BackgroundCommentators believe that the ethical decision-making climate is instrumental in enhancing interprofessional collaboration in intensive care units. Our aim was twofold: to determine the perception of the ethical climate, levels of moral distress, and intention to leave one's job among nurses and physicians, and between the different ICU types and determine the association between the ethical climate, moral distress, and intention to leave.MethodsWe performed a cross-sectional questionnaire study between May 2021 and August 2021 involving 206 nurses and physicians in a (...) large urban academic hospital. We used the validated Ethical Decision-Making Climate Questionnaire and the Measure of Moral Distress for Healthcare Professionals tools and asked respondents their intention to leave their jobs. We also made comparisons between the different ICU types. We used Pearson's correlation coefficient to identify statistically significant associations between the Ethical Climate, Moral Distress, and Intention to Leave.ResultsNurses perceived the ethical climate for decision-making as less favorable than physicians. They also had significantly greater levels of moral distress and higher intention to leave their job rates than physicians. Regarding the ICU types, the Neonatal/pediatric unit had a significantly higher overall ethical climate score than the Medical and Surgical units and also demonstrated lower moral distress scores and lower “intention to leave” scores compared with both the Medical and Surgical units. The ethical climate and moral distress scores were negatively correlated ; moral distress and "intention to leave" was positively correlated ; and ethical climate and “intention to leave” were negatively correlated.ConclusionsSignificant differences exist in the perception of the ethical climate, levels of moral distress, and intention to leave between nurses and physicians and between the different ICU types. Inspecting the individual factors of the ethical climate and moral distress tools can help hospital leadership target organizational factors that improve interprofessional collaboration, lessening moral distress, decreasing turnover, and improved patient care. (shrink)

Because of the coronavirus pandemic, reminders of death are particularly salient. Although much terror management theory research demonstrates that people engage in defensive tactics to manage mortality awareness, other work shows that existential concerns can motivate growth-oriented actions to improve health. The present study explored the associative link between coronavirus anxieties, fear of death, and participants' well-being. Results, using structural equation modeling, found that increased mortality concerns stemming from COVID-19 were associated with heightened benefit finding from the pandemic. Increased benefit (...) finding, in turn, was related to higher life satisfaction, meaning in life, self-esteem, resilience, and vitality while also correlating negatively with depression and stress scores. There was no evidence for reverse mediation in that fear of mortality did not predict well-being through coronavirus worries. Overall, although many persons have experienced mental health concerns as a function of the COVID-19 pandemic, our findings demonstrate positive benefits that paradoxically follow in terms of an increased appreciation of life, improved relationships, and better health. (shrink)

Difference and Habit: Deleuze anti-Hegelian critique of consciousness Since Antiquity, habit has been understood as a second nature, as something that we develop in a conscious or unconscious way, and which directs and structures both our cognitive and practical lives – our consciousness and our actions. For Hegel, habit effectuates the transition from nature to spirit or consciousness, thus forming the basis of morality. Habit thus constitutes an essential stage in the development of the mind and a crucial aspect of (...) Hegel’s philosophical anthropology. Habit also plays a crucial role in the thinking of the French philosopher Gilles Deleuze, who characterizes his philosophical project as anti-Hegelian or anti-dialectical. Even though many works examine the relationship between Deleuze and Hegel, almost none of these discuss the concept of habit of these authors, and the role that it plays in Deleuze’s so-called anti-Hegelianism. In this article, I address the concept of habit in Difference and Repetition, and the role it plays in Deleuze’s critique of Hegel. I also compare this concept with Hegel’s own conception of habit in his Anthropology. I show that Deleuze certainly does not understand repetition as second nature as Hegel does, because then it is impossible to account for the productive power of the unconscious or the sub-representative, and of real creativity. I distinguish my interpretation of habit in Deleuze from that of a number of other authors, who, in my view, do not draw all the conclusions from Deleuze’s interpretation of Hume. I then expound Deleuze’s original notion of habit and compare it with Hegel’s. (shrink)

Tentant de rompre avec une représentation de la sérendipité comme produit du hasard et de la chance relatifs à « l’esprit scientifique », il s’agit ici d’analyser comment la sérendipité peut être le produit d’une concordance des « temporalités de champs » résultant d’une combinatoire de temps d’habitus, d’activité et d’institution propres à chaque champ. Ces temporalités de champs rythmant leurs luttes pour le monopole de la pratique scientifique, elles constituent un point de concordance entre champs à partir desquels s’agencent (...) les conditions de production et d’identification d’une découverte « par sérendipité ». Une telle approche a, au reste, l’avantage de combler un point aveugle de la littérature sociologique et de proposer une analyse structuraliste du processus de découverte scientifique permettant de l’appréhender comme « pratique coordonnée d’institution ». (shrink)

Recent decades have seen a dramatic transformation in the mode of governing, with government increasingly outsourced to a network of private actors, spanning education, prisons, regulation, arbitration, the military, and access to healthcare and welfare. Chiara Cordelli’s The Privatized State probes the ethical and philosophical questions raised by this transformation, and develops a distinctive account of the wrong of privatization: that a privatized government cannot be a legitimate government. In so doing, Cordelli engages and advances not only pressing questions about (...) privatization, but also broader questions about public administration, political representation, democratic authority, and neorepublicanism. This symposium brings together scholars for a wide-ranging discussion of this transformation in governance and the deep and challenging questions it raises. (shrink)

Mobile phone-based applications (apps) can promote faster targeted actions to control COVID-19. However, digital contact tracing systems raise concerns about data security, system effectiveness, and their potential to normalise privacy-invasive surveillance technologies. In the absence of mandates, public uptake depends on the acceptability and perceived legitimacy of using technologies that log interactions between individuals to build public health capacity. We report on six online deliberative workshops convened in New South Wales to consider the appropriateness of using the COVIDSafe app to (...) enhance Australian contact tracing systems. All groups took the position (by majority) that the protections enacted in the app design and supporting legislation were appropriate. This support is contingent on several system attributes including: the voluntariness of the COVIDSafe app; that the system relies on proximity rather than location tracking; and, that data access is restricted to local public health practitioners undertaking contact tracing. Despite sustained scepticism in media coverage, there was an underlying willingness to trust Australian governing institutions such that in principle acceptance of the new contact tracing technology was easy to obtain. However, tensions between the need to prove system effectiveness through operational transparency and requirements for privacy protections could be limiting public uptake. Our study shows that informed citizens are willing to trade their privacy for common goods such as COVID-19 suppression. But low case numbers and cautionary public discourses can make trustworthiness difficult to establish because some will only do so when it can be demonstrated that the benefits justify the costs to individuals. (shrink)

Depuis l’Approche Communicative et aujourd’hui avec la méthode actionnelle, la littérature a été réhabilitée. Elle fait partie des supports de cours mais reste néanmoins réservée aux niveaux plus avancés du Cadre européen commun de référence pour les langues. Nous montrerons à travers plusieurs exemples qu’au contraire l’apprenant de FLE doit être sensibilisé dès le niveau débutant à la musicalité de la langue française par des textes où les auteurs se sont attachés à en travailler tout particulièrement le rythme, l’intonation, la (...) syllabation et la sonorité. Nous montrerons aussi qu’il faut aller au-delà de la phonématique pure et de la discrimination auditive par paires minimales et traiter de phénomènes que l’on a eu trop tendance à oublier mais qui ont reçu l’attention de certaines nouvelles phonologies qui se sont développées pour le domaine français : le « e » instable, la quantité vocalique, les enchaînements, la diérèse…. (shrink)

IntroductionMilitary personnel and Veterans are at increased risk of mental and physical health conditions, which can impact their families. Spouses often perform a vital role in caring for service members and Veterans facing illness or injury, which can lead to caregiver burden. In turn, this may contribute to relationship issues. Research suggests that ensuring that spouses are well supported can alleviate some of these negative effects. The current study examined whether social support received by spouses of newly released Veterans buffers (...) the impact of Veterans’ health on caregiver burden, subsequently impacting spouses’ relationship satisfaction.MethodsData were collected as part of the Canadian Armed Forces Transition and Well-being Survey. The sample included N = 595 spouses of Regular Force Veterans who released in 2016 with at least 2 years of service. We examined Veterans’ mental and physical health and spouses’ caregiver burden, social support, and relationship satisfaction. A moderated mediation model was tested using structural equation modeling.ResultsThere was a significant indirect association between Veterans’ health and spouses’ relationship satisfaction through caregiver burden. Furthermore, social support moderated the association, as evidenced by a weaker association between Veterans’ health and caregiver burden at low levels of social support compared to high levels.ImplicationsFindings suggest additional efforts should be made to ensure sufficient support is provided to spouses, especially when they are caring for a service member or Veteran facing illness or injury, to strengthen their families’ well-being. (shrink)

Background: Individuals with Autism Spectrum Disorder (ASD) have pronounced difficulties in attending to relevant visual information during social interactions. Method: We designed and evaluated the feasibility of a novel method to train this ability, by exposing participants to virtual human characters displayed on a screen which was entirely blurred, except for a gaze-contingent viewing window that followed participants’ eyes direction. The goal was to incite participants to direct their gaze towards the facial expressions of the virtual characters. Twenty-one adolescents with (...) ASD who attended ordinary school were randomized to either an experimental group, who was trained during a month and a half, or to a control group. Social communicative abilities were assessed during pre, post and follow-up tests. Results: After training, the experimental group showed significantly more interest in facial expressions on a test which involved understanding a dialogue. Significant differences were not found for the other tests used. Conclusions: This outcome suggests that the training method fostered participants’ awareness of the relevance of facial expressions. (shrink)

In the wake of the collapse of the Soviet bloc, it is timely to ask what continuing role, if any, the concept of sovereignty can and should play in the emerging "new world order." The aim of _Law, Power, and the Sovereign State_ is both to counter the argument that the end of the sovereign state is close at hand and to bring scholarship on sovereignty into the post-Cold War era. The study assesses sovereignty as status and as power and (...) examines the issue of what precisely constitutes a sovereign state. In determining how a political entity gains sovereignty, the authors introduce the requirements of de facto independence and de jure independence and explore the ambiguities inherent in each. They also examine the political process by which the international community formally confers sovereign status. Fowler and Bunck trace the continuing tension of the "chunk and basket" theories of sovereignty through the history of international sovereignty disputes and conclude by considering the usefulness of sovereignty as a concept in the future study and conduct of international affairs. They find that, despite frequent predictions of its imminent demise, the concept of sovereignty is alive and well as the twentieth century draws to a close. (shrink)

/p. 14 The humanities, as defined by Congress, include the history, theory, and criticism of the arts. While the National Endowment for the Arts funds the creation, performance, and display of art, the National Endowment for the Humanities funds the theoretical dimensions that place the arts within a broader cultural context. Admittedly, the line is sometimes difficult to draw precisely, but generally, the humanities center on verbal analysis of the phenomenon of art, using the methodology and content of various humanities (...) disciplines, such as history and philosophy. (shrink)

In philosophical studies regarding mathematical models of dynamical systems, instability due to sensitive dependence on initial conditions, on the one side, and instability due to sensitive dependence on model structure, on the other, have by now been extensively discussed. Yet there is a third kind of instability, which by contrast has thus far been rather overlooked, that is also a challenge for model predictions about dynamical systems. This is the numerical instability due to the employment of numerical methods involving a (...) discretization process, where discretization is required to solve the differential equations of dynamical systems on a computer. We argue that the criteria for numerical stability, as usually provided by numerical analysis textbooks, are insufficient, and, after mentioning the promising development of backward analysis, we discuss to what extent, in practice, numerical instability can be controlled or avoided. (shrink)

A growing body of research has suggested that high levels of family functioning—often measured as positive parent–child communication and low levels of parental stress—are associated with stronger cognitive development, higher levels of school engagement, and more successful peer relations as youth age. The COVID-19 pandemic has brought tremendous disruption to various aspects of daily life, especially for parents of young children, ages 3–5, who face isolation, disconnection, and unprecedented changes to how they engage and socialize. Fortunately, both youth and parent (...) brains are plastic and receptive to change. Resilience research shows that factors such as engaging in acts of kindness, developing trusting relationships, and responding compassionately to the feelings of others can help lay new neural pathways and improve quality of life. Yet, little research has investigated the effects of brain healthy parental practices of kindness with pre-school aged children. The current study examines whether an interactive, parent–child kindness curriculum can serve as a potentiator for brain health as measured by resilience and child empathy levels. During a peak of the pandemic, mother participants between the ages of 26–46 completed questionnaires on parental resilience levels and parent-reported child empathic pro-social behaviors before and after engaging in a 4 weeks online, self-paced, kindness curriculum. Half of the group received additional brain health education explaining the principles of neuroplasticity, empathy, perspective taking, and resiliency. Mothers in both groups showed increased resilience and reported higher levels of empathic behavior in their child after completing the curriculum. There was no significant difference between groups. Comparison of mean resilience levels during COVID-19 to pre-pandemic general means indicated that mothers are reporting significantly lower levels of resilience as well as decreased empathetic behaviors in their children. These results support the notion that kindness is a powerful brain health booster that can increase resilience and empathy. This research study was timely and relevant for parents in light of the myriad of stresses brought about by the ongoing COVID-19 pandemic. There are broader public health implications for equipping individuals with tools to take a proactive and preventative approach to their brain health. (shrink)

Abstract:Given the distinctiveness of its urban and civic spaces and of the famously strong but also complex sense of civic identity among its populace, sixteenth century Venice is a prime case study for applying spatial thinking when imagining the deliberate construction of space and the relationship of inhabitants to that space; in particular, the relationship between those in power and those without power as indicative throughout the cityscape. The formation and development of central features of Venetian urban space and identity, (...) since maritime topography constrained its urban space, created an unusually cohesive sense of civic identity linked to mythic historical memory. Looking through an interdisciplinary lens, theories of space offer a conceptual framework for imagining how the Venetian cityscape was created and evolved into one of the most diverse and unique cityscapes in the sixteenth century. (shrink)

Communication formats have been influenced by internet culture, and one communication format with staying power—and a heavy dose of humor—is the meme. Shifting over time, meme formats currently span a wide variety of screen captures from various types of media as well as individually produced art. Meme repositories frequently not only record memes but also allow people to make their own memes. Because of existing student familiarity with memes of various types and the process of making memes, memes serve as (...) an interesting and useful mode for shifting communication formats, including using meme creation as a basis for short writing assignments. I explain why assigning meme creation with short writing assignments allows for assessing student comprehension of texts and concepts, describe my own meme creation assignment, and offer support for the claim that this type of assignment has improved student learning, engagement, and writing in my courses. (shrink)

This title provides a synoptic overview of the current state of interdisciplinary research, education, administration and management, and problem solving - knowledge that spans the disciplines and interdisciplinary fields and crosses the space between the academic community and society at large.

Background: Understanding is an important goal of the informed consent process in research. We sought to assess the interrater reliability (IRR) and concurrent validity of two measures of understanding in child and young adult subjects and their parents. Methods: We conducted a cross-sectional survey and interview-based study of children and young adults participating in a clinical trial for cancer, along with one parent per child or young adult subject. We estimated the IRR of the Semi-Structured Comprehension Interview (SSCI) and the (...) MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR). We also estimated concordance between the SSCI, the MacCAT-CR, and the Quality of Informed Consent (QuIC). Results: For our sample of 32 subjects (16 parent–child pairs), IRR estimates were high for total score on the SSCI (intraclass correlation coefficient [ICC] = 0.88, 95% confidence interval [CI] = 0.76–0.94), as well as on the understanding (ICC = 0.93, 95% CI = 0.86–0.97) and reasoning (ICC = 0.97, 95% CI = 0.94–0.98) subscales of the MacCAT-CR. IRR was lower for the appreciation subscale of the MacCAT-CR (ICC = 0.70, 95% CI = 0.47–0.84). Scores on the SSCI were strongly correlated with scores on the understanding subscale of the MacCAT-CR (Spearman's rho = 0.72, 95% CI = 0.48–0.85) and the QuIC (Spearman's rho = 0.66, 95% CI = 0.24–0.87). Mean administration time for the SSCI was 3.1 minutes (95% CI = 2.7–3.5 minutes). Conclusions: The SSCI is a valid and reliable measure of understanding for use with both pediatric and adult research participants. It is easy to administer and score consistently, even by nonprofessional raters. The SSCI is a promising tool for use by clinician-investigators to study, detect, and correct deficiencies in understanding among children, adolescents, and adults making decisions about research participation. (shrink)

An important milestone was crossed recently in the discipline of philosophy, but hardly anyone seems to have noticed. In 2004, for the first time since statistics have been gathered on such things, women earned more than 30 percent of the doctorates in philosophy in this country, 33.3 percent, up from 27.1 percent the year before. The highest percentage women had achieved previously in philosophy was 29.4 percent, in..

Some recent commentators have acquiesced in the efforts of some religious groups to co-opt concepts of morality, thus leading many—inappropriately, I believe—to think we must keep all morality out of our civic life and especially out of the reasoning in our legal system. I review examples of the confusion in characterizing the 2003 Lawrence v. Texas decision as a conflict between constitutional rights and religious moral precepts. I argue that this approach capitulates to particular views of morality as religious morality. (...) I consider the appeals to morality in the dissent and the ensuing confusion among commentators about the significance ofthis opinion. I review alternate readings of the Lawrence majority opinion, including proposals that it be considered from the perspectives of the ethicalframeworks of Locke, Mill, or Kant. (shrink)

Theory of Mind is the ability to predict and understand the mental state of another. While ToM is theorized to play a role in language, we examined whether such a mentalizing ability plays an important role in establishing shared understanding in conversation. Pairs of participants engaged in a Lego model building task in which a director instructed a builder on how to create duplicate models from a prototype that only the director could see. We manipulated whether the director could see (...) or could not see the builder’s workspace. As predicted, the Mind in the Eyes test predicted accuracy when the workspace was hidden. A high mentalizing ability was an advantage when instructing, resulting in fewer errors, but may be a disadvantage when following instructions. This research indicates that ToM plays a key role in communicating information effectively in conversation. (shrink)

A recent study using a crossmodal matching task showed that the identity of a talker could be recognized even when the auditory and visual stimuli that were being matched were different sentences spoken by the talker. This finding implies that general temporal features of a person's speech are shared across the auditory and visual modalities.

Dès 1947, la construction de la nation birmane par Aung San, militaire victorieux de l’occupation japonaise, s’est faite en excluant certaines minorités, notamment musulmanes. En 1988, Aung San Suu Kyi revient au pays et prend la tête de l’opposition au nom de son père, assassiné en 1947, avec son parti la Ligue nationale pour la démocratie. Elle affirme son allégeance au bouddhisme et son soutien à l’armée malgré les exactions de celle-ci contre les minorités. Et c’est en tant que cheffe (...) de fait du gouvernement qu’elle comparait devant le tribunal de la Haye en 2019. (shrink)

One issue of dispute between methodological individualists and methodological holists is whether holist explanations are dispensable in the sense that individualist explanations are able to do their explanatory job. Methodological individualists say they are, whereas methodological holists deny this. In the first part of the paper, I discuss Elder-Vass’ version of an influential argument in support of methodological holism, the argument from emergence. I argue that methodological individualists should reject it: The argument relies on a distinction between individualist and holist (...) explanations that they find unacceptable and Elder-Vass’ reasons in support of his way of drawing this distinction are not good ones. In the second part, I examine what, if anything, would be good reasons in support of a particular way of differentiating between individualist and holist explanations. I propose that a good reason is one which shows, in an acceptable manner, that the distinction, drawn in the same way in all contexts, is useful from the perspective of offering explanations of the social world. I show that if this criterion is adopted, it will result in a fruitful reorientation of the whole debate between methodological individualists and methodological holists. (shrink)

Acknowledgments THROUGHOUT this book I cite the many people who have provided information on individual programs and activities. ...

Recent debates about inequality have focused almost exclusively on the distribution of wealth and disparities in income, but little notice has been paid to the distribution of free time. Free time is commonly assumed to be a matter of personal preference, a good that one chooses to have more or less of. Even if there is unequal access to free time, the cause and solution are presumed to lie with the resources of income and wealth. In Free Time, Julie (...) Rose argues that these views are fundamentally mistaken. First, Rose contends that free time is a resource, like money, that one needs in order to pursue chosen ends. Further, realizing a just distribution of income and wealth is not sufficient to ensure a fair distribution of free time. Because of this, anyone concerned with distributive justice must attend to the distribution of free time. On the basis of widely held liberal principles, Rose explains why citizens are entitled to free time—time not committed to meeting life's necessities and instead available for chosen pursuits. The novel argument that the just society must guarantee all citizens their fair share of free time provides principled grounds to address critical policy choices, including work hours regulations, Sunday closing laws, public support for caregiving, and the pursuit of economic growth. Delving into an original topic that touches everyone, Free Time demonstrates why all citizens have, in the words of early labor reformers, a right to "hours for what we will.". (shrink)

In a recent article in this journal, Brian Alters argued that, given the many ways in which the nature of science is described and poor student responses to NOS instruments such as Nature of Scientific Knowledge Scale, Nature of Science Scale, Test on Understanding Science, and others, it is time for science educators to reconsider the standard lists of tenets for the NOS. Alters suggested that philosophers of science are authorities on the NOS and that consequently, it would be wise (...) to investigate their views of current NOS tenets. To that end, he conducted a survey of members of the Philosophy of Science Association, and, via various statistical techniques, made claims about the nature and extent of variation among philosophers of science regarding basic beliefs about the NOS. As three philosophers of science, we laud Alters’ attempt to understand philosophers of science’ view on the NOS. We believe, however, that his techniques for investigating this question are inappropriate and that consequently, several of his conclusions are unwarranted. In this comment, we will substantiate these criticisms. In addition, we will address some of the important questions that motivate Alters’ research and attempt to unravel the “byzantine complexity” of philosophical views about the NOS. We begin with our concerns regarding Alters’ research. We then provide a taxonomy of philosophic issues; and finally, we suggest some roles for philosophy of science in science teaching and the education of science teachers. (shrink)

Silicon Valley and its innovation center counterparts have come upon food and agriculture as the next frontier for their unique style of innovation and impact. But what exactly can the tech sector, with expertise in information and communication technologies, bring to a domain in which the biophysical materiality of soil, plants, animals and human bodies have most challenged farmers and food companies? Based on a detailed analysis of all of the companies that have pitched their products at events sponsored by (...) the Silicon Valley-based convener, Foodbytes!, we show that a large proportion of tech-driven solutions are digital technologies transferred from other domains. These technologies at best inform decision-making on the ecological processes of food and farming, but do not provide tools to treat them, and otherwise provide business solutions not even aimed at major challenges in food and farming. Drawing on a small set of interview data, we additionally suggest that tech entrepreneurs migrate to food and agriculture because it seems purposeful, exciting, or lucrative, but sometimes lack a clear understanding of the problems they might solve with their digital technologies. In making our case about the mismatch of problem and solution, we bring into conversation recent critiques of digital solutionism with abiding concerns in agrarian political economy and critical food studies regarding the role of the biological in both challenging food production and spurring technological intervention. (shrink)

Although performance pressure has desirable consequences, there is evidence that it can produce unintended outcomes as employees tend to engage in dysfunctional and unethical behaviors to meet performance goals. Thus, the process through which employees think and behave unethically under performance pressure deserves more research attention. This study goes beyond the stress-appraisal perspective and investigates whether and when performance pressure influences individual work mindsets and behaviors from a moral reasoning perspective. Specifically, we contend that performance pressure is related to employee (...) expediency through moral decoupling. We further hypothesize dialectical thinking and moral identity to be the boundary conditions of the proposed relationships. Analyses of data from a field study in three waves provide support for most of the hypotheses. In particular, we find that moral decoupling accounts for additional variance after we control for the stress-appraisal effect of performance pressure on employee expediency. The study offers several contributions to the literature on performance pressure and unethical behavior. (shrink)

The introduction provides an overview of the ontological and the methodological individualism-holism debates. Moreover, these debates are briefly discussed in relation to two kindred disputes: The micro-macro and the agency-structure debates. Finally, the contributions to this book are briefly presented.

In this article, the nursing health history is revisited with a hermeneutic lens to uncover means by which this tool can better serve nursing practice. It is argued that further distanciation from the developmental and medical model is necessary to accurately uncover health and history in the nurse–client encounter. Based on the works of prominent hermeneutic philosophers, such as Heidegger, Gadamer, Merleau‐Ponty, Ricoeur, and Taylor, four orientations to health history and nursing are explored: orientation to caring, orientation to narrative, orientation (...) to time, and orientation to the body. The nursing health history is used as a vehicle for illuminating the usefulness of a hermeneutic perspective in everyday nursing practice. This article reveals views of health, history, and health history that are already known to nurses and the nursing milieu but are concealed by more dominant outlooks. The hermeneutical perspective presented in this article can help to reveal the important dimensions of everyday nursing practice and foster a richer attunement with the complex health experiences of individuals. (shrink)