BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation. Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA North European field survey (...) among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.ResultsAll outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.ConclusionsThe findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such as moral reflexivity and moral attitude outcomes, should still be included. In the future, a combination of empirical findings and normative reflection will contribute to the revision of the instrument. (shrink)

To support healthcare professionals in dealing with ethically difficult situations, Clinical Ethics Support (CES) services like Moral Case Deliberation (MCD) are increasingly implemented. To assess the impact of CES, it is important to evaluate outcomes. Despite general claims about outcomes from MCD experts and some qualitative research, there exists no conceptual analysis of outcomes yet. Therefore, the aim of this study was to systematically define and categorize MCD outcomes. An additional aim was to compare these outcomes with the outcomes in (...) the Euro-MCD Instrument from 2014, to further validate this Instrument. The concept mapping method was used and involves qualitative and quantitative steps including brainstorming, individual structuring, computation of concept maps (by principal component analysis and cluster analysis), group interpretation and utilization. In total, 12 experienced MCD participants from a variety of professional backgrounds participated in two sessions. The focus group brainstorm resulted in a list of 85 possible MCD outcomes, of which a point map and concept maps were constructed. After a thorough discussion of each cluster, final consensus was reached on the names and position of 8 clusters of MCD outcomes: 1) Organisation and Policy; 2) Team development; 3) Personal development focused on the Other Person; 4) Personal development as Professional, focused on Skills; 5) Personal development as Professional, focused on Knowledge; 6) Personal development as an Individual; 7) Perception and Connection; and 8) Concrete action. This study explored and categorized MCD outcomes in a concept mapping focus group. When comparing the results with the Euro-MCD Instrument, our study confirms that outcomes of MCD can be categorized in clusters referring to the organisational level, team development, personal development (both as an individual and a professional) and the concrete case-level. In developing CES evaluation tools, it is important to be explicit if an outcome refers to the individual or the team, to knowledge or skills, to the organisation or the specific case. The findings will be used in the further validation of the Euro-MCD Instrument. The current study further contributes to the field of evaluating CES in general and defining outcomes of MCD in particular. (shrink)

BackgroundAlthough the number of reporting guidelines has grown rapidly, few have gone through an updating process. The STARD statement (Standards for Reporting Diagnostic Accuracy), published in 2003 to help improve the transparency and completeness of reporting of diagnostic accuracy studies, was recently updated in a systematic way. Here, we describe the steps taken and a justification for the changes made.ResultsA 4-member Project Team coordinated the updating process; a 14-member Steering Committee was regularly solicited by the Project Team when making critical (...) decisions. First, a review of the literature was performed to identify topics and items potentially relevant to the STARD updating process. After this, the 85 members of the STARD Group were invited to participate in two online surveys to identify items that needed to be modified, removed from, or added to the STARD checklist. Based on the results of the literature review process, 33 items were presented to the STARD Group in the online survey: 25 original items and 8 new items; 73 STARD Group members (86 %) completed the first survey, and 79 STARD Group members (93 %) completed the second survey.Then, an in-person consensus meeting was organized among the members of the Project Team and Steering Committee to develop a consensual draft version of STARD 2015. This version was piloted in three rounds among a total of 32 expert and non-expert users. Piloting mostly led to rewording of items. After this, the update was finalized. The updated STARD 2015 list now consists of 30 items. Compared to the previous version of STARD, three original items were each converted into two new items, four original items were incorporated into other items, and seven new items were added.ConclusionsAfter a systematic updating process, STARD 2015 provides an updated list of 30 essential items for reporting diagnostic accuracy studies. (shrink)

Prison work creates ethical challenges for which a training program was initiated for Dutch prison staff to foster their Moral Craftsmanship (MCS). The concept of MCS is not yet defined and operationalized in literature. This explorative study aims to 1) define MCS, 2) identify conceptual elements of MCS, and 3) develop a measurement tool for MCS. A document and literature study provided input for the definition and selection of conceptual elements related within DCIA policy documents, identifying three conceptual levels of (...) MCS: individual (cognition, attitude, and actions), team, and leadership. This first MCSQ consists of seventy-one items distributed across the domains: values and norms, judgment and reasoning, consultation, implementation, looking back, interactions, and leadership. We tested its usability via ‘think-aloud interviews.’ Validation of the current version of the MCS-Questionnaire and consensus among experts about what to include or exclude in the concept of MCS are needed for further development. (shrink)

This study explores the impact of participation in a series of moral case deliberations (MCD) on the moral craftsmanship (MCS) of Dutch prison staff. Between 2017–2020, ten MCDs per team were implemented in three prisons (i.e., intervention group). In three other prisons (i.e., control group) no MCDs were implemented. We compared the intervention and control group using a self-developed questionnaire, administered before (pre-measurement) and after the series of MCDs (post-measurement). Results After the MCDs, participants scored significantly higher on 7 of (...) the 70 items related to MCS. On some items there were significant impact differences between the various professional disciplines. Discussion Possible explanations for a relatively low impact are discussed. A shorter and validated questionnaire is needed in order to further study the MCS of professionals and the impact of Ethics Support Services (ESS). Conclusions There was a positive development on some elements of MCS after participation in a series of MCDs. (shrink)

Ethics support services like Moral Case Deliberation intend to support healthcare professionals in ethically difficult situations. To assess outcomes of MCD, the Euro-MCD Instrument has been developed. Field studies to test this instrument are needed and have been conducted, examining important outcomes before MCD participation and experienced outcomes. The current study aimed to describe how participants’ perceive the importance of MCD outcomes after MCD; compare these perceptions with those before MCD participation; and test the factor structure of these outcomes. Swedish, (...) Norwegian and Dutch healthcare professionals rated the importance of outcomes in the Euro-MCD Instrument after four and eight MCDs. Ratings were compared with those before MCD participation using paired and independent samples t-tests. The factor structure was tested using exploratory factor analyses. After 4 and 8 MCDs, 443 respectively 247 respondents completed the instrument. More than 69% rated all MCD outcomes as ‘quite’ or ‘very’ important, especially outcomes from Enhanced Collaboration, Improved Moral Reflexivity and Improved Moral Attitude. Significant differences for 16 outcomes regarding ratings before and after MCD participation were not considered meaningful. Factor analyses suggested three categories, which seemingly resemble the domains Improved Moral Reflexivity, Enhanced Collaboration and a combination of Improved Moral Attitude and Enhanced Emotional Support. After participation in MCDs, respondents confirmed the importance of outcomes in the Euro-MCD Instrument. The question on perceived importance and the categorization of outcomes need reconsideration. The revised instrument will be presented elsewhere, based on all field studies and theoretical reflections. (shrink)

BackgroundClinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies (...) and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process.MethodsThe revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes.ResultsThe Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. ‘now’) instead of an assumed improvement over time (e.g. ‘better’) and we omitted the question about perceived importance.ConclusionsThe Euro-MCD 2.0 is shorter, less complex and more strongly substantiated by an integration of empirical findings, theoretical reflections and dialogues with participants and experts. Use of the Euro-MCD 2.0 will facilitate evaluation of MCD and can thereby monitor and foster implementation and quality of MCD. The Euro-MCD 2.0 will strengthen future research on evaluation of outcomes of MCD. (shrink)

'This book is an excellent, theoretically sound and politically relevant reader', Professor Wolfschaefer, Universitat des Bundeswehr, Hamburg 'Up to date complete overview of European monetary and fiscal policy issues. Highly readable, good mix of theory and data' 'I think the book contains a wealth of useful, precise information, presented in a straightforward, readable way in a quintessentially comparative perspective', Dr M Mclean, Royal Holloway University 'Excellent treatment - quite comprehensive, full references, accessible for non-economists', Charlotte Bretherton, Liverpool John Moores Univesity (...) 'A useful addition to student literature', MJ Macmillan, Exeter University 'This is a top class book and does not limit itself to assessing the adequacy of the European political economy to the precepts of advanced monetary economics...This book is an excellent tool for teaching EMU economics, and raising the level of EMU economics in the reaserch-field of international political economy. Students and scholars will appreciate the explicit assessment the authors make of complex economic issues, and their unbiased stance in the study of EMU economic and political interplay.' Miriam L.Campamella, Jean Monnet Professor, Faculty of Political Science, University of Turin. ECSA Review, Winter 2001This textbook offers a fresh and comprehensive examination of European monetary and fiscal policy in the third stage of Economic and Monetary Union. Professors Eijffinger and de Haan give a brief history of European economic integration before the transition to EMU, and continue with a comprehensive analysis of institutions, legislation, and policies. Their analysis includes the functions and goals of the European Central Bank, the Treaty on European Union, the Stability and Growth Pact, and the harmonization of taxes. Other topics discussed include the targets and instruments of European monetary policy, the integration of European financial markets, and the competition between financial institutions in Europe. (shrink)

One of the central explananda in the debate on social cognition is the interpretation of other people in terms of reasons for action. There is a growing dissatisfaction among participants in the debate concerning the descriptive adequacy of the traditional belief-desire model of action interpretation. Applying this model as an explanatory model at the subpersonal level threatens to leave the original explanandum largely unarticulated. Against this background we show how Brandom’s deontic scorekeeping model can be used as a valuable descriptive (...) tool for making folk psychology explicit. Following Brandom’s non-formalist and non-mentalistic account of reason discourse, we suggest that the process of making sense of others is best captured as proceeding from a ‘factive’ baseline. According to this picture the ascription of beliefs and desires is not the default interpretation strategy, but rather the result of prior scaffolding of the agent’s deontic score. We close by discussing Brandom’s model in the light of empirical findings on the ontogeny of reason attribution. (shrink)

Mole's (2008 [this issue]) argument that consciousness is a necessary concomitant of attention rests on the question of what is being attended in spatial attention. His answer is space. Some authors, including ourselves, claim that the fact that the processing of unseen objects can be modulated by spatial attention (e.g. Kentridge et al., 1999; 2004; 2008; Marzouki et al., 2007; Sumner et al., 2006) demonstrates that visual attention is not a sufficient precondition for visual awareness. Mole, however, contends that as (...) space, rather than any object that might occupy that space, is what is being attended, these experiments do not constitute evidence for a dissociation between attention and consciousness. We disagree. To understand the source of this disagreement we need to understand the various processes encompassed by the term 'attention' and to consider experimental evidence illustrating how these processes operate. We review evidence that spatial attention can be deployed with the specific goal of determining the properties of objects occupying the attended region of space. One might, for example, attend to a location with the goal of determining the colour of objects occupying that space as efficiently as possible. Mole's assumption that all that is attended in spatial attention is space is not consistent with this evidence. We conclude that attention can be directed at objects by mechanisms of so- called 'spatial attention' without those objects necessarily eliciting conscious visual experience and hence that attention is not a sufficient precondition for visual awareness. (shrink)

Decisions related to animal welfare standards depend on farmer’s multiple goals and values and are constrained by a wide range of external and internal forces. The aim of this paper is twofold, i.e., to develop a theoretical framework for farmers’ AW decisions that incorporates farmers’ goals, use and non-use values and to present an approach to empirically implement the theoretical framework. The farmer as a head of the farm household makes choices regarding production to maximize the utility of the household. (...) The overall utility of the farmer is determined by his multiple objectives. For the analysis of multi-objective problems, the multiple criteria decision - making paradigm provides an appropriate theoretical framework. However, theories from the field of social-psychology are needed to facilitate the identification of all relevant aspects in the decision making. The practical use of the conceptual framework is demonstrated using a simple numerical application of a multi-objective programming model. Two workshops were devoted to examining the scientific consistency and the practical usefulness of the approach. Implementing this approach will increase knowledge of the main factors and barriers that determine farmers’ decisions with regard to AW standards. This knowledge is relevant during the development of new AW concepts that aims to supply products that comply with above-legal AW standards for middle-market segments. (shrink)

In this article we take issue with theory theory and simulation theory accounts of folk psychology committed to (i) the belief-desire (BD) model and (ii) the assumption of universality (AU). Recent studies cast doubt on the compatibility of these commitments because they reveal considerable cross-cultural differences in folk psychologies. We present both theory theory and simulation theory with the following dilemma: either (i) keep the BD-model as an account of the surface properties of specific explicit folk psychologies and give up (...) AU in light of the cross-cultural evidence; or (ii) defend AU with respect to core capacities underlying different culture-specific folk psychologies, and explain why the BD-model will be genuinely explanatory at this level. (shrink)

Colour has been shown to facilitate the recognition of scene images, but only when these images contain natural scenes, for which colour is ‘diagnostic’. Here we investigate whether colour can also facilitate memory for scene images, and whether this would hold for natural scenes in particular. In the first experiment participants first studied a set of colour and greyscale natural and man-made scene images. Next, the same images were presented, randomly mixed with a different set. Participants were asked to indicate (...) whether they had seen the images during the study phase. Surprisingly, performance was better for greyscale than for coloured images, and this difference is due to the higher false alarm rate for both natural and man-made coloured scenes. We hypothesized that this increase in false alarm rate was due to a shift from scrutinizing details of the image to recognition of the gist of the image. A second experiment, utilizing images without a nameable gist, confirmed this hypothesis as participants now performed equally on greyscale and coloured images. In the final experiment we specifically targeted the more detail-based perception and recognition for greyscale images versus the more gist-based perception and recognition for coloured images with a change detection paradigm. The results show that changes to images are detected faster when image-pairs were presented in greyscale than in colour. This counterintuitive result held for both natural and man-made scenes and thus corroborates the shift from more detailed processing of images in greyscale to more gist-based processing of coloured images. (shrink)

De Interpretatione is among Aristotle's most influential and widely read writings; C. W. A. Whitaker presents the first systematic study of this work, and offers a radical new view of its aims, its structure, and its place in Aristotle's system. He shows that De Interpretatione is not a disjointed essay on ill-connected subjects, as traditionally thought, but a highly organized and systematic treatise on logic, argument, and dialectic.

Aristotle's treatise De Interpretatione is one of his central works; it continues to be the focus of much attention and debate. C. W. A. Whitaker presents the first systematic study of this work, and offers a radical new view of its aims, its structure, and its place in Aristotle's system, basing this view upon a detailed chapter-by-chapter analysis.By treating the work systematically, rather than concentrating on certain selected passages, Whitaker is able to show that, contrary to traditional opinion, it forms (...) an organized and coherent whole. He argues that the De Interpretatione is intended to provide the underpinning for dialectic, the system of argument by question and answer set out in Aristotle's Topics; and he rejects the traditional view that the De Interpretatione concerns the assertion and is oriented towards the formal logic of the Prior Analytics. In doing so, he sheds valuable new light on some of Aristotle's most famous texts. (shrink)

Het antieke sceptische oeuvre van Sextus Empiricus werd in de tijd van het humanisme herontdekt en verder ontwikkeld. De Engelse denken Hume nam de draad op in de achttiende eeuw en sindsdien is het scepticisme in het Europese denken een rol blijven spelen. Wittgenstein heeft dit rationalistisch scepticisme van richting doen veranderen en het de weg van postmoderne pluraliteit opgedreven.

For we see that many happenings must be united for things, that they may be able to beget and propagate their races; first that they may have food, and then a way whereby birth-giving seeds may pass through their frames, and issue from their slackened limbs; and that woman may be joined with man, they must needs each have means whereby they can interchange mutual joys.

For we see that many happenings must be united for things, that they may be able to beget and propagate their races; first that they may have food, and then a way whereby birth-giving seeds may pass through their frames, and issue from their slackened limbs; and that woman may be joined with man, they must needs each have means whereby they can interchange mutual joys.

Over the past twenty years, the annual meetings of the Semiotic Society of America have tracked the growth and development of modern sign theory in American scholarship. Since 1981, the published proceedings of SSA meetings have included representative semiotic work from a wide range of disciplines and every extant -system- of semiotic thought. The papers have especially represented some of the leading intellectual descendants of C.S. Peirce and Ferdinand de Saussure in the United States and Canada. On this ground, the (...) series remains the primary record of North American contributions to sign perspectives, embracing world-wide philosophical, literary, and scientific bases for a 21st-century -doctrine of signs-. The proceedings project has consistently pursued excellent scholarship, representative diversity, and quality production. With publication of Semiotics 1996, general editor John Deely and the Semiotic Society continue the record of -representing- American semiotics. The SSA also plan to incorporate more voices from Mexico in an effort to achieve a comprehensive North American -semiotic- which is strongly linked to practical and theoretical developments across the world.". (shrink)