An increasing number of older patients have to decide on a treatment plan for advanced chronic kidney disease, involving dialysis or conservative care. Shared decision-making is recommended as the model for decision-making in such preference-sensitive decisions. The aim of SDM is to come to decisions that are consistent with the patient’s values and preferences and made by the patient and healthcare professional working together. In clinical practice, however, SDM appears to be not yet routine and needs further implementation. A shift (...) from a biomedical to a person-centered conception might help to make the process more shared. Shared should, therefore, be interpreted as two persons bringing two perspectives to the table, that both need to be explored during the decision-making process. Starting from the patient’s perspective will enable to determine the mutual goals of care first and, subsequently, determine the best way for achieving those goals. To perform such SDM, the healthcare professional needs to become a skilled companion, being part of the patient’s relational context, and start asking the right questions about what matters to the patient as person. In this article, we describe the need for a person-centered conception of SDM for the setting of older patients with advanced CKD. (shrink)

Much problem solving and learning research in math and science has focused on formal representations. Recently researchers have documented the use of unschooled strategies for solving daily problems -- informal strategies which can be as effective, and sometimes as sophisticated, as school-taught formalisms. Our research focuses on how formal and informal strategies interact in the process of doing and learning mathematics. We found that combining informal and formal strategies is more effective than single strategies. We provide a theoretical account of (...) this multiple strategy effect and have begun to formulate this theory in an ACT-R computer model. We show why students may reach common impasses in the use of written algebra, and how subsequent or concurrent use of informal strategies leads to better problem-solving performance. Formal strategies facilitate computation because of their abstract and syntactic nature; however, abstraction can lead to nonsensical interpretations and conceptual errors. Reapplying the formal strategy will not repair such errors; switching to an informal one may. We explain the multiple strategy effect as a complementary relationship between the computational efficiency of formal strategies and the sense-making function of informal strategies. (shrink)

In this autoethnographic essay, I reflect on my brief personal experiences of conducting field research on ways in which way a small group of Tibetan Buddhist monks enact a monastic total institution in Ladakh, India. More specifically, I analyze my experiences in view of the relationship between dual and nondual mind, as discussed by Henry Vyner (2002) in Anthropology of Consciousness, and use this analysis to develop preliminary insights into the ways in which a Tibetan Buddhist monastery is constituted.

The number of discriminable colours is often assumed to be of the order of several million but the extent of detectable chromatic diversity present in individual natural scenes is an open question. Here, the aim was to estimate the number of discriminable colours seen in natural scenes. Hyperspectral data were obtained from a set of natural scenes over the range 400 - 720 nm at 10 nm intervals (Nascimento et al, 2002 Journal of the Optical Society of America A 19 (...) 1484 - 1490) and the representation of each scene in CIELAB space computed for all pixels of the image. The number of discriminable colours was estimated by counting the number of unit volumes in the three-dimensional volume defined by the scene when represented in CIELAB space. We found that the number of discriminable colours estimated in a scene could vary by an order of magnitude from scene to scene, but rarely exceeded 105, indicating a limited chromatic diversity. (shrink)

For years, experimental philosophers have attempted to discern whether laypeople find free will compatible with a scientifically deterministic understanding of the universe, yet no consensus has emerged. The present work provides one potential explanation for these discrepant findings: People are strongly motivated to preserve free will and moral responsibility, and thus do not have stable, logically rigorous notions of free will. Seven studies support this hypothesis by demonstrating that a variety of logically irrelevant (but motivationally relevant) features influence compatibilist judgments. (...) In Study 1, participants who were asked to consider the possibility that our universe is deterministic were more compatibilist than those not asked to consider this possibility, suggesting that determinism poses a threat to moral responsibility, which increases compatibilist responding (thus reducing the threat). In Study 2, participants who considered concrete instances of moral behavior found compatibilist free will more sufficient for moral responsibility than participants who were asked about moral responsibility more generally. In Study 3a, the order in which participants read free will and determinism descriptions influenced their compatibilist judgments—and only when the descriptions had moral significance: Participants were more likely to report that determinism was compatible with free will than that free will was compatible with determinism. In Study 3b, participants who read the free will description first (the more compatibilist group) were particularly likely to confess that their beliefs in free will and moral responsibility and their disbelief in determinism influenced their conclusion. In Study 4, participants reduced their compatibilist beliefs after reading a passage that argued that moral responsibility could be preserved even in the absence of free will. Participants also reported that immaterial souls were compatible with scientific determinism, most strongly among immaterial soul believers (Study 5), and evaluated information about the capacities of primates in a biased manner favoring the existence of human free will (Study 6). These results suggest that people do not have one intuition about whether free will is compatible with determinism. Instead, people report that free will is compatible with determinism when desiring to uphold moral responsibility. Recommendations for future work are discussed. (shrink)

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman (n = 506) and senior students (n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict were (...) higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students. (shrink)

About one third of patients with epilepsy have seizures refractory to the medical treatment. Electrical stimulation mapping is the gold standard for the identification of “eloquent” areas prior to resection of epileptogenic tissue. However, it is time-consuming and may cause undesired side effects. Broadband gamma activity recorded with extraoperative electrocorticography during cognitive tasks may be an alternative to ESM but until now has not proven of definitive clinical value. Considering their role in cognition, the alpha and beta bands could further (...) improve the identification of eloquent cortex. We compared gamma, alpha and beta activity, and their combinations for the identification of eloquent cortical areas defined by ESM. Ten patients with intractable focal epilepsy participated in a delayed-match-to-sample task, where syllable sounds were compared to visually presented letters. We used a generalized linear model approach to find the optimal weighting of each band for predicting ESM-defined categories and estimated the diagnostic ability by calculating the area under the receiver operating characteristic curve. Gamma activity increased more in eloquent than in non-eloquent areas, whereas alpha and beta power decreased more in eloquent areas. Diagnostic ability of each band was close to 0.7 for all bands but depended on multiple factors including the time period of the cognitive task, the location of the electrodes and the patient’s degree of attention to the stimulus. We show that diagnostic ability can be increased by 3–5% by combining gamma and alpha and by 7.5–11% when gamma and beta were combined. We then show how ECoG power modulation from cognitive testing can be used to map the probability of eloquence in individual patients and how this probability map can be used in clinical settings to optimize ESM planning. We conclude that the combination of gamma and beta power modulation during cognitive testing can contribute to the identification of eloquent areas prior to ESM in patients with refractory focal epilepsy. (shrink)

Supreme Audit Institutions (SAIs) investigate the regularity (conformity to legislation) and performance (economy, efficiency, and effectiveness) of central government policies and administration through the instrument of accountability. Both types of audit have their own research process and set of standards. This article deals with the question of whether this distinction inhibits a proper appraisal of policy and administration and investigates the possibilities for SAIs to attain more integrated assessment procedures. This question is of vital importance, not only to SAIs but (...) to any controlling and inspecting body, whether political or administrative. (shrink)

A notion of resource-bounded Baire category is developed for the class PC[0,1] of all polynomial-time computable real-valued functions on the unit interval. The meager subsets of PC[0,1] are characterized in terms of resource-bounded Banach-Mazur games. This characterization is used to prove that, in the sense of Baire category, almost every function in PC[0,1] is nowhere differentiable. This is a complexity-theoretic extension of the analogous classical result that Banach proved for the class C[0, 1] in 1931.

For the scholastic philosopher William Ockham (c. 1285-1347), there are three kinds of heresy. The first, and most unmistakable, is an outright denial of the truths of faith. Another is so obvious that a very simple person, even if illiterate, can see how it contradicts Divine Scripture. The third kind of heresy is less clear cut. It is perceptible only after long deliberation and only to individuals who are learned, and well versed in Scripture. It is this third variety of (...) heresy that J.M.M.H. Thijssen addresses in Censure and Heresy at the University of Paris, 1200-1400. The book documents 30 cases in which university trained scholars were condemned for disseminating allegedly erroneous opinions in their teaching or writing, and focuses particularly on four academic censures that have occupied prominent positions in the historiography of medieval philosophy. Thijssen grants central importance to a number of questions so far neglected by historians regarding judicial procedures, the authorities supervising the orthodoxy of teaching, and the effects of condemnations on the careers of the accused. He also places still current questions regarding academic freedom and the nature of doctrinal authority into their medieval contexts. (shrink)

"This book contains ideas to develop interdisciplinary and transdisciplinary views on economy and society. It aims to disseminate heterodox ideas on various subjects related to economics and global society. The book is organised in six parts. Part 1 contains the key lectures of Backhaus on the concept of state sciences and of Klamer on the importance of culture for economics. Parts 2- 6 contain successively contributions in the areas of economic paradigms and theories, population and society, corporate issues, environment, and (...) international relations. Examples of the content are: - the changes of family life cycles due to the rise of non-traditional households; - subjective and objective inflation rates after the introduction of the Euro; - the economics of genetic engineering; - the contribution of foreign direct investment to the economic development of host countries; - the inaccuracy of economic models applied in places characterized by extreme income disparities; - the improvement of political and corporate governance; - evolutionary thinking and emission trading; - freedom and order in the European Union; - the reform of social policy in Europe. The book provides interesting creative multi-disciplinary ideas with respect to various topical issues concerning the contemporary global society. It is highly recommended for economists and social scientists in search of broad views on social science and society.". (shrink)

This book is a collection of papers on the metaphysics and natural philosophy of John Buridan (ca. 1295-1361), one of the most innovative and influential ...

OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)