simulation would occur if the text describes a character who is taking deep breaths of air and the reader creates a mental image representing the experience of breathing. In this case, the reader’s mental image of breathing would stand for a property of the literary work - the fictional experience of breathing. -/- By contrast to the simulation, a reinterpretation would occur if the text describes a character who is gazing at long, wispy clouds that extend outward from a horizon and the reader uses his own experience of breathing to stand for the visual sense of looking at a long, continuous expanse of filmy white: the reader’s actual breathing would stand for a property of the literary work - the fictional experience of seeing. Breathing is not the same as seeing. This should help clarify the following definition. -/- I hypothesize that a reinterpretation occurs when the reader becomes aware of some component of the SVM system and reinterprets it as a property of the literary work that is not the same as that particular SVM process. The SVM experience is projected into the literary work. (shrink)

Although beef and dairy production in Alberta, Canada, enjoys strong public support, there are enduring public concerns, including farm animal welfare. Evolving codes of practice and animal care councils prescribe changes and improvements to many areas of farm management, and may be seen by farmers as an appropriate response to public animal welfare concerns. However, codes of practice do not address every animal welfare concern, and new concerns can arise over time. Drawing on social practice theory and in-depth field research (...) with 36 cattle and dairy farmers, this paper explores the materials, competencies, and meanings of four animal husbandry practices: branding, dehorning, weaning, and on-farm handling and moving. Findings show that branding and dehorning are evolving slowly with attention to pain management, but remain firmly rooted in ranching tradition and communities of practice. Weaning and animal handling practices are evolving more quickly with attention to changing materials, attitudes, and values that are more prevalent within producer communities. (shrink)

The Patient Self Determination Act of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient’s preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity. In general, patients are presumed to have DMC. A patient’s DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. (...) Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders. (shrink)

_The power and materiality of form. On studying the forms of knowledge in catechisms and ship’s logs._ The article argues that in the emerging field of the history of knowledge, with its focus on the production, circulation and exchange of knowledge, explorations of _ forms _ will represent a valuable addition. Form is related to genre. Yet, while the identification of genres is largely based on linguistic, literary or rhetorical criteria, form is also about structures and materiality as well as (...) about practical and institutional preconditions. Form often attracts less attention than contents, although the form makes this content recognizable _ as _ knowledge. Our argument builds on the exploration of two different early modern knowledge forms, the catechism and the ship's log respectively. Both demonstrate how form is decisive in defining contents as authoritative knowledge. They also illustrate how form is a prerequisite to enable knowledge to circulate and be part of cultural exchange, and thus to be socially efficient. The forms serve to codify existing knowledge, but also to the production and circulation of new insights. When forms like the log and the catechism are examined historically, however, they can also be seen to live their own lives in a tension between stability and change. The forms themselves become objects of negotiations, change and innovation. (shrink)

Anxiety disorders represent the most common class of mental illness. In fact, approximately one-third of adults report clinically significant symptoms of anxiety (Kessler et al., 2012), of which sy...

Twentieth-century ideologies, from liberalism to fascism, are rooted in humanism—the faith in the sovereignty of human reason and potential that grew out of Renaissance thought and discovery. This special issue asks if it is true that all vestiges of humanism have been dismantled, or whether humanism has taken on new forms. Have new versions of historical analysis and cultural studies reanimated humanist themes? What is posthumanism? These essays examine relationships among structuralism, poststructuralism, and the subject; explore the challenge of anticolonialist (...) critique to the coherence of antihumanism; reconsider the canon of antihumanists such as Heidegger and Foucault, and broach the intractable problems posed by efforts to comprehend the Holocaust, the camps, and ethnic cleansing. _Contributors_. Athena Athanasiou, Etienne Balibar, Mara de Gennaro, Carolyn J. Dean, Brady Thomas Heiner, Lynne Joyrich, Jacques Lezra. (shrink)

This article is a précis of the book, Living well now and in the future: Why sustainability matters. It provides an overview of the book, focusing especially on its conceptualization of the nature and normative dimensions of sustainability. The latter include its formulation of an ethic of sustainability and eudaimonic theory of justice. Some central claims are that the fundamental normative concern of sustainability is the long-term preservation of opportunity to live well, and that the conceptualization of preservation of opportunity (...) should be focused on the satisfaction of basic psychological needs associated with fulfillment of potential. (shrink)

This article provides practical guidance for researchers who wish to enroll and collect data from pediatric research participants through online and mobile platforms, with a focus on the involvement of both children and their parents in the decision to participate.

In lieu of an abstract, here is a brief excerpt of the content:The Institute of MedicineRuth Ellen Bulger (bio)IN 1863 the National Academy of Sciences (NAS) was established by federal charter to advise the government on scientific matters. Almost 100 years later, in 1971, the Academy created the Institute of Medicine within the NAS to focus on health-related problems and issues. Today the IOM has a program budget of about $13 million, which includes both private and government funds, and (...) is regarded as a leading center for health policy research.After briefly explaining the structure and general goals of IOM, this article describes several new or anticipated projects as well as some recently completed reports that have a strong ethical component.The IOMThe IOM's distinguished membership is made up of health care professionals of all sorts, scientists working in health-related disciplines, and lawyers, economists, and others knowledgeable in and involved with policies and activities associated with health issues. It is organized around eight working groups or divisions: Health Sciences Policy; Health Care Services; Health Promotion and Disease Prevention, including AIDS activities; International Health; Biobehavioral Sciences and Mental Disorders; the Food and Nutrition Board; the Medical Follow-up Agency; and the Health Policy Fellowship Programs. Each of these divisions is assisted by an oversight board that provides advice on its activities.It is important to know at the outset that IOM has decided that each of the divisions will include consideration of human values and ethical issues in their activities. Therefore, no separate locus was established within the IOM to deal with these matters. I am director of the Division of Health Sciences Policy, which is the only division that has made ethics a priority in its work, and it is the focus of this article.We have addressed questions of ethics, human values, social values, decision making, and priority setting in many of the division's reports. In fact, most of our reports at least raise ethical questions. In addition, a portion of the interest from endowment funds given to IOM by the Howard Hughes Medical Institute has been devoted to work in this area. [End Page 73]The division's advisory board, headed by Claude Bennett, chairman of the Department of Medicine, University of Alabama at Birmingham School of Medicine, has decided on two major priorities for the division: (1) foster an environment conducive to productive research, and (2) anticipate the impact of scientific—especially biomedical—advances on society, monitoring and considering the social and ethical factors that accompany basic scientific and technological progress. These two priorities are interdependent because the fostering of a good environment for research presupposes that the results of this research will produce beneficial effects for the society that supports the research.Upcoming StudiesSociety has been unable to establish a mechanism for discussing in a meaningful way—and possibly resolving—a number of pressing national issues with social, ethical, legal, and scientific ramifications. The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research considered several such issues and produced important reports about them. However, the commission was funded only until 1983. The Congressional Biomedical Ethics Advisory Committee was authorized in 1985 to address these contentious issues, but it was caught in the crossfire of congressional abortion politics and subsequently died. A new model is needed to attempt to develop national consensus on these complex, contentious issues.The Board on Health Sciences Policy has wrestled with this idea. Recently, it approved a proposal to establish a study committee charged with developing effective alternative methodologies for anticipating and addressing the social, legal, and ethical issues that may accompany rapid advances in biomedical science and technology. This multidisciplinary committee will be given a series of tasks: (1) to explore past experiences with some of these varying methodologies (i.e., town meetings, consensus conferences, forums, commissions, etc.); (2) to develop an agenda of issues likely to arise in the future; (3) to define and test a variety of alternative methodological approaches to these questions; (4) to evaluate strengths, weaknesses, and impact of the various approaches; and (5) to make recommendations on the process and structure by which this fact-finding, analytical, and decision-making function could be... (shrink)

影響全球的COVID-19已經進入第三年，在疫情時代或後疫情時代的種種爭論中，相關的倫理考量依然是學界關注的議題。本期的論文涉及具體的醫學倫理學問題，包括香港抗疫倫理焦點、ECMO的使用、疫情防控中的 道德兩難、現代科技大數據所引發的對個人隱私的焦慮、疫情處境中的善終和臨終關懷、審視傳統中醫學有關疫情控制的歷史研究、傳統墨家思想對現當下防疫管理的啟示作用。本期的論文的研究方法各有不同，包括哲學的、倫 理學的、實證的、歷史的、及比較的，其宗旨是引發人們對這些問題的反思和探討。.

This book discusses ways for people to handle today's bioethical issues in the context of America's history and culture--and from the perspective of various ...

This paper discusses the role of the expert in giving advice to policy makers. It argues that, since biotechnology is an area characterised by value conflicts and fragile public trust in scientific experts and authorities, broader consultation processes which include both ethicists and laypeople should be conducted.“Expertise, it may be argued, sacrifices the insight of common sense to intensity of experience… The expert fails to realise that every judgement he makes not purely factual in nature brings with it a scheme (...) of values which has no special validity about it” (Laski, 1930). (shrink)

Background: Most older people wish to live in the familiar surroundings of their own home until they die. Knowledge concerning dignity and dignity loss of home-dwelling older women living with incurable cancer should be a foundation for quality of care within municipal healthcare services. The informal caregivers of these women can help increase the understanding of sources related to dignity and dignity loss Aim: The aim of this study was to explore informal caregivers’ perceptions of sources related to dignity and (...) dignity loss in end-of-life of older home-dwelling women with incurable cancer. Research design and method: The study was founded upon Gadamer’s philosophical hermeneutics. In-depth interviews with 13 informal caregivers were carried out, and four participant observations were performed during home meetings. Ethical consideration: The study was based on voluntary participation, informed consent, confidentiality and the opportunity to withdraw at any time. The Norwegian Social Science Data Services approved the study. Results: Three main sources important in preserving the older women’s dignity were identified: maintaining one’s self-concept, remaining hopeful and sustaining freedom of choice. We also identified three main sources that lead to dignity loss: Sensing loss of human value, experiencing absence of gentleness and feelings of being treated as an object. Discussion and final considerations: On the individual level, the opportunity to maintain one’s self-concept and control in life, preserved dignity, while feelings of existential loneliness led to dignity loss. On the relational level, being confirmed as worthy human beings promoted the women’s dignity, whereas dignity loss was related to uncaring behaviours from healthcare professionals. On the societal level, individual decisions concerning travel situations and the place to stay when nearing end-of-life were of crucial importance. Constituting these women’s living space, these perspectives should be emphasized in healthcare professionals’ educational training and in the municipal end-of-life care of these patients. (shrink)

The articles collected in this volume point out that society as a whole is changing. Social change is due not only to changes in technology and economy, but also to the changing strategies and discourses of social scientists. To what exactly will this change lead in the 21st century? What kind of society lies ahead? In this book the reader will find many arguments and hints pertaining to these questions. She/he will be confronted by a plethora of enriching conceptions of (...) the relationships between social sciences and social changes. (shrink)

The essays gathered here demonstrate and justify the excitement and promise of cognitive historicism, providing a lively introduction to this new and quickly growing area of literary studies. Written by eight leading critics whose work has done much to establish the new field, they display the significant results of a largely unprecedented combination of cultural and cognitive analysis. The authors explore both narrative and dramatic genres, uncovering the tensions among presumably universal cognitive processes, and the local contexts within which complex (...) literary texts are produced. Alan Richardson's opening essay evaluates current approaches to the study of literature and cognition, locating them on the map of recent literary studies, indicating their most compelling developments to date, and suggesting the most promising future directions. The seven essays that follow provide innovative readings of topics ranging from Shakespeare (Othello, Macbeth, Cymbeline, The Rape of Lucrece) through Samuel Richardson's Clarissa, to contemporary authors Ian McEwan and Gilbert Sorrentino. They underscore some of the limitations of new historicist and post-structuralist approaches to literary cultural studies while affirming the value of supplementing rather than supplanting them with insights and methods drawn from cognitive and evolutionary theory. Together, they demonstrate the analytical power of considering these texts in the context of recent studies of cultural universals, 'theory of mind, ' cognitive categorization and genre, and neural-materialist theories of language and consciousness. This groundbreaking collection holds appeal for a broad audience, including students and teachers of literary theory, literary history, cultural studies, and literature and science studies. (shrink)

The promises of precision medicine are often heralded in the medical and lay literature, but routine integration of genomics in clinical practice is still limited. While the “last mile” infrastructure to bring genomics to the bedside has been demonstrated in some healthcare settings, a number of challenges remain — both in the receptivity of today's health system and in its technical and educational readiness to respond to this evolution in care. To improve the impact of genomics on health and disease (...) management, we will need to integrate both new knowledge and new care processes into existing workflows. This change will be onerous and time-consuming, but hopefully valuable to the provision of high quality, economically feasible care worldwide. (shrink)

This volume offers an empirical and diachronic investigation of the foundations and nature of metaphor in English. Metaphor is one of the hot topics in present-day linguistics, with a huge range of research focusing on the systematic connections between different concepts such as heat and anger, sight and understanding, or bodies and landscape. Until recently, the lack of a comprehensive data source made it difficult to obtain an overview of this phenomenon in any language, but this changed with the completion (...) in 2009 of The Historical Thesaurus of English, the only historical thesaurus ever produced for any language. Chapters in this volume use this unique resource as a basis for case studies of semantic domains including Animals, Colour, Death, Fear, Food, Reading, and Theft, providing a significant step forward in the data-driven understanding of metaphor. (shrink)