Impairments in executive functioning are prevalent in chronic pain conditions, with cognitive inflexibility being the most frequently reported. The current randomized, cross-over trial, piloted a computerized cognitive training program based on Relational Frame Theory, targeting improvement in cognitive flexibility. At baseline, 73 chronic pain patients completed testing on pre-selected outcomes of executive functioning, alongside IQ measures. When tested three times over the course of 5 months, there was a drop-out rate of 40% at the third time point, leaving 44 patients (...) who had data at all time points. The results showed that there was a substantial learning effect from the MINDFLEX training and a substantial time-dependent improvement on the primary outcomes of increased flexibility, but that this could not be tied to active training. In conclusion, this small study indicated a learning effect as well as improvement on primary outcomes. Based on the current results, a larger trial with improved feasibility of training is warranted. (shrink)

Chronic widespread pain is one of the most difficult pain conditions to treat due to an unknown etiology and a lack of innovative treatment design and effectiveness. Based upon preliminary findings within the fields of motivational psychology, integrative neuroscience, diaphragmatic breathing, and vagal nerve stimulation, we propose a new treatment intervention, motivational nondirective resonance breathing, as a means of reducing pain and suffering in patients with chronic widespread pain. Motivational nondirective resonance breathing provides patients with a noninvasive means of potentially (...) modulating five psychophysiological mechanisms imperative for endogenously treating pain and increasing overall quality of life. (shrink)

Chronic post-surgical pain (CPSP) represents a highly prevalent and significant clinical problem. Both major and minor surgeries entail risks of developing CPSP, and cancer-related surgery is no exception. As an example, more than 40% of women undergoing breast cancer surgery struggle with CPSP years after surgery. While we do not fully understand the pathophysiology of CPSP, we know it is multifaceted with biological, social, and psychological factors contributing. The aim of this review is to advocate for the role of response (...) outcome expectancies in the development of CPSP following breast cancer surgery. We propose the Cognitive Activation Theory of Stress (CATS) as an applicable theoretical framework detailing the potential role of cortisol regulation, inflammation, and inflammatory-induced sickness behavior in CPSP. Drawing on learning theory and activation theory, CATS offers psychobiological explanations for the relationship between stress and health, where acquired expectancies are crucial in determining the stress response and health outcomes. Based on existing knowledge about risk factors for CPSP, and in line with the CATS position, we propose the SURGEry outcome expectancy (SURGE) model of CPSP. According to SURGE, expectancies impact stress physiology, inflammation, and fear-based learning influencing the development and persistence of CPSP. SURGE further proposes that generalized response outcome expectancies drive adaptive or maladaptive stress responses in the time around surgery, where coping dampens the stress response, while helplessness and hopelessness sustains it. A sustained stress response may contribute to central sensitization, alterations in functional brain networks and excessive fear-based learning. This sets the stage for a prolonged state of inflammatory-induced sickness behavior – potentially driving and maintaining CPSP. Finally, as psychological factors are modifiable, robust and potent predictors of CPSP, we suggest hypnosis as an effective intervention strategy targeting response outcome expectancies. We here argue that presurgical clinical hypnosis has the potential of preventing CPSP in women with breast cancer. (shrink)

Vol. 2 is dedicated to the use of Kierkegaard by later Danish writers. Almost from the beginning Kierkegaard's works were standard reading for these authors. Danish novelists and critics from the Modern Breakthrough movement in the 1870s were among the first to make extensive use of his writings. These included the theoretical leader of the movement, the critic Georg Brandes, who wrote an entire book on Kierkegaard, and the novelists Jens Peter Jacobsen and Henrik Pontoppidan.

This work has been selected by scholars as being culturally important and is part of the knowledge base of civilization as we know it. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and (...) made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

This document presents the Bonn PRINTEGER Consensus Statement: Working with Research Integrity—Guidance for research performing organisations. The aim of the statement is to complement existing instruments by focusing specifically on institutional responsibilities for strengthening integrity. It takes into account the daily challenges and organisational contexts of most researchers. The statement intends to make research integrity challenges recognisable from the work-floor perspective, providing concrete advice on organisational measures to strengthen integrity. The statement, which was concluded February 7th 2018, provides guidance on (...) the following key issues: § 1. Providing information about research integrity§ 2. Providing education, training and mentoring§ 3. Strengthening a research integrity culture§ 4. Facilitating open dialogue§ 5. Wise incentive management§ 6. Implementing quality assurance procedures§ 7. Improving the work environment and work satisfaction§ 8. Increasing transparency of misconduct cases§ 9. Opening up research§ 10. Implementing safe and effective whistle-blowing channels§ 11. Protecting the alleged perpetrators§ 12. Establishing a research integrity committee and appointing an ombudsperson§ 13. Making explicit the applicable standards for research integrity. (shrink)

We present a case study of how mathematicians write for mathematicians. We have conducted interviews with two research mathematicians, the talented PhD student Adam and his experienced supervisor Thomas, about a research paper they wrote together. Over the course of 2 years, Adam and Thomas revised Adam’s very detailed first draft. At the beginning of this collaboration, Adam was very knowledgeable about the subject of the paper and had good presentational skills but, as a new PhD student, did not yet (...) have experience writing research papers for mathematicians. Thus, one main purpose of revising the paper was to make it take into account the intended audience. For this reason, the changes made to the initial draft and the authors’ purpose in making them provide a window for viewing how mathematicians write for mathematicians. We examined how their paper attracts the interest of the reader and prepares their proofs for validation by the reader. Among other findings, we found that their paper prepares the proofs for two types of validation that the reader can easily switch between. (shrink)

Following an established two-dimensional dichotomy for environmental leadership, environmentally friendly behavior as a leadership style has become an important topic in both research and practice. However, so far, it has remained unclear how these new concepts relate to well-established leadership styles such as transformational leadership, responsible leadership, and leaders' organizational citizenship behavior. In this study, we provide an in-depth examination of the environmentally focused substyles in contrast to their well-established counterparts, their antecedents, and the incremental value in predicting corporate environmental (...) responsiveness (CER). For that purpose, we surveyed N = 211 German leaders: Confirmatory factor analysis (CFA) and path model analyses suggest that, overall, established leadership styles and their respective environmentally specific substyle are empirically distinct constructs. Moreover, environmentally specific leadership behaviors explained significant variance beyond established concepts in predicting corporate environmental sustainability. Finally, our analyses suggest that leaders' extraversion and political orientation emerge as valid predictors (i.e., antecedents) of environmental leadership behavior. Overall, this study shows that CER is influenced on an individual level, underlining the important role of leaders' behavior in a rapidly worsening climate crisis. (shrink)

Background: Nursing home residents are a vulnerable population. Most of them suffer from multi-morbidity, while many have cognitive impairment or dementia and need care around the clock. Several ethical challenges in nursing homes have been described in the scientific literature. Most studies have used staff members as informants, some have focused on the relatives’ view, but substantial knowledge about the residents’ perspective is lacking. Objective: To study what nursing home residents and their relatives perceive as ethical challenges in Norwegian nursing (...) homes. Research design: A qualitative design with in-depth interviews with nursing home residents, and focus-group interviews with relatives of nursing home residents. The digitally recorded interviews were transcribed verbatim. Analysis was based on Interpretive Description. Participants and research context: A total of 25 nursing home residents from nine nursing homes in Norway, and 18 relatives of nursing home residents from three of these nursing homes. Ethical considerations: This study was reported to and approved by the Regional Ethics Committee in Oslo, Norway. Findings and discussion: The main ethical challenges in Norwegian nursing homes from the residents’ and relatives’ perspective were as follows: (a) acceptance and adaptation, (b) well-being and a good life, (c) autonomy and self-determination, and (d) lack of resources. The relationship with the staff was of outmost importance and was experienced as both rewarding and problematic. None of the residents in our study mentioned ethical challenges connected to end-of-life care. Conclusion: Residents and relatives experience ethical challenges in Norwegian nursing homes, mostly connected to “everyday ethical issues.”. (shrink)

In previous published research (“Conditionals and Inferential Connections: A Hypothetical Inferential Theory,” Cognitive Psychology, 2018), we investigated experimentally what role the presence and strength of an inferential connection between a conditional’s antecedent and consequent plays in how people process that conditional. Our analysis showed the strength of that connection to be strongly predictive of whether participants evaluated the conditional as true, false, or neither true nor false. In this article, we re-analyse the data from our previous research, now focussing on (...) the semantics of conditionals rather than on how they are processed. Specifically, we use those data to compare the main extant semantics with each other and with inferentialism, a semantics according to which the truth of a conditional requires the presence of an inferential connection between the conditional’s component parts. (shrink)

Questions have been raised on what role the knowledge provided by sustainability science actually plays in the transition to sustainability and what role it may play in the future. In this paper we investigate different approaches to sustainability transformation of food systems by analyzing the rationale behind transformative acts-the ground that the direct agents of change act upon- and how the type of rationale is connected to the role of research and how the agents of change are involved. To do (...) this we employ Max Weber’s distinction between instrumental rationality and value-rationality in social action. In particular, we compare two different approaches to the role of research in sustainability transformation: (1) Performance-based approaches that measure performance and set up sustainability indicator targets and benchmarks to motivate the agents in the food system to change; (2) Values-based approaches that aim at communicating and mediating sustainability values to enable coordinated and cooperative action to transform the food system. We identify their respective strengths and weaknesses based on a cross-case analysis of four cases, and propose that the two approaches, like Weber’s two types of rationality, are complementary-because they are based on complementary observer stances—and that an optimal in-between approach therefore cannot be found. However, there are options for reflexive learning by observing one perspective-and its possible blind spots-from the vantage point of the other, so we suggest that new strategies for sustainability transformation can be found based on reflexive rationality as a third and distinct type of rationality. (shrink)

The aim of this mixed methods field study was to gain a better understanding of how psychological factors can contribute to success in intervention-induced behavior change over time. While it can be difficult to change behavior, the use of interventions means that most participants succeed in change during the intervention. However, it is rare for the immediate change to automatically transform into maintained behavior changes. Most research conducted on health-related behavior change interventions contains quantitative studies that investigate key intervention components (...) on a group level. Hence, to bring more knowledge about maintained intervention-induced behavior change, there is need for a study approach that enhances the understanding of individual participants' experiences during and after the intervention. Therefore, the present study, which was conducted in Sweden, used a mixed methods design (triangulation) consisting of pre-, post-, and follow-up quantitative data (questionnaires and body measurements) and qualitative data (interviews), where the individuals' accounts are used to broaden the understanding of the intervention and the behavior change process. All study participants were enrolled in a volitional (fee-based and non-manipulated) intervention given by certified gyms. The quantitative data collection included 22 participants who completed questionnaires and body measurements before and after the intervention, plus 13 complete body measurements 6 months after the intervention. The qualitative data included pre-interviews with 12 participants and six follow-up-interviews. The questions in both questionnaires and interviews related to expectations, efficacy, motivation, goals, achievements, behavior change, and future. Overall, the results show that levels of expectations, efficacy, and motivation cannot be used in isolation to predict maintained intervention-induced behavior change. To successfully extend and maintain immediate change, it was crucial to experience goal achievement (but not BMI change). Furthermore,enabling talkwas salient in the pre-interviews with participants reporting successful immediate (and maintained) change. By contrast, pre-interviewdisabling talkturned out to be evident in interviews, with participants not responding to follow-up. When the qualitative and quantitative results are summarized and integrated, it appears that subjective goal achievement, combined with enabling self-talk, were crucial factors in successful maintained behavior change. (shrink)

BackgroundEthical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education that (...) promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.MethodsIn this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 articles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.ResultsThe review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.ConclusionsThe review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations. (shrink)

Mathematicians appear to have quite high standards for when they will rely on testimony. Many mathematicians require that a number of experts testify that they have checked the proof of a result p before they will rely on p in their own proofs without checking the proof of p. We examine why this is. We argue that for each expert who testifies that she has checked the proof of p and found no errors, the likelihood that the proof contains no (...) substantial errors increases because different experts will validate the proof in different ways depending on their background knowledge and individual preferences. If this is correct, there is much to be gained for a mathematician from requiring that a number of experts have checked the proof of p before she will rely on p in her own proofs without checking the proof of p. In this way a mathematician can protect her own work and the work of others from errors. Our argument thus provides an explanation for mathematicians’ attitude towards relying on testimony. (shrink)

In this paper, I describe some aspects of the phenomenon of "experimental mathematics" in order to discuss whether it constitutes a subdiscipline or a particular style of mathematics. My conclusion is that neither of these notions accurately capture the complex culture of experimental mathematics.

Resilience is often promoted as a boundary concept to integrate the social and natural dimensions of sustainability. However, it is a troubled dialogue from which social scientists may feel detached. To explain this, we first scrutinize the meanings, attributes, and uses of resilience in ecology and elsewhere to construct a typology of definitions. Second, we analyze core concepts and principles in resilience theory that cause disciplinary tensions between the social and natural sciences. Third, we provide empirical evidence of the asymmetry (...) in the use of resilience theory in ecology and environmental sciences compared to five relevant social science disciplines. Fourth, we contrast the unification ambition in resilience theory with methodological pluralism. Throughout, we develop the argument that incommensurability and unification constrain the interdisciplinary dialogue, whereas pluralism drawing on core social scientific concepts would better facilitate integrated sustainability research. (shrink)

Written over the last 18 months of his life and inspired by his interest in G. E. Moore's defence of common sense, this much discussed volume collects Wittgenstein's reflections on knowledge and certainty, on what it is to know a proposition for sure.

Since 2004, it has been mandated by law that all Danish undergraduate university programmes have to include a compulsory course on the philosophy of science for that particular program. At the Faculty of Science and Technology, Aarhus University, the responsibility for designing and running such courses were given to the Centre for Science Studies, where a series of courses were developed aiming at the various bachelor educations of the Faculty. Since 2005, the Centre has been running a dozen different courses (...) ranging from mathematics, computer science, physics, chemistry over medical chemistry, biology, molecular biology to sports science, geology, molecular medicine, nano science, and engineering. -/- We have adopted a teaching philosophy of using historical and contemporary case studies to anchor broader philosophical discussions in the particular subject discipline under consideration. Thus, the courses are tailored to the interests of the students of the particular programme whilst aiming for broader and important philosophical themes as well as addressing the specific mandated requirements to integrate philosophy, some introductory ethics, and some institutional history. These are multiple and diverse purposes which cannot be met except by compromise. -/- In this short presentation, we discuss our ambitions for using case studies to discuss philosophical issues and the relation between the specific philosophical discussions in the disciplines and the broader themes of philosophy of science. We give examples of the cases chosen to discuss various issues of scientific knowledge, the role of experiments, the relations between mathematics and science, and the issues of responsibility and trust in scientific results. Finally, we address the issue of how and why science students can be interested in and benefit from mandatory courses in the philosophy of their subject. (shrink)

This chapter is devoted to discussions about the nature of experiments in mathematics during the formative period of experimental mathematics and to a quantitative and qualitative analysis of the journal Experimental Mathematics founded in 1992. Particular attention is paid to interpret the roles of experiment and observation in the mathematical practices surrounding Experimental Mathematics.

Sustainability science seeks to extend scientific investigation into domains characterized by a distinct problem-solving agenda, physical and social complexity, and complex moral and ethical landscapes. In this endeavor it arguably pushes scientific investigation beyond its usual comfort zones, raising fundamental issues about how best to structure such investigation. Philosophers of science have long scrutinized the structure of science and scientific practices, and the conditions under which they operate effectively. We propose a critical engagement between sustainability scientists and philosophers of science (...) with respect to how to engage in scientific activity in these complex domains. We identify specific issues philosophers of science raise concerning current sustainability science and the contributions philosophers can make to resolving them. In conclusion we reflect on the steps philosophers of science could take to advance sustainability science. (shrink)

The rubber hand illusion is one of the most commonly used paradigms to examine the sense of body ownership. Touches are synchronously applied to the real hand, hidden from view, and a false hand in an anatomically congruent position. During the illusion one may perceive that the feeling of touch arises from the false hand, and that the false hand is one's own. The relationship between referral of touch and body ownership in the illusion is unclear, and some articles average (...) responses to statements addressing these experiences, which may be inappropriate depending on the research question of interest. To address these concerns, we re-analyzed three freely available datasets to better understand the relationship between referral of touch and feeling of ownership in the RHI. We found that most participants who report a feeling of ownership also report referral of touch, and that referral of touch and ownership show a moderately strong positive relationship that was highly replicable. In addition, referral of touch tends to be reported more strongly and more frequently than the feeling of ownership over the hand. The former observations confirm that referral of touch and ownership are related experiences in the RHI. The latter, however, indicate that when pooling the statements one may obtain a higher number of illusion ‘responders’ compared to considering the ownership statements in isolation. These results have implications for the RHI as an experimental paradigm. (shrink)

Decisions about brain surgery pose existential challenges because they are often decisions about life or death, and sometimes about possible personality changes. Therefore they require rigorous neuroethical consideration. However, we doubt whether metaphysical interpretations of ambiguous statements of patients are useful for deriving ethical and legal conclusions. Particularly, we question the application of psychological theories of personal identity on neuroethical issues for several reasons. First, even the putative “standard view” on personal identity is contentious. Second, diverse accounts of personal identity (...) have been introduced into the neuroethical debate, which are incompatible. Third, the criteria for “diagnosing” the supposed changes in “identity” are ambiguous and indeterminate. Fourth, the metaphysical theories of personal identity imply highly questionable ethical and legal revisions, namely the denial of advance directives, particularly of Ulysses contracts, and, for patients with brain cancer, even therapeutic nihilism.We discuss three examples in which ideas from the personal identity debate in metaphysics are straightforwardly applied to discuss ethical issues of neurosurgery. We discuss revisions of the current medico-legal practice that have been proposed on grounds of psychological theories of personal identity. We argue that the established status quo in law and clinical practice is beneficial to the patients concerned. Furthermore, it is metaphysically neutral, which is an important principle of liberal, democratic, pluralistic societies.We recommend a pragmatic approach: empirical research on personality changes arising from brain disorders or interventions, comprehensive information about risks of personality changes, and advance directives, particularly Ulysses contracts. (shrink)

In a celebrated experiment, Joshua Knobe showed that people are much more prone to attribute intentionality to an agent for a side effect of a given act when that side effect is harmful than when it is beneficial. This asymmetry has become known as ‘the Knobe Effect’. According to Knobe's Moral Valence Explanation, bad effects trigger the attributions of intentionality, whereas good effects do not. Many others believe that the Knobe Effect is best explained in terms of the high amount (...) of blame attributed in the harm condition, and the low amount of praise attributed in the help condition. This Blame Hypothesis explains the high number of intentionality attributions in the harm condition in terms of the high degree of blame people ascribe, and the low number of intentionality attributions in the help conditions in terms of the low degree of praise people attribute. We replicated Knobe's original experiment and conducted a logistic regression on the results to probe more deeply into the relationship between attributions of intentionality and responsibility. The statistical analysis revealed a hitherto unknown interaction effect: intentionality correlates with blame, but not with praise. This interaction effect is consistent with the Moral Valence Hypothesis, but inconsistent with the Blame Hypothesis, as well as with two of the three other hypotheses discussed here. (shrink)

The aim of this study was to gain a deeper understanding of the experience of time when living with severe incurable disease. A phenomenological and philosophical approach of description and deciphering were used. In our modern health care system there is an on-going focus on utilizing and recording the use of time, but less focus on the patient’s experience of time, which highlights the need to explore the patients’ experiences, particularly when life is vulnerable and time is limited. The empirical (...) data consisted of 26 open-ended interviews with 23 participants receiving palliative care at home, in hospital or in a nursing home in Norway. The theoretical frameworks used are mainly based upon K. Martinsens philosophy of care, K. E. Løgstrup phenomenological philosophy, in addition to C. Saunders’ hospice philosophy, L. Feigenberg’s thanatology and U. Qvarnström’s research exploring patient’s reactions to impending death. Experience of time is described as being a movement that moves the individual towards death in the field of opposites, and deciphered to be a universal, but a typical and unique experience emerging through three integrated levels: Sense of time; where time is described as a movement that is proceeding at varying speeds. Relate totime; where the awareness of limited life changes the understanding of time to be more existential. Being in time; where limited time seems to clarify the basic living conditions and phenomena of life. The existence of life when the prospect of death is present is characterized by emotional swings that move within polarizing dimensions which is reflected in the experience of time illustrated as the moves of the pendulum in a grandfather clock. The diversity of the experience of time is oscillating between going fast or slow, being busy or calm, being unpredictable but predictable, safe or unsafe and between being good or bad, depending on the embodied situation of the individual. (shrink)

IntroductionThe prefrontal cortex plays a crucial role in cognition, particularly in executive functions. Cortical reactivity measured with Transcranial Magnetic Stimulation combined with Electroencephalography is altered in pathological conditions, and it may also be a marker of cognitive status in middle-aged adults. In this study, we investigated the associations between cognitive measures and TMS evoked EEG reactivity and explored whether the effects of this relationship were related to neurofilament light chain levels, a marker of neuroaxonal damage.MethodsFifty two healthy middle-aged adults from (...) the Barcelona Brain Health Initiative cohort underwent TMS-EEG, a comprehensive neuropsychological assessment, and a blood test for NfL levels. Global and Local Mean-Field Power, two measures of cortical reactivity, were quantified after left prefrontal cortex stimulation, and cognition was set as the outcome of the regression analysis. The left inferior parietal lobe was used as a control stimulation condition.ResultsLocal reactivity was significantly associated with working memory and reasoning only after L-PFC stimulation. No associations were found between NfL and cognition. These specific associations were independent of the status of neuroaxonal damage indexed by the NfL biomarker and remained after adjusting for age, biological sex, and education.ConclusionOur results demonstrate that TMS evoked EEG reactivity at the L-PFC, but not the L-IPL, is related to the cognitive status of middle-aged individuals and independent of NfL levels, and may become a valuable biomarker of frontal lobe-associated cognitive function. (shrink)

It is unknown to what extent medical researchers generalize study findings beyond their samples when their sample size, sample diversity, or knowledge of conditions that support external validity do not warrant it. It is also unknown to what extent medical researchers describe their results with precise quantifications or unquantified generalizations, i.e., generics, that can obscure variations between individuals. We therefore systematically reviewed all prospective studies (n = 533) published in the top four highest ranking medical journals, Lancet, New England Journal (...) of Medicine (NEJM), Journal of the American Medical Association (JAMA), and the British Medical Journal (BMJ), from January 2022 to May 2023. We additionally reviewed all NEJM Journal Watch clinical research summaries (n = 143) published during the same time. Of all research articles reporting prospective studies, 52.5% included generalizations beyond specific national study populations, with the numbers of articles with generics varying significantly between journals (JAMA = 12%; Lancet = 77%) (p < 0.001, V = 0.48). There was no evidence that articles containing broader generalizations or generics were correlated with larger or more nationally diverse samples. Moreover, only 10.2% of articles with generalizations beyond specific national populations reported external validity strengthening factors that could potentially support such extrapolations. There was no evidence that original research articles and NEJM Journal Watch summaries intended for practitioners differed in their use of broad generalizations, including generics. Finally, from the journal with the highest citation impact, articles containing broader conclusions were correlated with more citations. Since there was no evidence that studies with generalizations beyond specific national study populations or with generics were associated with larger, more nationally diverse samples, or with reports of population similarity that may permit extensions of conclusions, our findings suggest that the generalizations in many articles were insufficiently supported. Caution against overly broad generalizations in medical research is warranted. (shrink)

Background The high public demand for healthcare services during the COVID-19 pandemic and strict infection control measures, coupled with threat of severe illness and death, and limited resources, led to many healthcare workers (HCWs) experiencing ethically challenging situations (ECSs). Objective To systematically explore first-hand accounts of ECS-evoking moral distress among HCWs during this public health emergency. Research design This was an open cohort study. All participants were asked whether they had been in ECS-evoking moral distress during the pandemic. Those who (...) had were asked to describe these situations. Answers were systematically analyzed according to three levels of root causes for ECSs, using thematic analysis. Participants and research context In January 2022, 977 HCWs from four Norwegian university hospitals participated. Ethical considerations The study received ethical approval from the Norwegian Ethical Review Authority (No. 130944). Results In total, 508 participants (52%) reported that they had experienced ECS-evoking moral distress during the pandemic, whereof 323 provided a qualitative description. We found that while a few reported ECSs caused at the patient level, and some described situations at the unit/team level, the vast majority reported situations caused at the system level, predominantly related to resource scarcity, particularly poor staffing. Conclusion Our findings strongly indicate that efforts to mitigate moral distress among HCWs should be targeted at the system level. More specifically, the study findings highlight resource limitations, particularly poor staffing, as a major cause of moral distress during the pandemic. (shrink)