BackgroundHospitalized older adults frequently have impaired cognition and must rely on surrogates to make major medical decisions. Ethical standards for surrogate decision making are well delineated, but little is known about what factors surrogates actually consider when making decisions.ObjectivesTo determine factors surrogate decision makers consider when making major medical decisions for hospitalized older adults, and whether or not they adhere to established ethical standards.DesignSemi-structured interview study of the experience and process of decision making.SettingA public safety-net hospital and a tertiary referral (...) hospital in a large city in the Midwest United States.ParticipantsThe study included 35 surrogates with a recent decision-making experience for an inpatient aged 65 or older.MeasurementsThe key factors that surrogates considered when making decisions. Interview transcripts were coded and analyzed using the grounded theory method of qualitative analysis.ResultsSurrogates considered patient-centered factors and surrogate-centered factors. Patient-centered factors included: respecting the patient’s input, using past knowledge of the patient to infer the patient’s wishes, and consider ing what is in the patient’s best interests. Some surrogates expressed a desire for more information about the patient’s prior wishes. Surrogate-centered factors included: surrogate’s wishes as a guide, surrogate’s religious beliefs and/or spirituality, surrogate’s interests, and family consensus.ConclusionOur study indicates that surrogate decision making is more complex than the standard ethical models, which are limited to considerations of the patient’s autonomy and beneficence. Because surrogates also imagine what they would want under the circumstances and consider their own needs and preferences, models of surrogate decision making must account for these additional considerations. Surrogates’ desire for more information about patients’ preferences suggests a need for greater advance care planning. (shrink)

Research of tutoring in parent-infant interaction has shown that tutors – when presenting some action – modify both their verbal and manual performance for the learner. Investigating the sources and effects of the tutors’ action modifications, we suggest an interactional account of ‘motionese’. Using video-data from a semi-experimental study in which parents taught their 8- to 11-month old infants how to nest a set of differently sized cups, we found that the tutors’ action modifications functioned as an orienting device to (...) guide the infant’s visual attention. Action modification and the recipient’s gaze can be seen to have a reciprocal sequential relationship and to constitute a constant loop of mutual adjustments. Implications are discussed for developmental research and for robotic ‘Social Learning’. We argue that a robot system could use on-line feedback strategies to pro-actively shape a tutor’s action presentation as it emerges. (shrink)

Research of tutoring in parent-infant interaction has shown that tutors – when presenting some action – modify both their verbal and manual performance for the learner. Investigating the sources and effects of the tutors’ action modifications, we suggest an interactional account of ‘motionese’. Using video-data from a semi-experimental study in which parents taught their 8- to 11-month old infants how to nest a set of differently sized cups, we found that the tutors’ action modifications functioned as an orienting device to (...) guide the infant’s visual attention. Action modification and the recipient’s gaze can be seen to have a reciprocal sequential relationship and to constitute a constant loop of mutual adjustments. Implications are discussed for developmental research and for robotic ‘Social Learning’. We argue that a robot system could use on-line feedback strategies to pro-actively shape a tutor’s action presentation as it emerges. (shrink)

In this article, we introduce a theory on the dynamic development of affective processes, affect regulation, and the relationship between emotions and sport performance. The theory focusses on how affective processes emerge and develop during competitive sport involvement. Based on Scherer’s component process model, we postulate six components of emotion that interact with each other in a circular fashion: triggering processes, physiological reactions, action tendencies, expressive behaviors, subjective experience, and higher cognitive processes. The theory stresses the dynamics of affective processes (...) and describes the consequences for performance in competitive sports. It assumes that the peculiarities of different sports must be taken into account in order to understand the affective processes, and offers starting points on which strategies can be used to effectively regulate affective states. Consequences for research and practice are derived and discussed. To study the development of affective processes, future research should test the assumptions in ecologically valid contexts, such as real competitions or competition-like situations, using multi-component measures of emotions. (shrink)

The present study contains an affect-based intervention intended to support exercise trainers in positively influencing their course participants’ affective responses to their exercise courses. We argue that positive affective responses are associated with habit formation, thereby being a promising approach for avoiding high drop-out rates in exercise courses. First, the present study aimed to investigate whether the intervention for exercise trainers could increase affective attitudes, and exercise instigation habit strength, and influence the development of weekly measured affective responses and automaticity (...) among adult participants of exercise courses. Second, it examined the relationship between the development of affective responses and exercise instigation habit strength. Ten exercise trainers of weekly sports and exercise courses at a German university received either an affect-based intervention or a control intervention. 132 of their course participants answered the Self-Report Habit Index for exercise instigation habit strength and items to measure affective attitude in the initial and final assessment. Moreover, they were assessed for a duration of 10 weeks during which, each time after attending the course, they reported their affective response to exercise as well as their automaticity in arriving at the decision to exercise. In the repeated measures ANOVA, there was a significant main effect of time for exercise instigation habit strength. Overall, habit strength was higher in the final than in the initial assessment. However, there were no significant differences between the two conditions in all study variables. In the latent growth curve model, the trajectory of the latent growth curve of valence was a significant predictor of the final exercise instigation habit strength. While the applied affect-based intervention was not successful in enhancing positive affective responses to exercise, the results indicate that positive affective responses may contribute to strengthening exercise instigation habits. Future studies should examine the effectiveness of interventions in long-term study designs. (shrink)

Research of tutoring in parent-infant interaction has shown that tutors – when presenting some action – modify both their verbal and manual performance for the learner (‘motherese’, ‘motionese’). Investigating the sources and effects of the tutors’ action modifications, we suggest an interactional account of ‘motionese’. Using video-data from a semi-experimental study in which parents taught their 8- to 11-month old infants how to nest a set of differently sized cups, we found that the tutors’ action modifications (in particular: high arches) (...) functioned as an orienting device to guide the infant’s visual attention (gaze). Action modification and the recipient’s gaze can be seen to have a reciprocal sequential relationship and to constitute a constant loop of mutual adjustments. Implications are discussed for developmental research and for robotic ‘Social Learning’. We argue that a robot system could use on-line feedback strategies (e.g. gaze) to pro-actively shape a tutor’s action presentation as it emerges. (shrink)