Introduction It is increasingly considered important that people make an autonomous and informed decision concerning colorectal cancer screening. However, the realisation of autonomy within the concept of informed decision-making might be interpreted too narrowly. Additionally, relatively little is known about what the eligible population believes to be a 'good' screening decision. Therefore, we aimed to explore how the concepts of autonomous and informed decision-making relate to how the eligible CRC screening population makes their decision and when they believe to have (...) made a 'good' screening decision. Methods We conducted 27 semi-structured interviews with the eligible CRC screening population. The general topics discussed concerned how people made their CRC screening decision, how they experienced making this decision and when they considered they had made a 'good' decision. Results Most interviewees viewed a 'good' CRC screening decision as one based on both reasoning and feeling/intuition, and that is made freely. However, many CRC screening non-participants experienced a certain social pressure to participate. All CRC screening non-participants viewed making an informed decision as essential. This appeared to be the case to a lesser extent for CRC screening participants. For most, experiences and values were involved in their decision-making. Conclusion Our sample of the eligible CRC screening population viewed aspects related to the concepts of autonomous and informed decision-making as important for making a 'good' CRC screening decision. However, in particular the existence of a social norm may be affecting a true autonomous decision-making process. Additionally, the present concept of informed decision-making with its strong emphasis on making a fully informed and well-considered decision does not appear to be entirely reflective of the process in practice. More efforts could be made to attune to the diverse values and factors that are involved in deciding about CRC screening participation. (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)

Recent developments in children's rights have led to increased criticism of the presumption of total incompetency until adulthood, a concept inconsistently defined by state law. Citing proposals from several disciplines, this article calls for increasing actual competency in decision-making through systematic education in conjunction with developmental levels and experience. The elements of informed consent are suggested as one mechanism for learning to make educated decisions in a variety of settings. The treatment of hyperkinetic children is discussed as a case example.

This chapter contains sections titled: Mothering and the Quest for Certainty Finding Answers to Mothering Questions Both/And Not Either/Or Toward a Pragmatic Approach to Mothering Notes.

Introduction -- Introducing phenomenology: Husserl and Heidegger -- Imagining the possible: hermeneutical phenomenology -- Experiencing transcendence: the "theological turn" of French phenomenology -- Letting be: the gelassenheit of the Annunciation -- Conclusion: Being-in-life: reading the Annunciation as theopoesis.

Domain experts regularly teach novice students how to perform a task. This often requires them to adjust their behavior to the less knowledgeable audience and, hence, to behave in a more didactic manner. Eye movement modeling examples (EMMEs) are a contemporary educational tool for displaying experts’ (natural or didactic) problem‐solving behavior as well as their eye movements to learners. While research on expert‐novice communication mainly focused on experts’ changes in explicit, verbal communication behavior, it is as yet unclear whether and (...) how exactly experts adjust their nonverbal behavior. This study first investigated whether and how experts change their eye movements and mouse clicks (that are displayed in EMMEs) when they perform a task naturally versus teach a task didactically. Programming experts and novices initially debugged short computer codes in a natural manner. We first characterized experts’ natural problem‐solving behavior by contrasting it with that of novices. Then, we explored the changes in experts’ behavior when being subsequently instructed to model their task solution didactically. Experts became more similar to novices on measures associated with experts’ automatized processes (i.e., shorter fixation durations, fewer transitions between code and output per click on the run button when behaving didactically). This adaptation might make it easier for novices to follow or imitate the expert behavior. In contrast, experts became less similar to novices for measures associated with more strategic behavior (i.e., code reading linearity, clicks on run button) when behaving didactically. (shrink)

Attention is being focused on the tone at the top in businesses in the United States with the publication of the Report of the Commission on Fraudulent Financial Reporting. There has been growing discontent with the quality of ethcial behavior in the business society and at the present moment many American companies are developing — or revising — codes of ethics and establishing procedures for their implementation. Yet, there is some question about the success of such efforts.This article describes the (...) efforts of an early American entrepreneur to develop a code of ethics and to implement it throughout his organization during the early years of relatively rapid growth. The code was introduced in 1913 and was supported through a variety of means in which the leader himself participated. That early code continues to be reissued as the company updates its overall code of ethics. The persistent and seemingly genuinc commitment to ethical behavior throughout the company was evident in all aspects of the leader's behavior. (shrink)

Ellen Meiksins Wood is a leading contemporary political theorist who has elaborated an innovative approach to the history of political thought, the social history of political theory .

Ellen Goodman uses extensive extracts from original writings to highlight the main themes of the Western legal tradition.The strength of the book is its clear ...

The author analyses the design of her collaborative animation about inattention blindness, the phenomenon of not being able to see things that are actually there, and compares it to related scientific research.1 The term was coined by Arien Mack and Irvin Rock in 1992. Stealing Attention, co-created by the author and neuroscientist Michael E. Goldberg, Director of the Mahoney Center for Brain and Behavior at Columbia University, explored inattention blindness. Animated images of hands playing the con game Three-Card Monte were (...) superimposed over images of antiquities stolen from Iraq. The flashing cards, yellow circles and stated instructions distracted the viewer from seeing the images of stolen antiquities, which disappeared from depicted shelves one by one over the time span of approximately three minutes. The author considers five questions: What is perceived without attention What does attention select Under what circumstances can attention be shifted Is an observer trained in art less likely to be distracted Can attention be trained. (shrink)

This book examines puzzles about the arts wherever their provenance - as long as there is empirical research using the methods of social science that can shed light on these questions. The examined research reveals how ordinary people think about these questions, and why they think the way they do - an inquiry referred to as intuitive aesthetics. The book shows how psychological research on the arts has shed light on and often offered surprising answers to such questions.

In Enthymemes and Topoi in Dialogue, Ellen Breitholtz presents a novel and precise account of reasoning from an interactional perspective. The account draws on the concepts of enthymemes and topoi, originating in Aristotelian rhetoric and dialectic, and integrates these in a formal dialogue semantic account using TTR, a type theory with records. Argumentation analysis and formal approaches to reasoning often focus the logical validity of arguments on inferences made in discourse from a god's-eye perspective. In contrast, Breitholtz's account emphasises (...) the individual perspectives of interlocutors and the function and acceptability of their reasoning in context. This provides an analysis of interactions where interlocutors have access to different topoi and therefore make different inferences. (shrink)

The book takes an unfamiliar interface and feature set and makes it logical and intuitive so that Aperture quickly feels like an old friend.

The development of T cells and B cells from pluripotent hematopoietic precursors occurs through a stepwise narrowing of developmental potential that ends in lineage commitment. During this process, lineage-specific genes are activated asynchronously, and lineage-inappropriate genes, although initially expressed, are asynchronously turned off. These complex gene expression events are the outcome of the changes in expression of multiple transcription factors with partially overlapping roles in early lymphocyte and myeloid cell development. Key transcription factors promoting B-cell development and candidates for this (...) role in T-cell development are discussed in terms of their possible modes of action in fate determination. We discuss how a robust, stable, cell-type–specific gene expression pattern may be established in part by the interplay between endogenous transcription factors and signals transduced by cytokine receptors, and in part by the network of effects of particular transcription factors on each other. BioEssays 21:726–742, 1999. © 1999 John Wiley & Sons, Inc. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

Das vorliegende Open-Access-Buch zeigt, wie Kinder im Grundschulalter auf philosophische Gedanken reagieren. Diese werden den Kindern in Form von Kürzesttexten dargeboten. Auf Veranschaulichungen wird bewusst verzichtet. Dieser Zugang zum Philosophieren erscheint ungewöhnlich, wird doch in der Regel beim Philosophieren mit Kindern auf anschauliche Zugänge zurückgegriffen. Es zeigt sich jedoch, dass Kinder auf diese ungewöhnliche Einladung auf ebenso ungewöhnliche, eigenwillige und kreative Weise reagieren. Die vorliegende empirische Studie kommt mithin zu dem Ergebnis: Der Einsatz von Kürzesttexten erweist sich als lohnend. Die (...) Autorin Ellen Franziska Möller ist ausgebildete Lehrerin (Sek I und Sek II) für die Fächer Philosophie, praktische Philosophie und Physik. Zwischen 2019 und 2022 hat sie am Philosophischen Seminar der Universität zu Köln das Forschungsprojekt "Philosophie in der Primarstufe" vertreten. (shrink)

The consideration of deliberate versus automatic processing of numeric representations is important to math education, memory for numbers, and decision-making. In this commentary, we address the possible roles for numeric representations in such higher-level cognitive processes. Current evidence is consistent with important roles for both automatic and deliberative processing of the representations.

Howe et al. fail to provide evidence that practice is sufficient and ignore evidence of high ability before instruction. They unsuccessfully discount savants; provide weak evidence against heritability of music, criticize retrospective evidence selectively, using it when it supports their position; and ultimately both accept and deny talent. Finally, they conflate a scientific question with one of policy.

In the spirit of full disclosure, I have been a member of the Delphi panels discussed in this article (Beskow and Weinfurt 2019) since their inception and was one of the people who was recently int...

As medical technology has advanced, the question of medical futility has become a topic of intense debate both within the medical community and within society as a whole. However, a unanimous definition thereof is yet to be decided—some commentators are sceptical as to whether an agreement will ever be reached—and this continues to lead to difficulties, tension, and even legal action when a treating physician disagrees with a patient and/or a patient’s family regarding care and treatment options. Although living in (...) a pluralistic society presents one of the major reasons as to why, despite 30 years of intense discussion, no consensus has been made; the issue of medical futility will always be complex as it is, by nature, multifaceted, and numerous elements—including possible risks, evidence of the probability of benefit, the wishes of the patient (and family), professional standards, and cost—interact. Nevertheless, the global medical community has seen the development of two distinctly different approaches to medical futility: one in which the autonomy of patients is of paramount importance in the decision whether or not to pursue a treatment; and one in which beneficence and primum non nocere—first do no harm—are almost entirely the clinician’s prerogative, and whereby he/she has a duty to refuse any treatment for which the potential risks outweigh the potential benefits for the patient. Recently, however, there has been a rejection of this dichotomous view of medical futility and the apparent “power struggle” between physician and patient, and a positive movement towards a more collaborative decision-making process that highlights the necessity of communication, aiming to result in the obtainment of the best possible outcome for each patient as an individual. (shrink)

This article proposes a form of visual narrative that fuses authoring and data within a unified paradigm called the ‘visual image data field’. A structure with multidimensional connections in a fluid environment that self-reflexively responds to its own usage supports the future language of visual sources. The intuitive gestures and curiosity that drive visual knowledge similarly drive development of this organic architecture. Diffusing iconic images that are shorthand for conveying historical trends makes this type of unambiguous expository reading obsolete as (...) images are embedded within the rich image fields native to digital media. A topsy-turvy game of images upsets the dominance of iconic images most frequently reproduced in text-based media and redistributes meaning across a pictorial array. Meaning not only changes according to the juxtaposition of images, but also emerges from the cracks between similar scenes. Images in relationship to other images acquire a granularity that deepens meaning by adding different qualities – less narrative and quantifiable – of understanding. If images become the ‘narremes’ or grammatical elements in a visual narratology, then meaning emerges from their sequencing and re-sequencing. (shrink)

The vast visual coverage of the Boxer Uprising in northern China that ended with foreigners traipsing through the Forbidden City in Beijing reflects both the richly innovative image technology at the turn of the century and the international interest in events that involved many of the world’s most powerful nations. Historians and students who seek to understand the incident through the innovative technology of today can, for the first time, access primary source images in large numbers malleably displayed in the (...) digital environment. The sheer volume of images collected in one place offers powerful new insights into a history already broadly covered in analytical texts and first-person accounts. One qualitative difference from previous histories is the emergence of subjective points of view that can be conveyed in multidimensional models that juxtapose experiential recordings of the day. Harnessing the tension of contrasting viewpoints – who knew what when – enables today’s learners to see through the lenses of past participants whose understanding was limited by location, communications and, one must remember, by not knowing the outcome. Those who were besieged in the Foreign Legations did not know if they would survive; soldiers and rebels on the road to Beijing knew only the difficulties of the march; illustrations in newspaper reports overseas were coloured by politics and both national and international rivalries. Digital visual representations have the possibility of recreating the collision of experiences that allow users to move between personal records and public reporting from the time to gain a knowledge that is unmitigated by an author’s text-based presentation and conclusions. The result is as much a revolution in perception of historical events – perception-based learning – as it is in information about these events. (shrink)

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, CERN (...) sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)