Objective: Illness perceptions are important predictors of emotional and behavioral responses in many diseases. The current study aims to investigate the COVID-19-related IP throughout Europe. The specific goals are to understand the temporal development, identify predictors and examine the impacts of IP on perceived stress and preventive behaviors.Methods: This was a time-series-cross-section study of 7,032 participants from 16 European countries using multilevel modeling from April to June 2020. IP were measured with the Brief Illness Perception Questionnaire. Temporal patterns were observed (...) considering the date of participation and the date recoded to account the epidemiological evolution of each country. The outcomes considered were perceived stress and COVID-19 preventive behaviors.Results: There were significant trends, over time, for several IP, suggesting a small decrease in negativity in the perception of COVID-19 in the community. Age, gender, and education level related to some, but not all, IP. Considering the self-regulation model, perceptions consistently predicted general stress and were less consistently related to preventive behaviors. Country showed no effect in the predictive model, suggesting that national differences may have little relevance for IP, in this context.Conclusion: The present study provides a comprehensive picture of COVID-19 IP in Europe in an early stage of the pandemic. The results shed light on the process of IP formation with implications for health-related outcomes and their evolution. (shrink)

Human-Computer Interaction and games set a new domain in understanding people’s motivations in gaming, behavioral implications of game play, game adaptation to player preferences and needs for increased engaging experiences in the context of HCI serious games. When the latter relate with people’s health status, they can become a part of their daily life as assistive health status monitoring/enhancement systems. Co-designing HCI-SGs can be seen as a combination of art and science that involves a meticulous collaborative process. The design elements (...) in assistive HCI-SGs for Parkinson’s Disease patients, in particular, are explored in the present work. Within this context, the Game-Based Learning design framework is adopted here and its main game-design parameters are explored for the Exergames, Dietarygames, Emotional games, Handwriting games, and Voice games design, drawn from the PD-related i-PROGNOSIS Personalized Game Suite holistic approach. Two main data sources were involved in the study. In particular, the first one includes qualitative data from semi-structured interviews, involving 10 PD patients and four clinicians in the co-creation process of the game design, whereas the second one relates with data from an online questionnaire addressed by 104 participants spanning the whole related spectrum, i.e., PD patients, physicians, software/game developers. Linear regression analysis was employed to identify an adapted GBL framework with the most significant game-design parameters, which efficiently predict the transferability of the PGS beneficial effect to real-life, addressing functional PD symptoms. The findings of this work can assist HCI-SG designers for designing PD-related HCI-SGs, as the most significant game-design factors were identified, in terms of adding value to the role of HCI-SGs in increasing PD patients’ quality of life, optimizing the interaction with personalized HCI-SGs and, hence, fostering a collaborative human-computer symbiosis. (shrink)

A síndrome de burnout é um fenómeno psicossocial que resulta de uma tensão emocional crónica, vivenciada pelos profissionais cujo trabalho envolve o relacionamento intenso e frequente com pessoas que necessitam de algum tipo de cuidado. O objectivo deste estudo foi comparar a prevalência e os factor..

Neurodegenerative Parkinson's Disease is one of the common incurable diseases among the elderly. Clinical assessments are characterized as standardized means for PD diagnosis. However, relying on medical evaluation of a patient's status can be subjective to physicians' experience, making the assessment process susceptible to human errors. The use of ICT-based tools for capturing the status of patients with PD can provide more objective and quantitative metrics. In this vein, the Personalized Serious Game Suite and intelligent Motor Assessment Tests, produced within (...) the i-PROGNOSIS European project, are explored in the current study. More specifically, data from 27 patients with PD at Stage 1 and Stage 3 produced from their interaction with PGS/iMAT are analyzed. Five feature vector scenarios are set, including features from PGS or iMAT scores or their combination, after also taking into consideration the age of patients with PD. These FVs are fed into three machine learning classifiers, i.e., K-Nearest Neighbor, Support Vector Machines, and Random Forest, to infer the stage of each patient with PD. A Leave-One-Out Cross-Validation method is adopted for testing the classification performance. The experimental results show that a high classification accuracy is achieved from both data sources, justifying the effectiveness of PGS/iMAT to efficiently reflect the motor skill status of patients with PD and further potentiating PGS/iMAT enhancement with a machine learning a part to infer for the stage of patients with PD. Clearly, this integrated approach provides new opportunities for remote monitoring of the stage of patients with PD, contributing to a more efficient organization and set up of personalized interventions. (shrink)

Cuando se piensa en arte, lo primero que se nos viene a la mente es una expresión de la actividad humana mediante la cual se manifiesta una visión personal sobre lo real o imaginado, es decir, el artista imita, expresa y crea, ya sea copiando lo que hay a su alrededor o fantaseando con lo que no hay. Pero, ¿será ésta una definición concreta? Al preguntar a varias personas qué es lo que consideran como arte, muchas contestarán que es eso (...) que te hace sentir, eso que te hace escapar de la realidad, mientras que otros dirán que es lo que está en las galerías o museos y que ellos no entienden las obras de arte de hoy en día. (shrink)

This study investigates whether the market valuation of the two summary accounting measures, book value of equity and net income, is higher for firms with reputation for sustainability leadership, when compared to firms that do not enjoy such reputation. The results are interpreted through the lens of a framework combining signalling theory and resource-based theory, according to which firms signal their commitment to sustainability to influence the external perception of reputation. A firm’s reputation for being committed to sustainability is an (...) intangible resource that can increase the value of a firm’s expected cash flows and/or reduce the variability of its cash flows. Our findings are according to expectations and show that the net income of firms with good sustainability reputation has a higher valuation by the market, when compared to their counterparts. (shrink)

Spoken language consists of a linear sequence of units, from which the existence of particular underlying hierarchical processing mechanisms is inferred. Uddén et al. use graph theory to provide a framework for describing the possible structural relationships that may underlie a linear output sequence. Being more explicit in defining different structures can help identifying and testing for such structures in AGL experiments, as well as help showing how behavioral and neuroimaging data reveals signatures of hierarchical processing in humans.

This study provides empirical evidence on how corporate sustainability performance (CSP), as proxied by membership of the Dow Jones sustainability index, is reflected in the market value of equity. Using a theoretical framework combining institutional perspectives, stake-holder theory, and resource-based perspectives, we develop a set of hypotheses that relate the market value of equity to CSP. For a sample of North American firms, our preliminary results show that CSP has significant explanatory power for stock prices over the traditional summary accounting (...) measures such as earnings and book value of equity. However, further analyses suggest that we should not focus on corporate sustainability itself. Our findings suggest that what investors really do is to penalize large profitable firms with low level of CSP. Firms with incentives to develop a high level of CSP not engaging on such strategy are, thus, penalized by the market. (shrink)

The concept of sustainable development is here revised in the light of a brief historical analysis, followed by a semantic analysis of the expressions development and sustainability. The authors criticize the common use of this concept in a loose way or in wide generalizations, to conclude, based on the principles of human ecology, that it is only possible to make it operational in limited spans of time and in limited spatial units.

Este texto, bem como as pesquisas que realizamos, tem como meta dar visibilidade às leituras literárias destinadas ao público infantil e juvenil, que enfatizem o tema étnico-racial, ou ainda, títulos que incluam a real participação de personagens negras, costumes afro-brasileiros e informações culturais produtoras de identificação entre o leitor e a narrativa, contribuindo, assim, com as mudanças atuais na história da educação brasileira. Neste texto, apresentamos seis títulos da Editora SM, que, em seu catálogo editorial para 2008/2009, dos 173 títulos (...) publicados, 20 títulos trazem a presença da cultura africana e afro-brasileira. Dos 20, optou-se pela análise de cinco títulos. Da análise desses títulos, constatou-se, acima de tudo, que um dos caminhos para o entendimento e a consciência acerca da pluralidade cultural está também na apropriação da leitura literária produtora de identidade e inclusão social. (shrink)

Neste artigo, apresentamos parte de um estudo realizado em um grupo aberto do Facebook de negacionistas das vacinas. Com referenciais teóricos pautados na Teoria AtorRede (ANT) e nos estudos de Bruno Latour, Anne-Marie Mol e John Law, tivemos o objetivo de mapear os processos de atuação e de construção de realidades de um grupo de negacionistas da vacina. Além da ANT, nossas orientações metodológicas estiveram pautadas também na Análise de Rede Social (ARS). Assim, investigamos posts e o conteúdo dos comentários (...) produzidos por membros da comunidade entre os meses de março e abril de 2021. Nossos resultados indicam que os participantes dessa comunidade antivacina produzem realidades em que se observam movimentos de ataque e de defesa contra a ciência. Diante disso, sugerimos que também nos posicionemos diante desta guerra em prol da defesa da ciência, dos cientistas, do conhecimento científico, assim como da democracia e da composição de um bom mundo comum. (shrink)

Establishing the basic knowledge, methodology, and technology for a framework for the continuous decoding of hand/arm movement intention was the aim of the ERC-funded project “Feel Your Reach”. In this work, we review the studies and methods we performed and implemented in the last 6 years, which build the basis for enabling severely paralyzed people to non-invasively control a robotic arm in real-time from electroencephalogram. In detail, we investigated goal-directed movement detection, decoding of executed and attempted movement trajectories, grasping correlates, (...) error processing, and kinesthetic feedback. Although we have tested some of our approaches already with the target populations, we still need to transfer the “Feel Your Reach” framework to people with cervical spinal cord injury and evaluate the decoders’ performance while participants attempt to perform upper-limb movements. While on the one hand, we made major progress towards this ambitious goal, we also critically discuss current limitations. (shrink)

Este artigo tem como principal objetivo analisar e discutir questões acerca de como à educação muitas vezes acaba por contribuir para o aumento das desigualdades sociais. Desse modo, através dessa análise pretende-se ainda destacar as contribuições e críticas do pensamento de Pierre Félix Bourdieu, Paul- Michel Foucault e Karl Marx sobre os problemas sociais que permeiam a sociedade desde o século XIX até os dias atuais e muitas vezes são fortalecidos pelos sistemas educacionais.

En este artículo nos proponemos analizar las relaciones entre exilio, lengua y territorio en una lectura de poemas seleccionados de los libros Vicio de Miami (1997) y Confesiones del estrangulador de Flagler Street (1998), de Néstor Díaz de Villegas (Cienfuegos, Cuba, 1956). El eje propuesto pretende comprender, por un lado, algunos aspectos de su poética, como aparece en sus primeros libros publicados; por otro, ponerla en perspectiva respecto a la condición del exilio cubano en los Estados Unidos en la época (...) de la crisis de Mariel (1980), especialmente desde sus repercusiones en el campo de la cultura. (shrink)

O espaço geográfico é uma categoria da ciência geográfica que possibilita uma acentuada e complexa possibilidade de refletir a coletividade social, sendo que neste desafio são trazidas à tona inúmeras perspectivas de análises da relação homem-natureza. Dessa feita, o presente estudo elabora uma breve discussão acerca do espaço geográfico enquanto uma ferramenta de análise das relações sociais, além de evidenciar a sua centralidade no interior da Geografia. Ao longo do estudo estão colocadas algumas concepções teóricas desta categoria geográfica, com destaque (...) para os entendimentos elaborados pela Geografia Crítica, uma reflexão que propõem a necessidade de se politizar os sujeitos por intermédio do ensino, com destaque para os conteúdos geográficos ensinados por seus respectivos professores desde os primeiros anos do ensino fundamental. A busca aqui foi a de confirmar a capacidade que a Geografia possui em se utilizar do próprio espaço geográfico na qual os alunos estão inseridos enquanto materialidade para uma concepção própria de mundo, sendo que através desta conquista, se permite compreender e pensar a construção de uma sociedade pela e para a própria coletividade envolvida. É esta a grande questão discorrida no presente ensaio, pensar uma proposta de ensino na geografia que politize os sujeitos, permitindo assim a formação de sujeitos ativos e cientes do seu papel no mundo. (shrink)

Este estudo, realizado por meio de pesquisa bibliográfica, tem como foco a Ética da Libertação de Dussel, com o objetivo de refletir sobre a relação entre o Eu e o Outro no campo social, debatendo a questão da exclusão social. A partir de sua ética analisa-se criticamente o discurso eurocêntrico moderno e a possibilidade de superação do irracionalismo moderno, por meio da razão crítico-libertadora. Está estruturado em duas partes: na primeira, apresentamos o olhar de Dussel sobre a modernidade, focando o (...) debate para o eu e o outro no pensamento moderno e, na segunda, tecemos reflexões a partir da Ética da Libertação de Dussel sobre a possibilidade de superação do irracionalismo moderno, por meio da razão libertadora. (shrink)

CYBATHLON is an international championship where people with severe physical disabilities compete with the aid of state-of-the-art assistive technology. In one of the disciplines, the BCI Race, tetraplegic pilots compete in a computer game race by controlling an avatar with a brain-computer interface. This competition offers a perfect opportunity for BCI researchers to study long-term training effects in potential end-users, and to evaluate BCI performance in a realistic environment. In this work, we describe the BCI system designed by the team (...) Mirage91 for participation in the CYBATHLON BCI Series 2019, as well as in the CYBATHLON 2020 Global Edition. Furthermore, we present the BCI’s interface with the game and the main methodological strategies, along with a detailed evaluation of its performance over the course of the training period, which lasted 14 months. The developed system was a 4-class BCI relying on task-specific modulations of brain rhythms. We implemented inter-session transfer learning to reduce calibration time, and to reinforce the stability of the brain patterns. Additionally, in order to compensate for potential intra-session shifts in the features’ distribution, normalization parameters were continuously adapted in an unsupervised fashion. Across the aforementioned 14 months, we recorded 26 game-based training sessions. Between the first eight sessions, and the final eight sessions leading up to the CYBATHLON 2020 Global Edition, the runtimes significantly improved from 255 ± 23 s to 225 ± 22 s, respectively. Moreover, we observed a significant increase in the classifier’s accuracy from 46 to 53%, driven by more distinguishable brain patterns. Compared to conventional single session, non-adaptive BCIs, the inter-session transfer learning and unsupervised intra-session adaptation techniques significantly improved the performance. This long-term study demonstrates that regular training helped the pilot to significantly increase the distance between task-specific patterns, which resulted in an improvement of performance, both with respect to class separability in the calibration data, and with respect to the game. Furthermore, it shows that our methodological approaches were beneficial in transferring the performance across sessions, and most importantly to the CYBATHLON competitions. (shrink)

Nicolas Asselin,Stéphanie Audet,Eric Crégheur,Julio Cesar Dias Chaves,Gavin McDowell,Charles-Frédéric Murray,Louis Painchaud,Paul-Hubert Poirier,Maryse Robert,Philippe Therrien.

Jeffery Aubin,Serge Cazelais,Marie Chantal,Julio Cesar Dias Chaves,Cathelyne Duchesne,Steve Johnston,Louis Painchaud,Paul-Hubert Poirier,Tuomas Rasimus,Gaëlle Rioual,Maryse Robert,Eric Crégheur.

Jeffery Aubin,Dianne Cole,Julio Cesar Dias Chaves,Jonathan von Kodar,Anne-France Morand,Timothy Pettipiece,Paul-Hubert Poirier,Martin Voyer,Eric Crégheur.

RESUMO A partir do exame da tradição heraclitiana e platônica sobre a transitoriedade e a imortalidade - conceitos compreendidos como universais - este artigo defende a seguinte antinomia como tese: para haver temporalidade é preciso haver eternidade. Essa tese é demonstrada por meio do estudo e atualização das noções de alma, espírito, ideia e memória, as quais estão conectadas invariavelmente ao tempo passado como princípio ontológico do fenômeno histórico. Para além do ponto de vista filosófico, portanto, da perspectiva específica do (...) conhecimento histórico, este estudo expõe algumas implicações teóricas acerca das condições de possibilidade da história, que são discutidas, finalmente, em diálogo com Friedrich Nietzsche e Jacob Burckhardt. ABSTRACT From the analysis of the Heraclitian and Platonic tradition on transience and immortality - understood as universal concepts - this essay defends the following antinomy as its thesis: if there is temporality there must be eternity. This thesis is demonstrated through the study and updating of the notions of soul, spirit, idea and memory, which are invariably connected to the past as the ontological principle of the historical phenomenon. Beyond the philosophical point of view, therefore, from the specific perspective of historical knowledge, this study exposes some theoretical implications about the conditions of possibility of history, which are finally discussed in dialogue with Friedrich Nietzsche and Jacob Burckhardt. (shrink)

Este texto reflete sobre o memoricídio, consequente à presunção racial branca, como vestígio de operações para o genocídio dos corpos e das mentes negras a partir da Peleja de Inácio da Catingueira contra Romano. Sob o jogo discursivo da humilhação, já se encontrava a vontade brutal de destruição de qualquer traço, perspectiva, visão remanescente de saberes e culturas africanas ou descendentes, fossem de cunho material, simbólico, reflexivo, imagético, expressivo, na língua, no corpo. No embate, Inácio, negro, escravizado, já rebaixado sob (...) a égide do sistema escravocrata, embate-se contra a tentativa presunçosa de aniquilamento perpetrada por seu oponente. (shrink)

Background Q-CEP (Qualificação dos Comitês de Ética em Pesquisa que compõem o Sistema CEP/Conep) is a nationwide project resulting from a partnership between the Brazilian National Research Ethics Commission (Conep), the Ministry of Health and Hospital Moinhos de Vento (HMV). It was developed to consolidate policy for ethical review of research with human beings in all members of the CEP/Conep System, Brazil’s national system of institutional review boards. The aim of this study was therefore to report on the experience and (...) results of the Q-CEP project. Methods An observational, retrospective study includes data from the Q-CEP, obtained from visits to all the institutional research ethics committees (RECs) in the country. The actions implemented by Q-CEP were part of a two-step process: (i) training visits to each REC; (ii) development of distance learning modules on strategic topics pertaining to research ethics evaluation. The data presented herein cover step one (training visits), defined by Q-CEP as the diagnostic stage of the project. For a country with social and economics inequalities such as Brazil, this is a particularly important stage; an accurate picture of reality is needed to inform planning of quality improvement strategies. Results In 2019–2021, Q-CEP visited 832 RECs and trained 11,197 people. This sample covered almost all active RECs in the country; only 4 (0.5%) were not evaluated. Of the 94 items evaluated, 62% did not reach the target of at least 80% compliance and around 1/4 (26%) were below 50% compliance. The diagnostic stage of the process revealed inadequacies on the part of the RECs in their ethical reviews. The analysis of informed consent forms showed compliance in only 131 RECs (15.74%). The description of pending issues made by RECs in their reports was compliant in 19.33% (n = 161). Administrative and operational aspects were also considered inadequate by more than half of the RECs. Conclusions Overall, Brazilian RECs showed poor compliance in several aspects of their operation, both in ethics evaluation and in other processes, which justifies additional training. The Q-CEP project is part of a quality improvement policy promoted by the Brazilian Ministry of Health. The data obtained in the diagnostic step of the project have contributed to the qualification and consolidation of one of the world’s largest research ethics evaluation systems. (shrink)

According to the mythical-religious literature time is determined by the eternal nature of divinity or origin of all things. From this adagio, theological literature is provoked and studies on the eternal nature of divinity suggest that if the universe was created the image of its creator the first must also be eternal. Therefore the question arises: how to shape that which by nature is formless, infinite, namely eternity? To answer this question the following paper develops a brief history about the (...) Judeo-Christian tradition on the problem of time and its relationship with eternity and also tries to prepare at the end one logical answer to the question about the form of eternity. (shrink)

The growth of urban violence in Brazil, as in other countries, has led citizens to demand more severe and punitive measures to solve the problem of juvenile crime. One motion submitted to the Brazilian parliament, for instance, proposes to reduce the age of penal majority from 18 to 16 years. Our hypothesis is that popular opinions about this proposal are largely constrained by construal levels and psychological distance. Accordingly, we expect that the knowledge and proximity to the circumstances associated with (...) juvenile transgression will influence opinions about the proposal. To test this hypothesis, we evaluated how opinion against or for the proposal can be explained by psychological distance and moral development theory. We studied two samples, composed of people who do not have a deep experience with the subject and workers from a juvenile justice court. After collecting socio-demographic information from the subjects and their answer to moral dilemmas, the data was subjected to a multivariate analysis by multimodal logistic regression for socio-demographic characteristics, Kohlberg moral stages, and opinion on the reduction of APM as dependent variables. Our findings suggest that 1) opinion about the APM depends on psychological distance and 2) socioeconomic variables may influence the average construal level of adolescent transgressors in the public’s perspective. (shrink)

This article aims to present how the philosopher Emmanuel Lévinas understands the issues of suffering and evil in the world, hardships frequently considered as obstacles to the belief in God. Breaking away from the logic of theodicies, the French-Lithuanian philosopher developed original and instigating perspectives on these themes, placing them in an eminently ethical domain. It concerns an ethic that escapes reciprocity, in a context of asymmetry, with the granting of absolute priority to the other man. Such reflections are particularly (...) relevant in the dramatic scenario established by the Covid-19 pandemic, which has given rise to suffering, death, and several uncertainties, among which the narrative of God. The new coronavirus has sparked a crisis of global dimensions, which raises the need for a new civilizational paradigm, prioritizing principles such as cooperation, human solidarity and ethical responsibility towards others, a horizon in which Lévinas' conceptions are included. (shrink)

A FALÊNCIA DO ESTADO SOMALI E A PIRATARIA EM ÁGUAS INTERNACIONAIS: UMA ABORDAGEM ILUSTRADA A PARTIR DO FILME “CAPITÃO PHILLIPS”.

ObjectiveLoss of control eating has been directly related to the core aspects of the psychopathology of eating disorders and to different dimensions of emotion and behavior regulation and self-criticism. This study investigates a model representing the interplay between these dimensions to understand LOC eating among a nonclinical sample.MethodsA total of 341 participants, recruited in a college campus, completed a set of self-report measures assessing LOC eating, weight suppression, psychopathology of eating disorders, depression, negative urgency, emotion regulation difficulties, and self-criticism. Path (...) analysis modeling tested a hypothesized model with 3 paths for LOC eating as follows: psychopathology of eating disorders; emotion and behavior regulation; and interplay between these paths.ResultsWe found goodness-of-fit indexes to our data: χ2 = 17.11, df = 10, Comparative Fit Index = 0.99, Tucker-Lewis index = 0.98, Root Mean Square Error Approximation = 0.045, Standardized Root Mean Square Residual = 0.041, suggesting that: participants with higher weight suppression showed higher degrees of the psychopathology of eating disorders, which was linked to higher levels of LOC eating; self-criticism was a mediator between emotion regulation and depression/negative urgency; self-criticism was a mediator between emotion regulation and disorder eating, which was significantly associated with LOC eating via increased negative urgency.ConclusionOur model shows that LOC eating occurs for individuals with the psychopathology of higher eating disorders who experience depressive symptoms and act rashly under distress for their inability to cope adequately with negative feelings of self-devaluation. These findings point to the importance of negative self-evaluations and feelings of inadequacy or worthlessness to understand LOC eating among college students. (shrink)

Robots are increasingly being studied for use in education. It is expected that robots will have the potential to facilitate children’s learning and function autonomously within real classrooms in the near future. Previous research has raised the importance of designing acceptable robots for different practices. In parallel, scholars have raised ethical concerns surrounding children interacting with robots. Drawing on a Responsible Research and Innovation perspective, our goal is to move away from research concerned with designing features that will render robots (...) more socially acceptable by end users toward a reflective dialogue whose goal is to consider the key ethical issues and long-term consequences of implementing classroom robots for teachers and children in primary education. This paper presents the results from several focus groups conducted with teachers in three European countries. Through a thematic analysis, we provide a theoretical account of teachers’ perspectives on classroom robots pertaining to privacy, robot role, effects on children and responsibility. Implications for the field of educational robotics are discussed. (shrink)

It has been argued that we cannot be morally responsible in the sense required to deserve blame or punishment if the world is deterministic, but still morally responsible in the sense of being apt targets for moral criticism. Desert-entailing moral responsibility is supposed to be more freedom-demanding than other kinds of responsibility, since it justifies subjecting people to blame and punishments, is nonconsequentialist, and has been shown by thought experiments to be incompatible with determinism. In this paper, I will show (...) that all these arguments can be resisted. (shrink)

The issue of communicated accountability is particularly important in Faith-Based Charity Organisations as the donated funds and use of those funds are often meant to fulfil religious obligations for the well-being of society. Integrating Stewart’s (1984) ladder of accountability with the Statement of Recommended Practice guidance for charities, this paper examines communicated accountability practices of Muslim and Christian Charity Organisations in England and Wales. Our content analysis results indicate communicated accountability to be generally limited, focusing on providing basic descriptive information (...) rather than judgement-based information. Our interviews with trustees and preparers of Trustee Annual Reports in Muslim Charity Organisations identified the reasons being due to high donor trust and consequently weak demand by stakeholders for the latter type of information, as well as internal organisational issues related to the organisational structure and culture, lack of internal professional expertise and high accountability cost. (shrink)