After many policy attempts to tackle the persistent rise in the costs of health care, physicians are increasingly seen as potentially effective resource stewards. Frameworks including the quadruple aim, value-based health care and choosing wisely underline the importance of positive engagement of the health care workforce in reinventing the system–paving the way to real affordability by defining the right care. Current programmes focus on educating future doctors to provide ‘high-value, cost-conscious care’ (HVCCC), which proponents believe is the future of sustainable (...) medical practice. Such programmes, which aim to extend population-level allocation concerns to interactions between an individual doctor and patient, have generated lively debates about the ethics of expanding doctors’ professional accountability. To empirically ground this discussion, we conducted a qualitative interview study to examine what happens when resource stewardship responsibilities are extended to the consulting room. Attempts to deliver HVCCC were found to involve inevitable trade-offs between benefits to the individual patient and (social) costs, medical uncertainty and efficiency, and between resource stewardship and trust. Physicians reconcile this by justifying good-value care in terms of what is in the best interest of individual patients–redefining the currency of value from monetary costs to a patient’s quality of life, and cost-conscious care as reflective medical practice. Micro-level resource stewardship thus becomes a matter of working reflexively and reducing wasteful forms of care, rather than of making difficult choices about resource allocation. (shrink)

This study considers one of the cognitive mechanisms underlying the development of second language vocabulary in children: The differentiation and sharpening of lexical representations. We propose that sharpening is triggered by an implicit comparison of similar representations, a process we call contrasting. We investigate whether integrating contrasting in a learning method in which children contrast orthographically and semantically similar L2 words facilitates learning of those words by sharpening their new lexical representations. In our study, 48 Dutch-speaking children learned unfamiliar orthographically (...) and semantically similar English words in a multiple-choice learning task. One half of the group learned the similar words by contrasting them, while the other half did not contrast them. Their word knowledge was measured immediately after learning as well as 1 week later. Contrasting was found to facilitate learning by leading to more precise lexical representations. However, only highly skilled readers benefitted from contrasting. Our findings offer novel insights into the development of L2 lexical representations from fuzzy to more precise, and have potential implications for education. (shrink)

In this article, we report on eight grand challenges for value sensitive design, which were developed at a one-week workshop, Value Sensitive Design: Charting the Next Decade, Lorentz Center, Leiden, The Netherlands, November 14–18, 2016. A grand challenge is a substantial problem, opportunity, or question that motives sustained research and design activity. The eight grand challenges are: Accounting for Power, Evaluating Value Sensitive Design, Framing and Prioritizing Values, Professional and Industry Appropriation, Tech policy, Values and Human Emotions, Value Sensitive Design (...) and Intelligent Algorithms, and Value Tensions. Each grand challenge consists of a discussion of its importance and a set of tractable key questions. (shrink)

Our lives are increasingly intertwined with the digital realm, and with new technology, new ethical problems emerge. The academic field that addresses these problems—which we tentatively call ‘digital ethics’—can be an important intellectual resource for policy making and regulation. This is why it is important to understand how the new ethical challenges of a digital society are being met by academic research. We have undertaken a scientometric analysis to arrive at a better understanding of the nature, scope and dynamics of (...) the field of digital ethics. Our approach in this paper shows how the field of digital ethics is distributed over various academic disciplines. By first having experts select a collection of keywords central to digital ethics, we have generated a dataset of articles discussing these issues. This approach allows us to generate a scientometric visualisation of the field of digital ethics, without being constrained by any preconceived definitions of academic disciplines. We have first of all found that the number of publications pertaining to digital ethics is exponentially increasing. We furthermore established that whereas one may expect digital ethics to be a species of ethics, we in fact found that the various questions pertaining to digital ethics are predominantly being discussed in computer science, law and biomedical science. It is in these fields, more than in the independent field of ethics, that ethical discourse is being developed around concrete and often technical issues. Moreover, it appears that some important ethical values are very prominent in one field (e.g., autonomy in medical science), while being almost absent in others. We conclude that to get a thorough understanding of, and grip on, all the hard ethical questions of a digital society, ethicists, policy makers and legal scholars will need to familiarize themselves with the concrete and practical work that is being done across a range of different scientific fields to deal with these questions. (shrink)

Increasing public concern for the welfare of fish species that human beings use and exploit has highlighted the need for better understanding of the cognitive status of fish and of their ability to experience negative emotions such as pain and fear. Moreover, studying emotion and cognition in fish species broadens our scientific understanding of how emotion and cognition are represented in the central nervous system and what kind of role they play in the organization of behavior. For instance, on a (...) macro neuro-architecture level the brains of fish species look dramatically different from those of mammals, while such a dramatic difference does not (always) occur at the level of emotion- and cognition-related behavior. Here, therefore, we discuss the evidence of emotion and cognition in fish species related to underlying neuro-architecture and the role that emotion and cognition play in the organization of behavior. To do so we use a framework encompassing a number of steps allowing a systematic approach to these issues. Emotion and cognition confer on human and non-human animals the capacity to compliment and/or override immediate reflexes to stimuli and so allow a large degree of flexibility in behavior. Systematic research on behavior that in mammals is indicative of emotion and cognition has been conducted in only a few fish species. The data thus far indicate that in these species brain-behavior relationships are not fundamentally different from those observed in mammals. Furthermore, data from other studies show evidence that behavior patterns related to emotion and cognition vary between fish species as well within fish species, related to sex and life history stage for example. From a welfare perspective, knowledge of such variability will potentially help us to design optimal living conditions for fish species kept by humans. (shrink)

High levels of somatic symptom distress represent a core component of both mental and physical illness. The exact aetiology and pathogenesis of this transdiagnostic phenomenon remain largely unknown. The Affective Picture Paradigm (APP) represents an innovative experimental paradigm to study somatic symptom distress. Based on the HiTOP framework and a population-based sampling approach, associations between facets of somatic symptom distress and symptoms induced by the APP were explored in two studies (N1 = 201; N2 = 254) using structural equation bi-factor (...) models. Results showed that the APP effect was significantly positively correlated with general somatic symptom distress (PHQ-15, HiTOP), cardio-respiratory symptoms (PHQ-15), as well as difficulties identifying feelings. In conclusion, negative affective cues in the APP can elicit somatic symptoms, particularly in people with higher levels of somatic symptom distress. Difficulties identifying feelings might contribute to this phenomenon. Results are compatible with a predictive processing account of somatic symptom perception. (shrink)

We report on the small-scale (0.5 13 h - 1M, a large-scale bias of ~2.0 and a satellite fraction of 12 ± 2 per cent. Thus, these galaxies occupy haloes with average masses in between those of the higher redshift BOSS CMASS sample and the original SDSS I/II luminous red galaxy sample © 2012 The Authors Published by Oxford University Press on behalf of the Royal Astronomical Society © doi:10.1093/mnras/sts314.

Weiss, Propen, and Reid gather a diverse group of scholars to analyze the growing obsolescence of the human-object dichotomy in today's world. In doing so, Design, Mediation, and the Posthuman brings together diverse disciplines to foster a dialog on significant technological issues pertinent to philosophy, rhetoric, aesthetics, and science.

Patient-reported outcomes are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts and dispositions. We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. If influences of response (...) shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used. (shrink)

The opportunity cost model (OCM) aims to explain various phenomena, among which the finding that performance degrades if executive functions are used repeatedly (). We argue that an OCM account of resource depletion requires two unlikely assumptions, and we discuss an alternative that does not require these assumptions. This alternative model describes the interplay between executive function and motivation.

BackgroundAlthough a large number of clinical trials on interventions demonstrating efficacy (or lack thereof) are conducted annually, much of this evidence is not accessible to scientists and clinicians.ObjectivesWe aimed to determine the publication rate of posttraumatic stress disorder (PTSD) trials that have been registered in clinical trial registries, and the factors associated with publication.MethodsTrials, completed on January 15, 2015, were identified via the US National Institutes of Health clinical trials registry, the European Union Clinical Trials Register and the WHO International (...) Clinical Trials Registry Platform. A systematic search for publications (published by the end of March 2018) related to each of the registered trials were then performed.ResultsFour hundred and thirty-eight of 1982 potentially eligible trials were included. Only 34% of interventional trials were registered prior to initiation, 9% were registered within 2 months of starting and 20% after trial completion. Of the 438 included trials, 72% had generated peer-reviewed publications, while an additional 7% had disseminated results in some other form (such as on the trial database), 26 months after trial completion. Randomisation of a trial was the only factor individually associated with publication, in logistic regression analysis (p < 0.001). Intervention type, university as sponsor and study registration prior to completion were factors that influenced the time to publication, using Cox regression (p < 0.001).ConclusionsThis study underscores the importance of timely and accurate publication and dissemination of trial results, in order to avoid the potential waste of resources and to ensure research integrity and patient safety. We suggest that authors and journal editors adhere to conditions set out by the International Committee of Medical Journal Editors and that more diligent data sharing is encouraged through prospective trial registration and trial reporting websites. (shrink)

This study assessed whether real-life stimulus material can elicit conscious and unconscious priming. A typical masked priming paradigm was used, with brand logo primes. We used a rigorous method to assess participants’ awareness of the subliminal information. Our results show that shortly presented and masked brand logos have the power to prime their brand names and, remarkably, words associated to the brand . However, this only occurred when the logos could be categorized clearly above the consciousness threshold. Once the primes (...) were presented close to the consciousness threshold, no subliminal influences on behavior were observed. (shrink)

Biomedical research policy in recent years has often tried to make such research more ‘translational’, aiming to facilitate the transfer of insights from research and development to health care for the benefit of future users. Involving patients in deliberations about and design of biomedical research may increase the quality of R&D and of resulting innovations and thus contribute to translation. However, patient involvement in biomedical research is not an easy feat. This paper discusses the development of a method for involving (...) patients in biomedical research aiming to address its main challenges.After reviewing the potential challenges of patient involvement, we formulate three requirements for any method to meaningfully involve patients in biomedical research. It should enable patients to put forward their experiential knowledge, to develop a rich view of what an envisioned innovation might look like and do, and to connect their experiential knowledge with the envisioned innovation. We then describe how we developed the card-based discussion method ‘Voice of patients’, and discuss to what extent the method, when used in four focus groups, satisfied these requirements. We conclude that the method is quite successful in mobilising patients’ experiential knowledge, in stimulating their imaginaries of the innovation under discussion and to some extent also in connecting these two. More work is needed to translate patients’ considerations into recommendations relevant to researchers’ activities. It also seems wise to broaden the audience for patients’ considerations to other actors working on a specific innovation. (shrink)

Information technology is an integral part of the practices and institutions of post-industrial society. It is also a source of hard moral questions and thus is both a probing and relevant area for moral theory. In this volume, an international team of philosophers sheds light on many of the ethical issues arising from information technology, including informational privacy, digital divide and equal access, e-trust and tele-democracy. Collectively, these essays demonstrate how accounts of equality and justice, property and privacy benefit from (...) taking into account how information technology has shaped our social and epistemic practices and our moral experiences. Information technology changes the way that we look at the world and deal with one another. It calls, therefore, for a re-examination of notions such as friendship, care, commitment and trust. (shrink)

There is widespread understanding of the close connection between religion and the ecological crisis, and that in order to amend this crisis, theological resources are needed. This monograph seeks to contribute to this endeavor by engaging the theology of Dietrich Bonhoeffer. His theology is particularly suitable in this context, due to its open-ended nature, and to the prophetic and radical nature of the questions he was prepared to ask--that is why there are many other attempts to contextualize Bonhoeffer's theology in (...) areas that he himself has not directly written about. In this monograph, Steven van den Heuvel first of all addresses the question of how to translate Bonhoeffer's theology in a methodologically sound way. He settles on a modified form of the general method of correlation. Then, secondly, van den Heuvel sets out to describe five major concepts in Bonhoeffer's work, bringing these into critical interplay with discussions in environmental ethics and eco-theology. In making the correlations he thoroughly describes each concept, situating it in the historic and intellectual background of Bonhoeffer's time. He then transposes these concepts to contemporary environmental ethics, describing what contribution Bonhoeffer's theology can make. - back of book. (shrink)

There has been a time in my teaching career that I used to cite in my introductory classes ‘Moral Philosophy’ from Erica Jong's Fear of Flying . The situation leading up to the quote is that the main character, Isadora, is asked a sexual favour by her brother in law, Pierre. Her answer and the subsequent dialogue read then as follows: ‘I can't’ , I said. ‘Come on,’ Pierre said, ‘I'll teach you.’ ‘I didn't mean that … I meant that (...) I can't; morally , I can…’. (shrink)

In this interview with Jan Hendrik van den Berg, the Dutch phenomenologist and psychiatrist addresses the origins of his work, his most significant influences, and the purpose of metabletic phenomenology in the modern age. In the course of the interview. Dr. Van den Berg provides a basic overview of his work, and highlights the central finding of his metabletic analyses: a loss of wonder before nature, which results from the more fundamental loss of genuine spirituality in the modern world.