Tool making has been proposed as a key force in driving the complexity of human material culture. The ontogeny of tool‐related behaviors hinges on social, representational, and creative factors. In this study, we test the associations between these factors in development across two different cultures. Results of Study 1 with 5‐to‐6‐year‐old Turkish children in dyadic or individual settings show that tool making is facilitated by social interaction, hierarchical representation, and creative abilities. Results of a second (...) explorative study comparing the Turkish sample with a sample of 5‐to‐6‐year‐old children in New Zealand suggest that tool innovation might be affected by culture, and that the role of cognitive and creative factors diminishes through social interaction in tool making. (shrink)

Standpoint epistemology, the view that social identity is relevant to knowledge-acquisition, has been consigned to the margins of mainstream philosophy. In part, this is because the principles of standpoint epistemology are taken to be in opposition to those which guide traditional epistemology. One goal of this paper is to tease out the characterization of traditional epistemology that is at odds with standpoint epistemology. The characterization of traditional epistemology that I put forth is one which endorses the thesis of intellectualism, the (...) view that knowledge does not depend on non-epistemic features. I then suggest that two further components – the atomistic view of knowers and aperspectivalism – can be usefully interpreted as supporting features of intellectualism. A further goal of this paper is to show that we ought to resist this characterization of traditional epistemology. I use pragmatic encroachment as a dialectical tool to motivate the denial of intellectualism, and consequently, the denial of both supporting components. I then attempt to show how it is possible to have a view, similar to pragmatic encroachment, that takes social identity, rather than stakes, to be the feature that makes a difference to what a person is in a position to know. (shrink)

Standpoint epistemology is committed to a cluster of views that pays special attention to the role of social identity in knowledge‐acquisition. Of particular interest here is the situated knowledge thesis. This thesis holds that for certain propositions p, whether an epistemic agent is in a position to know that p depends on some nonepistemic facts related to the epistemic agent's social identity. In this article, I examine two possible ways to interpret this thesis. My first goal here is to clarify (...) existing interpretations of this thesis that appear in the literature but that are undeveloped and often mistakenly conflated. In so doing, I aim to make clear the different versions of standpoint epistemology that one might accept and defend.This project is of significance, I argue, because standpoint epistemology provides helpful tools for understanding a phenomenon of recent interest: epistemic oppression. My second goal is to provide an analysis that makes clear how each of the readings I put forth can be used to illuminate forms of epistemic oppression. (shrink)

This article explores the evolution of consciousness as directly correlated to hunting, gathering, tool-making and art. The methodology is qualitative theoretical analyses, articulated around Jean Gebser’s seminal work, The Ever-Present Origin. Hunting and gathering are expressions of a magical, unitary, ‘self-dissolving’ consciousness. Tool-making on the other hand is depicted as evolving from a mythical consciousness of duality, polarity, symbolism and a state of being qualified by ‘crystallisation of the I’. Lastly, art is a function of a (...) consciousness of ‘self-transcendence’, ‘I and I’, idealisation and a transpersonal state of being. The article concludes by positing that hunting, gathering, tool-making and art can be reframed as ‘forms of the movement of consciousness’. (shrink)

During the last decade, the ontogeny of tool making has received growing attention in the literature on tool-related behaviors. However, the cognitive demands underlying tool making are still not clearly understood. In this cross-sectional study of 52 Turkish preschool children from 3 to 6 years of age, the roles of executive function (response inhibition), ability to form hierarchical representations (hierarchical structuring), and social learning were investigated with the hook task previously used with children and animals. (...) In this task, children needed to bend a pipe cleaner to fetch a small bucket with a sticker out of a tall jar. This study replicated earlier findings that preschoolers have great difficulty in tool innovation. However, social learning facilitates tool making, especially after 5 years of age. Capacities to form hierarchical representations and to inhibit prepotent responses were significant positive predictors of tool making after social learning. (shrink)

In three studies, we explored the retention and transfer of tool-making knowledge, learnt from an adult demonstration, to other temporal and task contexts. All studies used a variation of a task in which children had to make a hook tool to retrieve a bucket from a tall transparent tube. Children who failed to innovate the hook tool independently saw a demonstration. In Study 1, we tested children aged 4 to 6 years (N = 53) who had (...) seen the original demonstration 3 months earlier. Performance was excellent at the second time, indicating that children’s knowledge was retained over the 3 month period. In Studies 2 and 3 we explored transfer of the new knowledge to other tasks. In Study 2, children were given two variants of the apparatus that differed in surface characteristics (e.g. shape and colour). Participants generalised their knowledge to these new apparatuses even though the new pipecleaner also differed in size and colour. Five- to 6-year-olds (n = 22) almost always transferred their knowledge to problems where the same tool had to be made. Younger, 3- to 5-year-olds’ (n = 46), performance was more variable. In Study 3, 4- to 7-year-olds (N = 146) saw a demonstration of hook making with a pipecleaner, but then had to make a tool by combining pieces of wooden dowel (or vice versa: original training on dowel, transfer to pipecleaner). Children did not transfer their tool-making knowledge to the new material. Children retained tool-making knowledge over time and transferred their knowledge to new situations in which they needed to make a similar tool from similar materials, but not different materials. We concluded that children’s ability to use tool-making knowledge in novel situations is likely to depend on memory and analogical reasoning, with the latter continuing to develop during middle childhood. (shrink)

Chimpanzee/human technological differences are vast, reflect multiple interacting behavioral processes, and may result from the increased information-processing and hierarchical mental constructional capacities of the human brain. Therefore, advanced social, technical, and communicative capacities probably evolved together in concert with increasing brain size. Interpretations of these evolutionary and species differences as continuities or discontinuities reflect differing scientific perspectives.

Within the last decade, burgeoning interest in the intersection of epistemology and social issues has generated a new set of research questions. These questions range from the relevance of social identity, to peer disagreement, to debates on the significance of moral considerations to epistemic evaluations, to discussions of our epistemic practices and how those practices exclude certain agents and certain bodies of knowledge. Central in this new and emerging body of work is the realization that epistemology has more to do (...) than simply answer questions about what knowledge consists in; it must also acknowledge that our answers to these questions might be influenced by features we have previously failed to make space for. It is in this respect that we are witnessing a renewed interest in a theoretical approach long consigned to the margins of epistemology – that of standpoint epistemology. (shrink)

Our ability to dismantle white supremacy is compromised by the fact that we don’t fully appreciate what, precisely, white supremacy is. In this chapter, I suggest understanding white supremacy as an epistemological system – an epistemic frame that serves as the foundation for how we understand and interact with the world. The difficulty in dismantling an epistemological system lies in its resilience – a system’s capacity to resist change to its underlying structure while, at the same time, offering the appearance (...) of large-scale reform. Using white supremacy as a case study, here I explore what features enable this resilience. An analysis of white supremacy that presents it as more than a tool of social and political oppression, but as an epistemic system that makes this oppression possible, allows us to better understand, and eventually overthrow, such systems. (shrink)

Localism is a social movement often associated with “buy local” food initiatives or the prevention of big-box retail expansion. At its core, however, localism is also about fostering local independence by encouraging businesses to opt for local alternatives when making purchasing decisions. In this article, we develop and test hypotheses that organizations with stronger community-oriented identities are more likely to source locally and that this relationship is moderated by the importance of the focal firm’s purchasing decisions. Results support the (...) strong influence of identity but the conditional effect is unconfirmed. (shrink)

Using a model of cognition as extended and enactive, we examine the role of materiality in making minds as exemplified by lithics and writing, forms associated with conceptual thought and meta-awareness of conceptual domains. We address ways in which brain functions may change in response to interactions with material forms, the attributes of material forms that may cause such change, and the spans of time required for neurofunctional reorganization. We also offer three hypotheses for investigating co-influence and change in (...) cognition and material culture. This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No. 785793. (shrink)

In the summer of 1914, Archduke Franz Ferdinand was assassinated in Sarajevo, an event which led to the horror of World War I and which many historians suggest marked the beginning of the twentieth century. In 1992, Sarajevo again lurched into prominence as the focal point of one of the century’s bloodiest civil wars. Yet Sarajevo at one point epitomized the dreams of the Enlightenment, a city where Christians, Jews, and Muslims peacefully coexisted. In the midst of Sarajevo’s recent decline (...) into chaos and destruction, Susan Sontag decided to produce Act I of Waiting for Godot, which, despite ever-looming danger, played to packed houses. Why? Why did this city of hope lie crushed at the end of the twentieth century? Why did Sontag stage an artistic production in the middle of such overwhelming tragedy? Why Waiting for Godot ? And, most important, why the appreciative, silent tears of audience members who risked their lives to attend a play in the middle of a war?These are the questions that guide David Toole’s theological reflections in Waiting for Godot in Sarajevo, where he seeks to come to terms with what it means to live a life of dignity in a world of undeniable suffering. Toole skillfully weaves together Friedrich Nietzsche’s views on nihilism with Michel Foucault’s analysis of power to produce a metaphysics of tragedy, or a “politics of dying.” Such politics are then used to shed new theological light on the Christian apocalypse and what it means to be alive at the end of the twentieth century. In making his argument, Toole draws innovative connections between such diverse figures as John Milbank, Alasdair MacIntyre, Euripides, John Howard Yoder, and Norman Maclean (author of A River Runs Through It and Young Men and Fire ), all the while using Beckett’s play as a compass for his direction. The end result is a fascinating, eminently readable, unexpectedly adventurous theological inquiry into the meaning of life. (shrink)

Design features for language and stone toolmaking (not tool use) involve similar if not homologous cognitive processes. Both are arbitrary transformations of internal symbolization, whereas non-human tool using is mostly an iconic transformation. The major discontinuity between humans and non-humans (chimpanzees) is language. The presence of stone tools made to standardized patterns suggests communicative and social control skills that involved language.

OF all the things that Plato was, he was primarily a philosopher and a metaphysician. Should this statement seem merely to emphasize the obvious; then let us explain why so simple a statement should rate special mention. There have always been those who are too willing to look upon the author of the ‘Theory of Ideas’ as an artist, a mystic, a poet but not a metaphysician. In this view, Plato’s Ideas are understandable only through the analysis of the personality (...) of an artist; it is a view which interjects far too much of the subjective into what must be seen as the objective ground for his whole philosophy. The possibility of such conflicting views on Plato can be explained by the fact that nowhere does Plato present in his writings a truly definitive Theory of Ideas and a workable proof for them. Some like Stewart require the assistance of psychology to examine Plato. Fite, on a priori grounds, makes a feeble attempt to take Plato out of the realm of any metaphysics whatsoever. Grote confuses reason and myth until nothing remains of Plato but a kind of mixed-up jumble. Others, of course, are loyal to the commitments of a critic and endeavour to discover the meaning of Plato and to present it fairly and honestly. (shrink)

In this article we propose that executive functions play a key role in the origin of language. Our proposal is based on the methodological assumption that some of the cognitive systems involved in language functioning are also involved in its phylogenetic origin. In this regard, we demonstrate that a key property of language functioning is discourse coherence. Such property is not dependent on grammatical elements but rather is processed by cognitive systems that are not specific for language, namely the executive (...) functions systems of action planning, control and organization. Data from cognitive archaeology on the making of stone tools show that the processes requested to produce Prehistoric tools imply action organization operations similar to those involved in the processing of coherence. Based on these considerations, we propose that executive functions represent the link between stone tool making and language origins and suggest that they allowed our ancestors to develop forms of proto-discourse governed by coherence. (shrink)

Permaculture is primarily a thinking tool for designing low carbon, highly productive systems. It originated in Australia in the 1970s and was conceived by Bill Mollison and David Holmgren as a response to the devastating effects of a temperate European agriculture on the fragile soils of an ancient antipodean landscape. Like the dust bowls of the Great Plains in the USA in the 1930s, an alien agriculture has the capacity to turn a delicately balanced ecology into desert. Their initial (...) response was to design a permanent agriculture with tree crops and other perennials inhabiting all the niches from the canopy to the ground cover and below. The soil is left untilled to establish its own robust micro-ecology. Key to this is that the land must be biodiverse and stable for future generations. From perennial tree crops, permaculture has developed into an integrated system of design that encompasses everything from agriculture, horticulture, architecture, and ecology, as well as economy and legal systems for businesses and communities. (shrink)

This article considers ethical dilemmas that nurse managers may confront and suggests an ethical decision-making model that could be used as a tool for resolving such dilemmas. The focus of the article is on the question: Can nurse managers choose the ethically right solution in conflicting situations when nurses’ rights collide with patients’ rights to quality care in a world of cost-effective and economic constraint? Managers’ responsibility is to ensure and facilitate a safe and ethical working environment in (...) which nurses are able to give quality care to their patients. In nursing it is frequently declared that managers’ main obligations are to patients’ needs and their rights to receive quality care. However, managers’ ethical responsibilities are not only to patients but also to the nurses working in their institution. This article describes a real (but disguised) situation from an Israeli health care context to illustrate the dilemmas that may arise. The question is posed of whether nurse managers can maintain patients’ and nurses’ rights and, at the same time, fulfill their obligation to the conflicting demands of the organization. The article also offers a way to solve conflict by using an ethical decision-making model. (shrink)

Logic is one of the most male-dominated areas within the already hugely male-dominated subject of philosophy. Popular hypotheses for this disparity include a preponderance of confident, mathematically-minded male students in the classroom, the historical association between logic and maleness, and the lack of female role-models for students, though to date none of these have been empirically tested. In this paper I discuss the effects of various attempts to address these potential causes whilst teaching second-year formal and philosophical logic courses at (...) different universities in the UK. I found the most noticeable positive effect came from assigning a good proportion of reading by female authors presenting an original point of view. I go on to suggest some implementations for incorporating more texts by female authors into our arsenal of tools for teaching logic. (shrink)

We are plagued today by a decline in ethical behavior. Scandals come so thick and fast that any attempt to list them is out of date in weeks if not days. But ethics isn’t just a matter of headlines; it’s a part of everyone’s life. We’re called on to make ethical decisions, large and small, all the time. This can be particularly tricky in the workplace, where our decisions can affect not just ourselves but coworkers, clients, customers, and even the (...) entire company. Existing ethics books are of limited use. They generally feature one author’s opinions on very specific situations, which may well have nothing to do with the problems we’re facing. And anyway, we don’t need expert advice. Mark Pastin insists every one of us is qualified to resolve even the thorniest dilemmas ourselves, and in this profoundly practical book he gives us the tools to do just that. Pastin argues that we all have an innate ethical –he calls it “the ethics eye.” The problem is, we’re not aware we have it or how to develop it. Here he provides practical tools we can use to open up our ethics eye so that we can consistently see what is right and do it. Make an Ethical Difference shows how to apply these tools using actual ethical dilemmas drawn from Pastin’s decades of experience as an advisor to governments, corporations, and NGOs. The point is not to try to wedge your situation into one of the examples—it’s to show how a tool that can be applied to any situation is used in one particular instance. And once you’ve reached a decision, Pastin offers strategies for building consensus with those who might disagree with you. People often feel hopeless and skeptical that there is anything they as individuals can do to raise society’s ethical level or resolve long-standing impasses. By using the unique tools in this book, we will gain confidence in our innate ethical sense and take actions that will elevate the ethical level of the groups and organizations we belong to and society as a whole. (shrink)

Although clinical ethics support services are becoming increasingly prevalent in Europe and North America, they remain an uncommon feature of the Irish healthcare system and Irish health professionals lack formal support when faced with ethically challenging cases. We have developed a variant on existing clinical ethics decision-making tools which is designed to build capacity and confidence amongst Irish practitioners and enable them to confront challenging situations in the absence of any dedicated support structure. The tool provided below follows (...) a transparent stepwise procedure which avoids an overcomplicated analysis while remaining sensitive to the complexity of the issues addressed. The novelty of the tool lies in the explicit association it makes between each step in the process and one or more responsibilities based on established norms of ethical decision-making in the public domain. (shrink)

The authors believe there is a need for novel ways of enhancing professional judgment and discretion in the contemporary healthcare environment. The objective is to provide a framework to guide a discursive analysis of an ongoing clinical scenario by a small group of healthcare professionals (4–12) to achieve consensual understanding in the decision-making necessary to resolve specific healthcare inadequacies and promote organisational learning. REPVAD is an acronym for the framework’s five decision-making dimensions of reasoning, evidence, procedures, values, attitudes (...) and defences. The design is set out in terms of well-defined definitions of the dimensions, a rationale for using REPVAD, and explications of dimensions one at a time. Furthermore, the REPVAD process of application to a scenario is set out, and a didactic scenario is given to show how REPVAD works together with a sample case. A discussion is fleshed out in four real life student cases, and a conclusion indicates strengths and weaknesses and the possibility of further development and transferability. In terms of findings, the model has been tried, tested and refined over a number of years in the development of advanced practitioners at university healthcare faculties in two European countries. Consent was obtained from the four participating students. (shrink)

Research using mHealth apps has the potential to positively impact health care management and outcomes. However, choosing an appropriate mHealth app may be challenging for the health researcher. The author team used existing evaluation tools, checklists, and guidelines to assess selected mHealth apps to identify strengths, challenges, and potential gaps within existing evaluation tools. They identified specific evaluation tool components, questions, and items most effective in examining app content, usability, and features, including literacy demand and cultural appropriateness; technical information; (...) practical aspects of app functionality; and evolving capabilities of mobile medical apps. Challenges included the subjective nature of the results, time required to complete the evaluation, lack of emphasis on evidence‐based content, and inadequate tool flexibility. Health researchers considering the integration of mobile apps into research will benefit from evaluation tools that assess both evidence‐based content and the ability of the mobile app to securely integrate with other digital technologies involved in patient care. Next steps will include the involvement of health care providers and professionals, including nurses a wide range of expertise, to develop an mHealth evaluation tool that focuses on identifying quality, evidence‐based mobile apps into patient outcomes research. (shrink)

Interruptions are often inevitable and occur many times in daily life (Ratwani & Trafton, 2010). Interruptions at work can disrupt progress on tasks and result in costly mistakes (Brumby, Cox, Back...

Algorithmic risk assessment tools, such as COMPAS, are increasingly used in criminal justice systems to predict the risk of defendants to reoffend in the future. This paper argues that these tools may not only predict recidivism, but may themselves causally induce recidivism through self-fulfilling predictions. We argue that such “performative” effects can yield severe harms both to individuals and to society at large, which raise epistemic-ethical responsibilities on the part of developers and users of risk assessment tools. To meet these (...) responsibilities, we present a novel desideratum on algorithmic tools, called explainability-in-context, which requires clarifying how these tools causally interact with the social, technological, and institutional environments they are embedded in. Risk assessment practices are thus subject to high epistemic standards, which haven't been sufficiently appreciated to date. Explainability-in-context, we contend, is a crucial goal to pursue in addressing the ethical challenges surrounding risk assessment tools. (shrink)

Global health research partnerships have many benefits, including the development of research capacity and improving the production and use of evidence to improve global health equity. These partnerships also include many challenges, with power and resource differences often leading to inequitable and unethical partnership dynamics. Responding to these challenges and to important gaps in partnership scholarship, the Canadian Coalition for Global Health Research conducted a three-year, multi-regional consultation to capture the research partnership experiences of stakeholders in South Asia, Latin America, (...) and sub-Saharan Africa. The consultation participants described persistent inequities in the conduct of global health research partnerships and called for a mechanism through which to improve accountability for ethical conduct within partnerships. They also called for a commitment by the global health research community to research partnership ethics. The Partnership Assessment Toolkit is a practical tool that enables partners to openly discuss the ethics of their partnership and to put in place structures that create ethical accountability. Clear mechanisms such as the PAT are essential to guide ethical conduct to ensure that global health research partnerships are beneficial to all collaborators, that they reflect the values of the global health endeavor more broadly, and that they ultimately lead to improvements in health outcomes and health equity. (shrink)

Prior research has used an Interactive Landslide Simulator tool to investigate human decision making against landslide risks. It has been found that repeated feedback in the ILS tool about damages due to landslides causes an improvement in human decisions against landslide risks. However, little is known on how theories of learning from feedback would account for human decisions in the ILS tool. The primary goal of this paper is to account for human decisions in the ILS (...) tool via computational models based upon reinforcement learning and to explore the model mechanisms involved when people make decisions in the ILS tool. Four different reinforcement-learning models were developed and evaluated in their ability to capture human decisions in an experiment involving two conditions in the ILS tool. The parameters of an Expectancy-Valence model, two Prospect-Valence-Learning models, a combination EV-PU model, and a random model were calibrated to human decisions in the ILS tool across the two conditions. Later, different models with their calibrated parameters were generalized to data collected in an experiment involving a new condition in ILS. When generalized to this new condition, the PVL-2 model’s parameters of both damage-feedback conditions outperformed all other RL models. We highlight the implications of our results for decision making against landslide risks. (shrink)

Thinking tools is a regular feature that offers tips and pointers on thinking clearly and rigorously.

We argue that providing cumulative risk as an estimate of the uncertainty in dynamically changing risky environments can help decision-makers meet mission-critical goals. Specifically, we constructed a simplified aviation-like weather decision-making task incorporating Next-Generation Radar images of convective weather. NEXRAD radar images provide information about geographically referenced precipitation. NEXRAD radar images are used by both pilots and laypeople to support decision-making about the level of risk posed by future weather-hazard movements. Using NEXRAD, people and professionals have to infer (...) the uncertainty in the meteorological information to understand current hazards and extrapolate future conditions. Recent advancements in meteorology modeling afford the possibility of providing uncertainty information concerning hazardous weather for the current flight. Although there are systematic biases that plague people’s use of uncertainty information, there is evidence that presenting forecast uncertainty can improve weather-related decision-making. The current study augments NEXRAD by providing flight-path risk, referred to as the Risk Situational Awareness Tool. RSAT provides the probability that a route will come within 20 NMI radius of hazardous weather within the next 45 min of flight. The study evaluates four NEXRAD displays integrated with RSAT, providing varying levels of support. The “no” support condition has no RSAT. The “baseline” support condition employs an RSAT whose accuracy is consistent with current capability in meteorological modeling. The “moderate” support condition applies an RSAT whose accuracy is likely at the top of what is achievable in meteorology in the near future. The “high” support condition provides a level of support that is likely unachievable in an aviation weather decision-making context without considerable technological innovation. The results indicate that the operators relied on the RSAT and improved their performance as a consequence. We discuss the implications of the findings for the safe introduction of probabilistic tools in future general aviation cockpits and other dynamic decision-making contexts. Moreover, we discuss how the results contribute to research in the fields of dynamic risk and uncertainty, risk situation awareness, cumulative risk, and risk communication. (shrink)

This special issue of the Journal of Agricultural and Environmental Ethics presents so-called ethical tools that are developed to support systematic public deliberations about the ethical aspects of agricultural biotechnologies. This paper firstly clarifies the intended connotations of the term “ethical tools” and argues that such tools can support liberal democracies to cope with the issues that are raised by the application of genetic modification and other modern biotechnologies in agriculture and food production. The paper secondly characterizes the societal discussion (...) on agricultural biotechnology and defends the thesis that normative perspectives fuel this discussion, so one cannot come to grips with this discussion if one neglects these perspectives. The paper thirdly agrues that no such thing exists as “one” societal debate in which these issues should be discussed. There are several interwined debates, and different actors participate in different discourses. Some practical instruments are necessary in order to include the right issues in these debates. These instruments will be coined as “ethical tools,” since they are practical instruments that can be used (tools) in order to support debates and deliberative structures for a systematic engagement with ethical issues (hence, ethical tools). Finally, the paper clarifies the ethics of these ethical tools and presents the tools as discussed in the remainder of this special issue: 1) tools to include ethical issues in public consulation and involvement; 2) tools to support systematic reflection upon ethical issues in decision-making; and 3) tools to support explicit communication about values in the food chain. (shrink)

The COVID-19 pandemic has strained healthcare resources the world over, requiring healthcare providers to make resource allocation decisions under extraordinary pressures. A year later, our understanding of COVID-19 has advanced, but our process for making ethical decisions surrounding resource allocation has not. During the first wave of the pandemic, our institution uniformly ramped-down clinical activity to accommodate the anticipated demands of COVID-19, resulting in resource waste and inefficiency. In preparation for the second wave, we sought to make such ramp (...) down decisions more prudently and ethically. We report the development of a tool that can be used to make fair and ethical decisions in times of resource scarcity. We formed an interprofessional team to develop and use this tool to ensure that a diverse range of stakeholder perspectives were represented in this development process. This team, called the clinical activity recovery team, established institutional objectives that were combined with well-established procedural values, substantive ethical principles and decision-making criteria by using a variation on the well-known accountability for reasonableness ethical framework. The result of this is a stepwise, semiquantitative, ethical decision tool that can be applied to resource allocation challenges in order to reach fair and ethically defensible decisions. This ethical decision tool can be applied in various contexts and may prove useful at both the institutional and the departmental level; indeed this is how it is applied at our centre. As the second wave of COVID-19 strains healthcare resources, this tool can help clinical leaders to make fair decisions. There are no data in this work. (shrink)

This commentary builds on Haico te Kulve and Arie Rip’s ( 2011 ) notion of “engagement agents,” individuals that must be able to move between multiple dimensions, or “levels” of research, innovation, and policy processes. The commentary compares and contrasts the role of the engagement agent within the Constructive Technology Assessment and integration approaches, and suggests that on-site integration research represents one way to transform both social and natural scientists into competent and informed “engagement agents,” a new generation of researchers (...) that possess the knowledge and capacities to forge “novel linkages” between the oftentimes disparate terrains of science, politics, and policy. (shrink)

Advance directives (ADs) offer the opportunity for patients to express their desires regarding medical care in advance of any form of incapacitation. However, the efficacy of ADs in achieving care that aligns with patients’ preferences is the subject of intense ethical debate. Current instructional AD formats may not allow for expression of the reasoning or values behind a patient’s care preferences, limiting their utility and efficacy. Here, we review written AD formats and their limitations, and discuss video messages, as a (...) supplement to written ADs, as a potential improvement. While video messages have limitations of their own, their potential use as a tool for better understanding patients’ wishes and values suggests a need for further research and consideration of their application and integration into standard clinical practice. (shrink)

Background and PurposeMany critically ill patients in intensive care units (ICUs) are unable to communicate their wishes about goals of care, particularly about the use of life-sustaining treatments. Surrogates and clinicians struggle with medical decisions because of a lack of clarity regarding patients’ preferences, leading to prolonged hospitalizations and increased costs. This project focused on the development and implementation of a tool to facilitate a better communication process by (1) assuring the early identification of a surrogate if indicated on (...) admission and (2) clarifying the decision-making standards that the surrogate was to use when participating in decision making. Before introducing the tool into the admissions routine, the staff were educated about its use and value to the decision-making process.Project and MethodsThe study was to determine if early use of a simple method of identifying a patient’s surrogate and treatment preferences might impact length of stay (LOS) and total hospital charges. A pre- and post-intervention study design was used. Nurses completed the surrogacy information tool for all patients upon admission to the neuroscience ICU. Subjects (total N=203) were critically ill patients who had been on a mechanical ventilator for 96 hours or longer, or in the ICU for seven days or longer. The project included staff education on biomedical ethics, critical communication skills, early identification of families and staff in crisis, and use of a simple tool to document patients’ surrogates and previously expressed care wishes. Data on hospital LOS and hospital charges were collected through a retrospective review of medical records for similar four-month time frames pre- and post-implementation of the assessment tool.ResultsSignificant differences were found between pre- and post-groups in terms of hospital LOS (F=6.39, p=.01) and total hospital charges (F=7.03, p=.009).ConclusionsProject findings indicate that the use of a simple admission assessment tool, supported by staff education about its completion, use, and available resources, can decrease LOS and lower total hospital charges. The reasons for the difference between the pre- and post-intervention groups remain unclear. Further research is needed to evaluate if the quality of communications between patients, their legally authorized representatives, and clinicians—as suggested in the literature—may have played a role in decreasing LOS and total hospital charges. (shrink)

Aim: To improve clinical and ethical understanding of patient preferences for information and involvement in decision making.Objectives: To develop and evaluate a clinical tool to elicit these preferences and to consider the ethical issues raised.Design: A before and after study.Setting: Three UK hospices.Participants: Patients with advanced life-threatening illnesses and their doctors.Intervention: Questionnaire on information and decision-making preferences.Main outcome measures: Patient-based outcome measures were satisfaction with the amount of information given, with the way information was given, with family (...) or carer information, and confidence about future decision making. Doctor-based outcome measures were confidence in matching information to patient preference, matching family or carer communication to patient preference, knowing patient preferences and matching future decision making with patient preference.Results: Of 336 admissions, 101 patients completed the study . Patient satisfaction with the way information was given and family communication improved after introduction of the tool. Doctor confidence improved across all outcome measures .Conclusions: Patient satisfaction and doctor confidence were improved by administering the questionnaire, but complex ethical issues were raised by implementing and applying this research. The balance of ethical considerations were changed by advanced life-threatening illness, because there is increased risk of harm through delivery of information discordant with the patient’s own preferences. The importance of truly understanding patient preferences towards the end of life is highlighted by this study. (shrink)

Citizens can be meaningfully involved in multiple phases of the urban planning process from decision-making to implementation via a dedicated online platform through which they can interact with planners and decision-makers. In historical contexts, local people are essential resources for decision-makers seeking critical local information needed for effective planning and intervention—including what those citizens recall from the past about the area’s social values and the built environment and what they imagine and hope for their neighborhood’s future. This public knowledge, (...) collected through storytelling and mapping, can play a fundamental role in shaping the framework for neighborhood rehabilitation plans. As a foundation for designing an online visual questionnaire to collect local knowledge and understand the views and expectations of local people, this study focuses on theoretical ideas to define a framework for an online visual questionnaire tool. The tool presented provides a common visual language that people can easily understand and use whatever their social class, education, or background. It also has the benefit of enabling citizens and planners to interact directly regardless of their geographical location. To proposing a framework for the online visual questionnaire, the first step was to review some existing visual tools and methods, including analog used for community engagement and digital used in urban planning to encourage and support public participation. Through an analysis of these methods, some important variables and criteria were identified that further our understanding of citizens’ perceptions of their neighborhoods. The next step, as part of a larger study, will be examining a historical public space, including a bazaar, hammam, and cistern—located in the historical context of Yazd— a central city in Iran registered as a cultural heritage site by UNESCO— as a case study with the larger goal of identifying some specific. (shrink)