Background: Electroconvulsive therapy is one of the most effective treatments for major depressive disorder. Recently, there has been increasing attention to evaluate the effect of ECT on resting-state functional magnetic resonance imaging. This study aims to compare rs-fMRI of depressive disorder patients with healthy participants, investigate whether pre-ECT dynamic functional network connectivity network estimated from patients rs-fMRI is associated with an eventual ECT outcome, and explore the effect of ECT on brain network states.Method: Resting-state functional magnetic resonance imaging data were (...) collected from 119 patients with depression or depressive disorder, and 61 healthy participants, with an age mean of 52.25 years old. The pre-ECT and post-ECT Hamilton Depression Rating Scale were 25.59 ± 6.14 and 11.48 ± 9.07, respectively. Twenty-four independent components from default mode and cognitive control network were extracted, using group-independent component analysis from pre-ECT and post-ECT rs-fMRI. Then, the sliding window approach was used to estimate the pre-and post-ECT dFNC of each subject. Next, k-means clustering was separately applied to pre-ECT dFNC and post-ECT dFNC to assess three distinct states from each participant. We calculated the amount of time each subject spends in each state, which is called “occupancy rate” or OCR. Next, we compared OCR values between HC and DEP participants. We also calculated the partial correlation between pre-ECT OCRs and HDRS change while controlling for age, gender, and site. Finally, we evaluated the effectiveness of ECT by comparing pre- and post-ECT OCR of DEP and HC participants.Results: The main findings include depressive disorder patients had significantly lower OCR values than the HC group in state 2, where connectivity between cognitive control network and default mode network was relatively higher than other states, Pre-ECT OCR of state, with more negative connectivity between CCN and DMN components, is linked with the HDRS changes. This means that those DEP patients who spent less time in this state showed more HDRS change, and The post-ECT OCR analysis suggested that ECT increased the amount of time DEP patients spent in state 2.Conclusion: Our finding suggests that dynamic functional network connectivity features, estimated from CCN and DMN, show promise as a predictive biomarker of the ECT outcome of DEP patients. Also, this study identifies a possible underlying mechanism associated with the ECT effect on DEP patients. (shrink)

Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences. Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences. Design: Single group pre-/post-test design with two questionnaires. Methods: Questionnaires used were the Rushton Moral (...) Resilience Scale measuring Moral Resilience and the Euro-MCD, measuring Moral Competences. Respondents mainly consisted of nurses and nurse assistants who used CURA in daily practice. Forty-seven respondents contributed to both pre- and post-test with 18 months between both tests. Analysis was done using descriptive statistics and Wilcoxon signed rank tests. This study followed the SQUIRE checklist. Ethical considerations: This study was approved by the Institutional Review Board of Amsterdam UMC. Informed consent was obtained from all respondents. Results: The total Moral Resilience score and the scores of two subscales of the RMRS, that is, Responses to Moral Adversity and Relational Integrity, increased significantly. All subscales of the Euro-MCD increased significantly at posttest. Using CURA more often did not lead to significant higher scores on most (sub) scales. Conclusion: This study indicates that CURA can be used to foster moral resilience and moral competences of healthcare professionals. CURA therefore is a promising instrument to support healthcare professionals in dealing with moral challenges in everyday practice. (shrink)

BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were (...) asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

The explorer Albert Grünwedel’s Tibetan maps of Shambhala are a controversial and contested part of the history of the exploration of the Silk Routes. In the early 1900s Albert Grünwedel collected material related to archaeological sites at Kucha and Turfan including several Tibetan maps of the region, which he published in 1920 in the book Alt-Kutscha. Soon after publication, doubts were raised about the authenticity of the maps, which presented Kucha and Qocho in terms of the mythical realm of Shambhala, (...) and they are still widely considered to be either fabrications or delusions. Judging from internal references to historical figures of the late twelfth century, the maps may derive from sources as early as the thirteenth century, and can be linked to an increasing interest in the Kālacakra tantra and the realm of Shambhala described therein. I conclude that the Alt-Kutscha maps should not be regarded as fakes, nor as historically descriptive maps, but as guides for pilgrims that reimagined these sites in terms of the sacred geography of tantric Buddhism, with particular reference to the mythology of Shambhala. (shrink)

Children accrue experiences with buoyancy on a daily basis, yet research paints a mixed picture of children’s buoyancy knowledge. Whereas children’s predictions and explanations of the floating and the sinking of common objects are often based on a single feature (e.g., mass or facts), children’s predictions of novel cubes reveal solution strategies based on mass and volume integrations. Correspondingly, category learning theory suggests that categories (e.g., floaters vs. sinkers) are easier to identify when items mainly vary from one another in (...) the relevant defining features. For example, a set of cubes only varies in mass and volume and hence density, thereby being able to highlight the deterministic role of density when placed in water. Here we asked how item variation during hands-on exploration affects children’s subsequent predictions and explanations of buoyancy. Kindergarteners and first-, second-, and third-grade children individually explored either a set of 10 systematically varied cubes (i.e., systematic condition; n = 95) or a set of 10 common objects (i.e., non-systematic condition; n = 96) in a water basin. Next, the children predicted the buoyancy of five new cubes and five new common objects one at a time. Subsequently, the children explained their predictions one subset at a time. The children in the systematic condition were more accurate in their predictions of the test cubes than the children in the non-systematic condition. Latent class regression analyses identified three cube prediction solution strategies. The children in the systematic condition were more likely to use a strategy in which buoyancy decisions were made based on an accurate integration of mass and volume, while the children in the non-systematic condition were more likely to use a strategy in which mass was given more predictive load than volume. A third strategy was characterized by guessing. Latent class analyses of the children’s explanations revealed different explanation strategies, each appealing to several features, but as hypothesized, no clear condition differences were found. The findings indicate that even 5 min of exploration with systematically varied cubes can already help children use an advanced buoyancy prediction strategy. This provides evidence in favor of using category learning theory to inform early science education design. (shrink)

Evaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with five-point Likert scales (...) were used. The feasibility questionnaire was given to all respondents, the perceived outcomes questionnaire only to the course participants. Data collection took place over a period of six months. Respondents were predominantly positive on most items of the feasibility questionnaire. The steps of CURA are clearly described (84% of course participants agreed or strongly agreed, 94% of colleagues) and easy to apply (78–87%). The perceived outcomes showed that CURA helped respondents to reflect on moral challenges (71% (strongly) agreed), in perspective taking (67%), with being aware of moral challenges (63%) and in dealing with moral distress (54%). Respondents did experience organizational barriers: only half of the respondents (strongly) agreed that they could easily find time for using CURA. CURA is a feasible instrument for nurses and nurse assistants providing palliative care. However, reported difficulties in organizing and making time for reflections with CURA indicate organizational preconditions ought to be met in order to implement CURA in daily practice. Furthermore, these results indicate that CURA helps to build moral competences and fosters moral resilience. (shrink)

Vorrede | In diesem charakteristischerweise hervorragend recherchierten Beitrag erörtern Kappeler und Fichtel die Konsequenzen sozialer und einkommensbedingter Ungleichheit für die individuelle Gesundheit und die empfundene Einsamkeit aus einer evolutionären Perspektive. Das zentrale Argument der Autoren ist, dass sich die modernen Großgesellschaften, in denen fast alle Menschen heutzutage leben, grundsätzlich von den egalitären Kleingesellschaften unterscheiden, in denen wir evolviert sind und in denen wir bis vor lediglich 20.000 Jahren alle gelebt haben. Diese Zeitspanne war gemäß den meisten Schätzungen viel zu kurz, (...) als dass sich durch die Evolution notwendige Anpassungen in der menschlichen Natur an das Leben in modernen Großgesellschaften hätten etablieren können. (shrink)

The zone of latent solutions hypothesis provides an alternative approach to explaining cultural patterns in primates and many other animals. According to the ZLS hypothesis, non-human great ape cultures consist largely or solely of latent solutions. The current competing hypothesis for ape culture argues instead that at least some of their behavioural or artefact forms are copied through specific social learning mechanisms and that their forms may depend on copying. In contrast, the ape ZLS hypothesis does not require these forms (...) to be copied. Instead, it suggests that several social learning mechanisms help determine the frequency of these behaviours and artefacts within connected individuals. The ZLS hypothesis thus suggests that increases and stabilisations of a particular behaviour’s or artefact’s frequency can derive from socially-mediated form reinnovations. Therefore, and while genes and ecology play important roles as well, according to the ape ZLS hypothesis, apes typically acquire the forms of their behaviours and artefacts individually, but are usually socially induced to do so. The ZLS approach is often criticized—perhaps also because it challenges the current null hypothesis, which instead assumes a requirement of form-copying social learning mechanisms to explain many ape behavioural forms. However, as the ZLS hypothesis is a new approach, with less accumulated literature compared to the current null hypothesis, some confusion is to be expected. Here, we clarify the ZLS approach—also in relation to other competing hypotheses—and address misconceptions and objections. We believe that these clarifications will provide researchers with a coherent theoretical approach and an experimental methodology to examine the necessity of form-copying variants of social learning in apes, humans and other species. (shrink)

This article presents an ethics support instrument for healthcare professionals called CURA. It is designed with a focus on and together with nurses and nurse assistants in palliative care. First, we shortly go into the background and the development study of the instrument. Next, we describe the four steps CURA prescribes for ethical reflection: (1) Concentrate, (2) Unrush, (3) Reflect, and (4) Act. In order to demonstrate how CURA can structure a moral reflection among caregivers, we discuss how a case (...) was discussed with CURA at a psychogeriatric ward of an elderly care home. Furthermore, we go into some considerations regarding the use of the instrument in clinical practice. Finally, we focus on the need for further research on the effectiveness and implementation of CURA. (shrink)

_An engaging introduction to Zen Buddhism, featuring a new English translation of one of the earliest Zen texts_ Leading Buddhist scholar Sam van Schaik explores the history and essence of Zen, based on a new translation of one of the earliest surviving collections of teachings by Zen masters. These teachings, titled _The Masters and Students of the Lanka_, were discovered in a sealed cave on the old Silk Road, in modern Gansu, China, in the early twentieth century. All more (...) than a thousand years old, the manuscripts have sometimes been called the Buddhist Dead Sea Scrolls, and their translation has opened a new window onto the history of Buddhism. Both accessible and illuminating, this book explores the continuities between the ways in which Zen was practiced in ancient times, and how it is practiced today in East Asian countries such as Japan, China, Korea, and Vietnam, as well as in the emerging Western Zen tradition. (shrink)

The cultural group selection approach provides a compelling explanation for recent changes in human societies, but has trouble explaining why our ancestors, rather than any other great ape, evolved into a hyper-cooperative niche. The cooperative breeding hypothesis can plug this gap and thus complement CGS, because recent comparative evidence suggests that it promoted proactive prosociality, social transmission, and communication in Pleistocene hominins.

The author examines belief-centered and act-centered conceptions ofracism through a discussion and critique ofconceptions ofrace and racism offered by K. Anthony Appiah, J.L.A. Garcia, and Michael Phillips.

A groundbreaking study of the lost tradition of Tibetan Zen containing the first translations of key texts from one thousand years ago. Banned in Tibet, forgotten in China, the Tibetan tradition of Zen was almost completely lost to us. According to Tibetan histories, Zen teachers were invited to Tibet from China in the 8th century, at the height of the Tibetan Empire. When doctrinal disagreements developed between Indian and Chinese Buddhists at the Tibetan court, the Tibetan emperor called for a (...) formal debate. When the debate resulted in a decisive win by the Indian side, the Zen teachers were sent back to China, and Zen was gradually forgotten in Tibet. This picture changed at the beginning of the 20th century with the discovery in Dunhuang (in Chinese Central Asia) of a sealed cave full of manuscripts in various languages dating from the first millennium CE. The Tibetan manuscripts, dating from the 9th and 10th centuries, are the earliest surviving examples of Tibetan Buddhism. Among them are around 40 manuscripts containing original Tibetan Zen teachings. This book translates the key texts of Tibetan Zen preserved in Dunhuang. The book is divided into ten sections, each containing a translation of a Zen text illuminating a different aspect of the tradition, with brief introductions discussing the roles of ritual, debate, lineage, and meditation in the early Zen tradition. Van Schaik not only presents the texts but also explains how they were embedded in actual practices by those who used them. (shrink)

We welcome Tomasello’s new book on the natural history of human morality as an important confirmation of the evolutionary approach, which sees adaptive behaviors and their psychological underpinnings as linked to a species’ socioecology (the package of subsistence, social, mating, and rearing systems). This perspective automatically leads to the conclusion that the basic set of moral preferences is a straightforward human adaptation to the derived cooperative foraging niche of nomadic foragers, which involves a high degree of interdependence. We provide more (...) background information in support of this evolutionary approach, call for work on defining the contents of the innate core of moral preferences it implies, and urge philosophers to pursue its implications more seriously. Tomasello also offers a historical reconstruction, but his scenario is not compatible with recent comparative data showing a surprising overlap with aspects of human morality, nor does it fit the currently best-supported evolutionary scenario of hominin foraging. We offer a better-fitting alternative, but also call for more behavioral work in child development and on nonhuman primates to improve this reconstruction. (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)

We fully agree with Buchbinder et al. (2024) that there is too much focus on moral distress as arising from individual clinical encounters, as well as on individual healthcare professionals in addr...

We make three points. First, even if Finlay et al.'s proposed developmental mechanisms hold, there remains great scope for selection on specific brain structures. Second, the positive covariance among the size of brain structures provides far less support for the proposed developmental mechanisms than Finlay et al. acknowledge. Third, even if the proposed mechanisms are the primary size determinants for most brain structures, these structures should not be considered.

The Gathering of Intentions: A History of Tibetan Buddhist Tantra, by Jacob P. Dalton. Columbia University Press, 2016. 272pp. Hb. $60.00, ISBN-13: 9780231176002.

In the last decade, a number of studies in the behavioural sciences, particularly in psychology and economics, have explored the complexity of individual risk behaviour and its underlying factors. Most previous studies have examined the influences of various socio-economic, cognitive, biological and psychological factors on human decision-making however, the relationship between the decision-makers’ risk preferences and occupational background has not received much empirical attention. Accordingly, in the current study, we investigated how occupational background, together with decision-making framing (e.g., variations in (...) decision domain, context, presentation of risk and utility ratios), influence participants’ risk preferences for decision options with equivalent expected utility. Our novel findings indicate that risk preferences may vary among individuals from different occupational backgrounds. As such, when the task was framed in gain terms, participants who mostly deal with health/safety-related risks on a day-to-day basis (high-risk occupations) were predominantly risk-averse (avoiding risky options), while participants who mostly deal with financial/social risks (white-collar occupations) were prone to risk-seeking behaviour (avoiding certain options). Specifically, in “high-risk” occupations, participants’ pattern of choices changed from risk-averse in gain scenarios to risk-seeking in loss scenarios. However, the opposite pattern of risk preferences was found in participants with “white-collar” occupations. Our findings indicate that decision-makers’ occupational backgrounds influence risk preferences under some circumstances. (shrink)

Volume 24, Issue 12, December 2024, Page 62-64.

In this article, we develop an approach for the moral assessment of research and development networks on the basis of the reflective equilibrium approach proposed by Rawls and Daniels. The reflective equilibrium approach aims at coherence between moral judgments, principles, and background theories. We use this approach because it takes seriously the moral judgments of the actors involved in R & D, whereas it also leaves room for critical reflection about these judgments. It is shown that two norms, namely reflective (...) learning and openness and inclusiveness, which are used in the literature on policy and technological networks, contribute to achieving a justified overlapping consensus. We apply the approach to a case study about the development of an innovative sewage treatment technology and show how in this case the two norms are or could be instrumental in achieving a justified overlapping consensus on relevant moral issues. (shrink)

BackgroundExisting clinical ethics support (CES) instruments are considered useful. However, users report obstacles in using them in daily practice. Including end users and other stakeholders in developing CES instruments might help to overcome these limitations. This study describes the development process of a new ethics support instrument called CURA, a low-threshold four-step instrument focused on nurses and nurse assistants working in palliative care. MethodWe used a participatory development design. We worked together with stakeholders in a Community of Practice throughout the (...) study. Potential end users (nurses and nurse assistants in palliative care) used CURA in several pilots and provided us with feedback which we used to improve CURA.ResultsWe distinguished three phases in the development process. Phase one, Identifying Needs, focused on identifying stakeholder and end user needs and preferences, learning from existing CES instruments, their development and evaluation, and identify gaps. Phase two, Development, focused on designing, developing, refining and tailoring the instrument on the basis of iterative co-creation. Phase three, Dissemination, focused on implementation and dissemination. The instrument, CURA, is a four-step low-threshold instrument that fosters ethical reflection.ConclusionsParticipatory development is a valuable approach for developing clinical ethics support instruments. Collaborating with end users and other stakeholders in our development study has helped to meet the needs and preferences of end users, to come up with strategies to refine the instrument in order to enhance its feasibility, and to overcome reported limitations of existing clinical ethics instruments. (shrink)