We assessed how synchronous speech listening and lipreading affects speech recognition in acoustic noise. In simple audiovisual perceptual tasks, inverse effectiveness is often observed, which holds that the weaker the unimodal stimuli, or the poorer their signal-to-noise ratio, the stronger the audiovisual benefit. So far, however, inverse effectiveness has not been demonstrated for complex audiovisual speech stimuli. Here we assess whether this multisensory integration effect can also be observed for the recognizability of spoken words. To that end, we presented audiovisual (...) sentences to 18 native-Dutch normal-hearing participants, who had to identify the spoken words from a finite list. Speech-recognition performance was determined for auditory-only, visual-only (lipreading) and auditory-visual conditions. To modulate acoustic task difficulty, we systematically varied the auditory signal-to-noise ratio. In line with a commonly-observed multisensory enhancement on speech recognition, audiovisual words were more easily recognized than auditory-only words (recognition thresholds of -15 dB and -12 dB, respectively). We here show that the difficulty of recognizing a particular word, either acoustically or visually, determines the occurrence of inverse effectiveness in audiovisual word integration. Thus, words that are better heard or recognized through lipreading, benefit less from bimodal presentation. Audiovisual performance at the lowest acoustic signal-to-noise ratios (45%) fell below the visual recognition rates (60%), reflecting an actual deterioration of lipreading in the presence of excessive acoustic noise. This suggests that the brain may adopt a strategy in which attention has to be divided between listening and lipreading. (shrink)

Background Speech understanding may rely not only on auditory, but also on visual information. Non-invasive functional neuroimaging techniques can expose the neural processes underlying the integration of multisensory processes required for speech understanding in humans. Nevertheless, noise (from fMRI) limits the usefulness in auditory experiments, and electromagnetic artefacts caused by electronic implants worn by subjects can severely distort the scans (EEG, fMRI). Therefore, we assessed audio-visual activation of temporal cortex with a silent, optical neuroimaging technique: functional near-infrared spectroscopy (fNIRS). Methods (...) We studied temporal cortical activation as represented by concentration changes of oxy- and deoxy-hemoglobin in four, easy-to-apply fNIRS optical channels of 33 normal-hearing adult subjects and 5 post-lingually deaf cochlear implant (CI) users in response to supra-threshold unisensory auditory and visual, as well as to congruent auditory-visual speech stimuli. Results Activation effects were not visible from single fNIRS channels. However, by discounting physiological noise through reference channel subtraction, auditory, visual and audiovisual speech stimuli evoked concentration changes for all sensory modalities in both cohorts (p<0.001). Auditory stimulation evoked larger concentration changes than visual stimuli (p<0.001). A saturation effect was observed for the audiovisual condition. Conclusions Physiological, systemic noise can be removed from fNIRS signals by reference channel subtraction. The observed multisensory enhancement of an auditory cortical channel can be plausibly described by a simple addition of the auditory and visual signals with saturation. (shrink)

Cohen Kadosh, Tzelgov, and Henik [Cohen Kadosh, R., Tzelgov, J., and Henik, A. (2008). A synesthetic walk on the number line: The size effect. Cognition, 106, 548-557] present a new paradigm to probe properties of the mental number line. They describe two experiments which they argue to be inconsistent with the exact small number model proposed by Verguts, Fias, and Stevens [Verguts, T., Fias, W., Stevens, M. (2005). A model of exact small-number representation. Psychonomic Bulletin and Review, 12, 66-80]. We (...) discuss the data, assumptions, and conclusions of Cohen Kadosh et al.'s paper in relation to existing models of numerical cognition. (shrink)

The iCat is a user-interface robot with the ability to express a range of emotions through its facial features. This article summarizes our research to see whether we can increase the believability and likability of the iCat for its human partners through the application of gaze behaviour. Gaze behaviour serves several functions during social interaction such as mediating conversation flow, communicating emotional information and avoiding distraction by restricting visual input. There are several types of eye and head movements that are (...) necessary for realizing these functions. We designed and evaluated a gaze behaviour system for the iCat robot that implements realistic models of the major types of eye and head movements found in living beings: vergence, vestibulo ocular reflexive, smooth pursuit movements and gaze shifts. We discuss how these models are integrated into the software environment of the iCat and can be used to create complex interaction scenarios. We report about some user tests and draw conclusions for future evaluation scenarios. (shrink)

In their 2007 paper, Swierstra and Rip identify characteristic tropes and patterns of moral argumentation in the debate about the ethics of new and emerging science and technologies (or “NEST-ethics”). Taking their NEST-ethics structure as a starting point, we considered the debate about tissue engineering (TE), and argue what aspects we think ought to be a part of a rich and high-quality debate of TE. The debate surrounding TE seems to be predominantly a debate among experts. When considering the NEST-ethics (...) arguments that deal directly with technology, we can generally conclude that consequentialist arguments are by far the most prominently featured in discussions of TE. In addition, many papers discuss principles, rights and duties relevant to aspects of TE, both in a positive and in a critical sense. Justice arguments are only sporadically made, some “good life” arguments are used, others less so (such as the explicit articulation of perceived limits, or the technology as a technological fix for a social problem). Missing topics in the discussion, at least from the perspective of NEST-ethics, are second “level” arguments—those referring to techno-moral change connected to tissue engineering. Currently, the discussion about tissue engineering mostly focuses on its so-called “hard impacts”—quantifiable risks and benefits of the technology. Its “soft impacts”—effects that cannot easily be quantified, such as changes to experience, habits and perceptions, should receive more attention. (shrink)

BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES (...) practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions.ResultsThe main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices.ConclusionsThe evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA. (shrink)

Recent results have shown that the relative activation of muscles is different for isometric contractions and for movements. These results exclude an explanation of muscle activation patterns by a combination ofreciprocal and coactivation commands. These results also indicate that joint stiffness is not uniquely determined and that it may be different for isometric contractions and movements.

Synthetic biology is an emerging technology that asks for inclusive reflection on how people frame the field. To unravel how we can facilitate such reflection, this study evaluates the Frame Reflection Lab. Building upon playfulness design principles, the FRL comprises a workshop with video-narratives and co-creative group exercises. We studied how the FRL facilitated frame reflection by organizing workshops with various student groups. Analysis of 12 group conversations and 158 mini-exit surveys yielded patterns in first-order reflection as well as patterns (...) in second-order reflection. Also patterns in participants’ framing of synthetic biology could be induced; participants’ viewpoints converged to some extent, yet with openness to individual viewpoint differences. Although the FRL method fortified the reflection processes of participants, the narratives and the workshop’s flexible format could inhibit the reflection too. Therefore, we advise designers of future frame reflection methods to apply stronger conversational facilitation and narratives of slightly mysterious yet identifiable narrators, in case e.g. video-narratives are created and used to scaffold the reflection process. Nevertheless, we argue that the use of a playful frame reflection method like the FRL could function well as a step to precede more application-specific deliberation or decision-making on synthetic biology and as a method for the collection of contemporary citizen viewpoints plus rationales underlying these, for the further responsible development of the emerging field. (shrink)

Dishonesty is ubiquitous in our world. The news is frequently filled with high-profile cases of corporate fraud, large-scale corruption, lying politicians, and the hypocrisy of public figures. On a smaller scale, ordinary people often cheat, lie, misreport their taxes, and mislead others in their daily life. Despite such prevalence of cheating, corruption, and concealment, people typically consider themselves to be honest, and often believe themselves to be more moral than most others. This book aims to resolve this paradox by addressing (...) the question of why people are dishonest all too often. What motivates dishonesty, and how are people able to perceive themselves as moral despite their dishonest behaviour? What personality and interpersonal factors make dishonesty more likely? And what can be done to recognize and reduce dishonesty? This is a fascinating overview of state-of-the-art research on dishonesty, with prominent scholars offering their views to clarify the roots of dishonesty. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...) confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

Moral case deliberation (MCD) is a specific form of clinical ethics, aiming to stimulate ethical reflection in daily practice in order to improve the quality of care. This article focuses on the implementation of MCD in nursing homes and the questions how and where to organize MCD. The purpose of this study was to evaluate one way of organizing MCD in two Dutch nursing homes. In both of these nursing homes the MCD groups had a heterogeneous composition and were organized (...) apart from existing institutional communication structures. As part of a naturalistic evaluation, systematic observations, interviews and focus groups were completed. The findings indicate that the heterogeneous composition and MCD meetings separate from existing structures have benefits. However, the participants also reported negative experiences. This gives rise to the question whether a mixed MCD group which meets separately is an effective way to embed MCD as an instrument for reflection on moral issues in daily practice. We conclude that there is no single answer to that question. In the end, the two implementation strategies (i.e. within existing communication structures and a mixed MCD group) can be complementary to each other. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

An important approach to understand how the brain gives rise to consciousness is to probe the depth of unconscious processing, thus to define the key features that cause conscious awareness. Here, we investigate the possibility for subliminal stimuli to shape the context for unconscious processing. Context effects have generally been assumed to require consciousness. In the present experiment, unconscious context processing was investigated by looking at the impact of the context on the response activation elicited by a subliminal prime. We (...) compared the effects of the same subliminal prime on target processing when the prime was embedded in different unconscious contexts. Results showed that the same prime can evoke opposite responses depending on the unconscious context in which it is presented. Taken together, the results of this study show that context effects can be unconscious. (shrink)

Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder, and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient’s autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded in clinical (...) practice and corresponds with the experiences of patients with obsessions and/or compulsions. We present a naturalistic case study giving both the patient’s and the therapist’s perspective based on in-depth interviews and a narrative analysis. The case study shows that competence is not merely an assessment by a therapist, but also a co-constructed reality shaped by the experiences and stories of patient and therapist. The patient, a medical student, initially told her story in a restitution narrative, focusing on cognitive rationality. Reconstructing the history of her disease, her story changed into a quest narrative where there was room for emotions, values and moral learning. This fitted well with the therapist’s approach, who used motivational interventions with a view to appealing to the patient’s responsibility to deal with her condition. We conclude that in practice both the patient and therapist used a quest narrative, approaching competence as the potential for practical reasoning to incorporate values and emotions. (shrink)

In this paper, we examine how organizations’ impression management evolves in response to rising stakeholder pressures regarding organizations’ corporate responsibility initiatives. We conducted a comparative case study analysis over a period of 13 years for two organizations—Exxon and BP—that took extreme initial stances on climate change. We found that as stakeholder pressures rose, their IM tactics unfolded in four phases: advocating the initial stance, sensegiving to clarify the initial stance, image repairing, and adjusting the stance. Taken together, our analysis of (...) IM over these four phases provides three key insights about the evolution of IM in the face of rising pressures. First, when faced with stakeholder pressures, it seems that organizations do not immediately resort to conforming but tend to give in gradually when pressures increase and start to come from relatively powerful stakeholders. Second, evolution of IM seems to be characterized by path dependence, i.e., even as organizations’ positions evolve, they continue to show their conviction in their initial positions and try to convey that their subsequent positions flow logically from the previous ones. Finally, IM involves navigation between symbolism and substance, and companies tend to strive toward harmonizing their symbolic and substantive actions as stakeholder pressure increases. (shrink)

In this article we discuss the ethical dilemmas facing performance evaluators and the "evaluatees" whose performances are measured in a business context. The concepts of role morality and common morality are used to develop a framework of behaviors that are normally seen as the moral responsibilities of these actors. This framework is used to analyze, based on four empirical situations, why the implementation of a performance measurement system has not been as effective as expected. It was concluded that, in these (...) four cases, unethical behavior (i.e. deviations from the ethical behaviors identified in the framework) provided, at least to some extent, an explanation for the lower than expected effectiveness of the performance measurement procedures. At the end of the paper we present an agenda for further research through which the framework could be further developed and systematically applied to a broader set of cases. (shrink)

Argumentation as the public exchange of reasons is widely thought to enhance deliberative interactions that generate and justify reasonable public policies. Adopting an argumentation-theoretic perspective, we survey the norms that should govern public argumentation and address some of the complexities that scholarly treatments have identified. Our focus is on norms associated with the ideals of correctness and participation as sources of a politically legitimate deliberative outcome. In principle, both ideals are mutually coherent. If the information needed for a correct deliberative (...) outcome is distributed among agents, then maximising participation increases information diversity. But both ideals can also be in tension. If participants lack competence or are prone to biases, a correct deliberative outcome requires limiting participation. The central question for public argumentation, therefore, is how to strike a balance between both ideals. Rather than advocating a preferred normative framework, our main purpose is to illustrate the complexity of this theme. (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)

Worldwide there are substantial differences within and between countries in aggression and violence. Although there are various exceptions, a general rule is that aggression and violence increase as one moves closer to the equator, which suggests the important role of climate differences. While this pattern is robust, theoretical explanations for these large differences in aggression and violence within countries and around the world are lacking. Most extant explanations focus on the influence of average temperature as a factor that triggers aggression, (...) or the notion that warm temperature allows for more social interaction situations in which aggression is likely to unfold. We propose a new model, CLimate, Aggression, and Self-control in Humans, that helps us to understand differences within and between countries in aggression and violence in terms of differences in climate. Lower temperatures, and especially larger degrees of seasonal variation in climate, call for individuals and groups to adopt a slower life history strategy, a greater focus on the future, and a stronger focus on self-control. The CLASH model further outlines that slow life strategy, future orientation, and strong self-control are important determinants of inhibiting aggression and violence. We also discuss how CLASH differs from other recently developed models that emphasize climate differences for understanding conflict. We conclude by discussing the theoretical and societal importance of climate in shaping individual and societal differences in aggression and violence. (shrink)