AimsThis study evaluates a protocol for early, routine ethics consultation for patients on extracorporeal membrane oxygenation to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress.MethodsWe conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019. Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of (...) treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers’ perceptions of the impact of the early intervention protocol.ResultsLimited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a ‘bridge to nowhere’, EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy.ConclusionData from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC—at least while this medical technology is in its nascent stages. (shrink)

We found a direct relationship between variation in informants' grammaticality intuitions about pronoun coreference and variation in the same informants' use of a clause segmentation strategy during sentence perception. It has been proproposed that ‘c‐command’, a structural principle defined in terms of constituent dominance relations, constrains within‐sentence coreference between pronouns and noun antecedents. The relative height of the pronoun and the noun in the phrase structure hierarchy determines whether the c‐command constraint blocks coreference: Coreference is allowed only when the complement (...) structure containing the noun is attached higher than the pronoun. We collected informants' judgments on pronoun‐noun coreference in which the noun antecedent was contained in a complement structure dominated by either the Sentence‐node (S‐node) (higher than the pronoun) or the Verb‐phrase‐node (VP‐node) (not higher than the pronoun). We also assessed each informant's perceptual clause‐closure tendency using an auditory word‐monitor paradigm. Informants who strongly segmented clauses in the perceptual task did not differentiate between an S‐ and VP‐attachment of sentence complements, as revealed in their coreference judgments, but rather appeared to attach all sentence complements to the S‐node. Informants with relatively weak perceptual segmentation differentiated their coreference judgments according to the node attachment of the complement structure. These results indicate that the linguistic universal controlling within‐sentence coreference applies to the perceptually available structure for a sequence, not to its pure linguistic structure. Hence, linguistic intuitions result from the interaction of three independent faculties: language‐specific knowledge, perceptual processes, and linguistic universals. (shrink)

L’intervention que reprend cet article porte sur un cadre-dispositif singulier de thérapie familiale basé sur l’épistémologie psychanalytique groupale. Ce cadre est singulier dans la mesure où il a été tenté d’articuler un travail entre groupe de thérapeutes et néo-groupe. La réflexion développée ici s’origine dans la clinique des auteurs : lorsqu’ils parlent en groupe d’une famille, la règle d’association libre les amène fréquemment à évoquer une autre famille rencontrée précédemment en séance. Quelle est la nature et la fonction de cette (...) résonance? L’article pose l’hypothèse d’un nouveau contre-transfert : le contre-transfert transfamilial. Une vignette clinique permet d’illustrer le cheminement qui a conduit les auteurs à y aboutir. (shrink)

In this study, we developed and validated an instrument that researchers can use to measure the collective effort of principals and teachers who excise their own unique leadership to genera...

Gervain et al. discuss both behavioral and neurophysiological AGL studies that investigate rule and structure learning processes in infants. The paper provides an overview of all the major AGL paradigms used to date to investigate infant learning abilities at the level of morpho‐phonology and syntax from a very early age onwards. Gervain et al. also discuss the implications of the results for a general theory of natural language acquisition.

Gervain et al. discuss both behavioral and neurophysiological AGL studies that investigate rule and structure learning processes in infants. The paper provides an overview of all the major AGL paradigms used to date to investigate infant learning abilities at the level of morpho‐phonology and syntax from a very early age onwards. Gervain et al. also discuss the implications of the results for a general theory of natural language acquisition.