In criticism of Edith Wharton’s The House of Mirth, more attention has been paid in recent years to the unconventional side of Lily Bart. Wai-Chee Dimock, for example, calls Lily “something of a rebel”, while Benjamin D. Carson and Elaine Showalter place her as “intruder” and “outsider” in her society, respectively. Ruth Bernard Yeazell admits at least “the faltering pulse of resistance” in Lily, and Maureen Howard describes her as “just unconventional enough”. Lily as a conformist is an obvious picture (...) to paint, which is why exploring her non-conformism in criticism has been so stimulating and fruitful. However, even with so much focus on her unconventionality, few critics have.. (shrink)

In this article we describe research methods that are used for the study of individual multiattribute evaluation processes. First we explain that a multiattribute evaluation problem involves the evaluation of a set of alternatives, described by their values on a number of alternatives. We discuss a number of evaluation strategies that may be applied to arrive at a conclusion about the attractiveness or suitability of the alternatives, and next introduce two main research paradigms in this area, structural modelling and process (...) tracing. We argue that the techniques developed within these paradigms all have their advantages and disadvantages, and conclude that the most promising technique to detect the true nature of the evaluation strategy used by a judge seems to be the analysis of verbal protocols. At the same time we think it is wise not to rely on just one technique, but to use a multimethod approach to the study of multiattribute evaluation processes whenever that is possible. (shrink)

This article argues that non-ideal theory is distinctive in its use of a certain methodology which is prior to specific topics (such as injustice, oppression, etc.), grounded in the idea of socially situated knowledge, and able to address ideological situatedness. Drawing on standpoint epistemology, we show that one’s social position within given power structures has implications for knowledge acquisition and that being in a vulnerable or marginalised position can be advantageous to knowledge acquisition. Following ideology critique, we argue that both (...) marginalised and powerful social positions are embedded within a given ideology. As ideology is more than a mere set of attitudes or beliefs that social agents endorse or resist, situated agents and theorists cannot develop normative criteria that are not themselves situated. Hence, non-ideal theory has to be equipped with methods that are likely to make this situatedness visible. We close by presenting some diverse methods that already do so. (shrink)

There is an increased interest in how excessive avoidance can diminish. Avoidance reduction is typically tested by using Extinction with Response Prevention protocols, where feared stimuli a...

Acknowledgments I wish to express my gratitude to Dr. Jakob Amstutz for his continual feedback during my writing of this work. ...

Background Implementing person-centred care (PCC) in nursing homes is challenging due to a gap between theory and practice. Bridging this gap requires suitable education, which focuses on learning how to attune care to the values and preferences of residents and take moral, relational, and situational aspects into account. Staff’s stories about the care they provide (i.e. caring stories) may deliver valuable insights for learning about these aspects. However, there is limited research on using staff's narratives for moral learning. Objective This (...) study aims to provide insight into the perspectives of nursing staff on using their caring stories to learn about PCC. Research design In this qualitative research, we conducted two rounds of interviews with 17 participants working in nursing homes. We wanted to obtain nursing staff’s perceptions of working with their caring stories and the impact on PCC. Ethical considerations Participation was voluntary, and participants provided written consent. The study protocol is approved by The Institutional Review Board of the Medical Ethical Committee Leiden-Den Haag-Delft. Findings Working with caring stories enables nursing staff to provide PCC and improves job satisfaction. It increases awareness of what matters to residents, fosters information rich in context and meaning, and enhances voice and vocabulary. Through in-depth team reflections, nursing staff discussed the significant moments for residents, which centralizes the discussions on the moral quality of care. Discussion Working with caring stories fosters dialogue on PCC and enhances reflection on ethical situations in daily encounters, contributing to the moral development of nursing staff. Putting nursing staff’s narratives at the centre of learning suits their daily practice and intrinsic motivation. Therefore, the outcomes of this study are an addition to the existing literature about using narratives in long-term care. Conclusion Using nursing staff's narratives contributes to PCC and positively impacts nursing staff. We recommend using staff's caring stories as a vehicle for moral learning in the transition to PCC. (shrink)

With technological possibilities in healthcare steadily increasing, more tools for digital cognitive rehabilitation become available. Acceptance of such technological advances is crucial for successful implementation. Therefore, we examined technology acceptance specifically for this form of rehabilitation in a sample of healthcare providers involved in cognitive rehabilitation. An adjusted version of the Technology Acceptance Model questionnaire was used, including the subscales for perceived usefulness, perceived ease of use, subjective norm, and intention to use, which all contribute to actual use of a (...) specific technology. Results indicate a generally favorable attitude toward the use of digital cognitive rehabilitation and positive responses toward the TAM constructs. Only for subjective norm, a neutral mean response was found, indicating that this could pose a potential obstacle toward implementation. Potential differences between subgroups of different age, gender, and professional background were assessed. Age and gender did not affect the attitude toward digital cognitive rehabilitation. Occupational therapists showed lower scores than healthcare psychologists and physiatrists with regard to perceived usefulness, possibly linked to a difference in operational and managerial tasks. The findings of his study stimulate further implementation of digital cognitive rehabilitation, where the role of subjective norms should be specifically considered. (shrink)

In this article, we explain the mechanisms that allow social enterprises to balance their missions, and the risk of mission drift as organizations grow. We empirically explore Incubator-BUS (I-BUS), a student organization within a private Brazilian university, which sought to incubate cooperatives for vulnerable groups. Although initially successful in balancing its missions, I-BUS then failed. We show how scaling-up can complicate the balancing of different missions within the same organization. We propose that, to balance their missions, social enterprises—especially recently formed (...) and democratically managed enterprises—need not only “spaces of negotiation,” as suggested in the literature, but also “herding spaces” that connect an organization to its institutional context. We indicate why herding spaces are critical, but then show how scaling-up can result in organizational “compartmentalization” that undermines them. (shrink)

The potential health risks of vegan diets specifically for women and children are discussed. Women and children are at higher risk of malnutrition from consumption of unsupplemented vegan diets than are adult males. Those who are very young, pregnant, lactating, elderly, or who suffer from poverty, disease or other environmentally induced disadvantages are at special risk. The size of these risks is difficult to quantify from existing studies. Fortunately the risk of dietary deficiency disease can be avoided and the potential (...) health benefits of vegan diets can be realized when diets for these groups are planned in line with theRecommended Dietary Allowances so that nutrient intakes reach or exceed recommended levels, and access to preventive and curative health services is assured. (shrink)

The human brain’s ongoing activity is characterized by intrinsic networks of coherent fluctuations, measured for example with correlated functional magnetic resonance imaging signals. So far, however, the brain processes underlying this ongoing blood oxygenation level dependent (BOLD) signal orchestration and their direct relevance for human behavior are not sufficiently understood. In this study, we address the question of whether and how ongoing BOLD activity within intrinsic occipital networks impacts on conscious visual perception. To this end, backwardly masked targets were presented (...) in participants’ left visual field only, leaving the ipsi-lateral occipital areas entirely free from direct effects of task throughout the experiment. Signal time courses of ipsi-lateral BOLD fluctuations in visual areas V1 and V2 were then used as proxies for the ongoing contra-lateral BOLD activity within the bilateral networks. Magnitude and phase of these fluctuations were compared in trials with and without conscious visual perception, operationalized by means of subjective confidence ratings. Our results show that ipsilateral BOLD magnitudes in V1 were significantly higher at times of peak response when the target was perceived consciously. A significant difference between conscious and non-conscious perception with regard to the pre-target phase of an intrinsic-frequency regime suggests that ongoing V1 fluctuations exert a decisive impact on the access to consciousness already before stimulation. Both effects were absent in V2. These results thus support the notion that ongoing slow BOLD activity within intrinsic networks covering V1 represents localized processes that modulate the degree of readiness for the emergence of visual consciousness. (shrink)

Ruchkin et al.'s view of working memory as activated long-term memory is more compatible with language processing than models such as Baddeley's, but it raises questions about individual differences in working memory and the validity of domain-general capacity estimates. Does it make sense to refer to someone as having low working memory capacity if capacity depends on particular knowledge structures tapped by the task?

The beneficial effects of physical exercise on physical health and cognitive functioning have been repeatedly shown. However, evidence of its effect on psychosocial functioning in healthy adults is still scarce or inconclusive. One limitation of many studies examining this link is their reliance on correlational approaches or specific subpopulations, such as clinical populations. The present study investigated the effects of a physical exercise intervention on key factors of psychosocial functioning, specifically well-being, stress, loneliness, and future time perspective. We used data (...) from healthy, previously sedentary older adults who participated in a 6-month at-home intervention, either engaging in aerobic exercise or as part of a control group who participated in foreign language-learning or reading of selected native-language literature. Before and after the intervention, comprehensive cardiovascular pulmonary testing and a psychosocial questionnaire were administered. The exercise group showed significantly increased fitness compared to the control group. Contrary to expectations, however, we did not find evidence for a beneficial effect of this fitness improvement on any of the four domains of psychosocial functioning we assessed. This may be due to pronounced stability of such psychological traits in older age, especially in older adults who show high levels of well-being initially. Alternatively, it may be that the well-documented beneficial effects of physical exercise on brain structure and function, as well as cognition differ markedly from beneficial effects on psychosocial functioning. While aerobic exercise may be the driving factor for the former, positive effects on the latter may only be invoked by other aspects of exercise, for example, experiences of mastery or a feeling of community. (shrink)

This collection of essays provides a reassessment of the question of sexual difference, taking into account important shifts in feminist thought, post-humanist theories, and queer studies. The contributors offer new and refreshing insights into the complex question of sexual difference from a post-feminist perspective, and how it is reformulated in various related areas of study, such as ontology, epistemology, metaphysics, biology, technology, and mass-media.

Robust stakeholder engagement in health research requires broad communicative integration, not only of patients but also other stakeholders such as health system leaders, clinicians, and researcher...

How does literature engage with the legacies of Empire? This article examines how imperial decline and nation building are reflected in textual production after the First World War. With Turkey as a case study, it focuses on the post-imperial narrative as a form of narration dealing with the experience of imperial loss, political contingency and possibilities of national belonging. I argue that Turkey’s post-imperial condition is shaped by coming to terms with the loss of the Ottoman Empire, on the one (...) hand, and a nationalising present embedded in the experience of Western-dominated modernity, on the other. Against this backdrop, I examine essays from the compilations Yaşadığım Gibi (1970, ‘As I lived’) and Beş Şehir (1946, ‘Five Cities’) by Ahmet Hamdi Tanpınar, a key intellectual of the early republican era. The analysis of these post-imperial narratives reveals how Tanpınar tries to root Turkey’s national modernity in selected elements of the imperial past. For Tanpınar, continuity with (Turkified) imperial heritage is a prerequisite for a strong nation-state. (shrink)

In aging humans, aerobic exercise interventions have been found to be associated with more positive or less negative changes in frontal and temporal brain areas, such as the anterior cingulate cortex (ACC) and hippocampus, relative to no-exercise control conditions. However, individual measures such as gray-matter (GM) probability may afford less reliable and valid conclusions about maintenance or losses in structural brain integrity than a latent construct based on multiple indicators. Here, we established a latent factor of GM structural integrity based (...) on GM probability assessed by voxel-based morphometry, magnetization transfer saturation, and mean diffusivity. Based on this latent factor, we investigated changes in structural brain integrity during a six-month exercise intervention in brain regions previously reported in studies using volumetric approaches. Seventy-five healthy, previously sedentary older adults aged 63–76 years completed an at-home intervention study in either an exercise group (EG;n= 40) or in an active control group (ACG;n= 35). Measures of peak oxygen uptake (VO2peak) taken before and after the intervention revealed a time-by-group interaction, with positive average change in the EG and no reliable mean change in the ACG. Significant group differences in structural brain integrity changes were observed in the right and left ACC, right posterior cingulate cortex (PCC), and left juxtapositional lobule cortex (JLC). In all instances, average changes in the EG did not differ reliably from zero, whereas average changes in the ACG were negative, pointing to maintenance of structural brain integrity in the EG, and to losses in the ACG. Significant individual differences in change were observed for right ACC and left JLC. Following up on these differences, we found that exercising participants with greater fitness gains also showed more positive changes in structural integrity. We discuss the benefits and limitations of a latent-factor approach to changes in structural brain integrity, and conclude that aerobic fitness interventions are likely to contribute to brain maintenance in old age. (shrink)

Substance ontologists claim that substances are ontologically primary because the category of substance enjoys unique explanatory potential. Unless it can be shown that "only" substances fulfill the central explanatory tasks in ontology, this inference from explanatory success to ontological primacy amounts to a fallacy akin to the error Whitehead called 'the fallacy of misplaced concreteness'. I investigate recent prototypical arguments for substance metaphysics and try to show that some explanatory functions of substance can also be fulfilled by other ontological categories. (...) In particular, I argue against M. Ayers that there is no reason to think that all and only substances are discrete individuals, natural wholes, and logical units. I conclude that the category of substance does not provide us with a uniquely powerful explanans for the notion of logical and physical unity. (shrink)

Voluntades anticipadas: desafíos éticos en el cuidado del paciente Diretivas antecipadas de vontade: desafios éticos no cuidado do paciente Advance healthcare directives are intended for the individual to personally express their will and preferences about healthcare and treatment ahead of time. This literature review aims to describe the concept and structure of advance directives and the ethical aspects involved in patient care. Using the keywords “Advance Healthcare Directive” AND “Ethical Implication” and its Spanish equivalents, five databases were accessed: ProQuest, Philosophy, (...) PubMed, Web of Science and Scielo. Publications were narrowed down to the 2010-2018 period. Thirty-one articles were obtained and read critically. Results of this review were grouped into the following categories: concept, structure, clinical situations in which advance directives apply, strengths and limitations, as well as the ethical aspects involved. End of life-related experiences in which a person loses their ability to make decisions and cannot express their wishes, so it is impossible to know their will, are more common nowadays. Most health workers are not appropriately trained in the preparation and application of advance directives, which becomes an opportunity to research and delve deeper into the subject. Advance directives are a tool that gives health workers reliable information on a patient’s values and wishes, so it is vital to train them to provide respectful quality care. Para citar este artículo / To reference this article / Para citar este artigo Forero J, Vargas I, Bernales M. Voluntades anticipadas: desafíos éticos en el cuidado del paciente. Pers Bioet. 2019;23:224-244. DOI: https://doi.org/10.5294/pebi.2019.23.2.5 Recibido: 26/01/2019 Aceptado: 22/08/2019. (shrink)

When did Livy write his history? How many books had it, and what did the lost ones cover? Such answers as can be given to these questions come almost entirely from the one extant summary, the Periochae. The manuscripts of the Periochae disagree, however, on a matter of considerable interest: out of a hundred or so, only three, supported by a lost fourth, have been cited as adding to the title Ex libro CXXI the subtitle qui editus post excessum Augusti (...) dicitur. When the latest editor, P. Jal in the Collection Budé , declares himself unconvinced of its authenticity , he leaves the reader to decide whether authenticity means truth, authorial origin, or presence in the archetype; but whatever it means, seeds of suspicion have been sown. (shrink)