Background: Discussing treatment risks has become increasingly important in medical communication. Still, despite regulations, physicians must decide how much and what kind of information to present. Objective: To investigate patients’ preference for information about a small risk of a complication of colonoscopy, and whether medical and personal factors contribute to such preference. To propose a disclosure policy related to our results. Design: Vignettes study. Setting: Department of Gastroenterology, Academic Medical Centre, the Netherlands. Patients: 810 consecutive colonoscopy patients. Intervention: A home-sent (...) questionnaire containing three vignettes. Vignettes varied in the indication for colonoscopy, complication severity and level of risk. Patients were invited to indicate their wish to be informed and the importance of such information. In addition, sociodemograhic, illness-related and psychological characteristics were assessed. Main outcome measurements: Wish to be informed and importance of information. Results: Of 810 questionnaires, 68% were returned. Patients generally wished to be informed about low-risk complications, regardless of the indication for colonoscopy or the severity of the complication. The level of risk did matter, though (OR = 2.48, SE = 0.28, p = 0.001). The information was considered less important if done for population screening purposes or diagnosis of colon cancer, if the complication was less severe (bleeding) and if the risk was smaller (0.01% and 0.1%). Patients’ information preference was also related to age, mood and coping style. Limitations: Difficulty of vignettes. Conclusions: Patients generally wish to be informed about all possible risks. However, this might become uninformative. A stepwise approach is suggested. (shrink)

Inspired by Williamson’s knowledge-first epistemology, I propose a position on practical knowledge that can be called the ‘know-how-first view’; yet whereas Williamson is one of the pioneers of the new intellectualism about know-how, I employ the know-how-first view to argue against intellectualism and instead develop a know-how-first version of anti-intellectualism. Williamson argues that propositional knowledge is a sui generis unanalyzable mental state that comes first in the epistemic realm; in parallel, I propose that know-how is a sui generis unanalyzable power (...) that comes first in the practical realm. To motivate this suggestion, I put forward two arguments: drawing on dispositionalist ideas, I argue that the practical component of know-how is unanalyzable; based on an investigation of the natures of intentionality and intelligence, I argue that know-how is prior to intentional and intelligent abilities in the order of explanation of agential action. Deploying this know-how-first anti-intellectualism, I then set out know-how-first solutions to two challenging problems for anti-intellectualism: the sufficiency problem and the necessary condition problem. (shrink)

Whereas most current theories on emotions posit a central position to goals, direct tests of associations between emotions and goals have been sparse. We investigated such relations by comparing ratings of value importance and frequency of emotional experiences in daily life. The results confirmed our general expectation that associations would be found between values and emotions related to corresponding goals. We argue that data like these are fundamental to further development of emotion theory.

The objective of this work is to categorize the available fly ashes in different parts of the world into distinct groups based on its compositional attributes. Kohonen's self-organizing feature map and radial basis function networks are applied in a cascading fashion for the classification of fly ashes in terms of its chemical parameters. The basic procedure of the methodology consists of three stages: apply self-organizing neural net to ascertain possible number of groups, delineate them and identify the group sensitive attributes; (...) find mean values of sensitive attributes of the elicited groups and augment them as start-up prototypes in k-means algorithm and find the refined centroids of these groups; incorporate the centroids in a two layer radial basis function network and fine-tune the delineated groups and develop an indexing equation using the weights of the stabilized network. Further, to demonstrate the utility of this classification scheme, the so formed groups were correlated with their performance in High Volume Fly Ash Concrete System [HVFAC]. The categorization was found to be excellent and compares well with Canadian Standard Association's [CSA A 3000] classification scheme. (shrink)

In this paper, I will examine John Smeaton’s contribution to the vis viva controversy in Britain, focusing on how the hybridization of science, technology, and industry helped to establish vis viva, or mechanic power, as a measure of motive force. Smeaton, embodying the ‘hybrid expert’ who combined theoretical knowledge and practical knowhow, demonstrated that the notion of vis viva possessed a greater explanatory power than momentum, because it could be used to explain the difference in efficiency between overshot and undershot (...) waterwheels. Smeaton’s conclusions were correct since waterwheel efficiency was already measured in terms that were proportional to vis viva, not momentum, as a result of the industrial applications of waterwheel technology, which favored measuring efficiency by the product of mass and vertical displacement. Toward the end of the eighteenth century, the loss of motive force in the inelastic collision driving the undershot wheel began to be seen as equivalent to the expenditure of labor in the manufacture of commodities, further underlining how strictly scientific conclusions about motive force could have their origin in industrial practices. (shrink)

All projects take place within a context of uncertainty. That is especially noticeable in complex hydroelectric power generation projects, which are affected by factors such as the large number of multidisciplinary tasks to be performed in parallel, long execution times, or the risks inherent in various fields like geology, hydrology, and structural, electrical, and mechanical engineering, among others. Such factors often lead to cost overruns and delays in projects of this type. This paper analyzes the efficiency of the Earned Value (...) Management technique and its Earned Schedule extension, as means of forecasting costs and deadlines when applied to complex hydroelectric power production projects. It is worth noting that this analysis was based on simulation models applied to real-life projects. The results showed that cost forecasting becomes very accurate over time, whereas duration forecasting is not reliably accurate. (shrink)

An appropriate kind of curved Hilbert space is developed in such a manner that it admits operators of $\mathcal{C}$ - and $\mathfrak{D}$ -differentiation, which are the analogues of the familiar covariant and D-differentiation available in a manifold. These tools are then employed to shed light on the space-time structure of Quantum Mechanics, from the points of view of the Feynman ‘path integral’ and of canonical quantisation. (The latter contains, as a special case, quantisation in arbitrary curvilinear coordinates when space is (...) flat.) The influence of curvature is emphasised throughout, with an illustration provided by the Aharonov-Bohm effect. (shrink)

The vast majority of contributions to the literature on spirituality in nursing make extravagant claims about transcendence, eternity, the numinous, higher powers, higher levels of existence, invisible forces, cosmic unity, the essence of humanity, or other supernatural concepts. Typically, these assertions are made without the support of argument or evidence; and, as a consequence, alternative ways of theorizing ‘spirituality’ have been closed off, while the lack of consistent scholarship has turned the topic into a metaphysical backwater. In this paper, I (...) adopt a different premise, rejecting unsupported claims, and surveying the ‘spirituality’ terrain from a naturalistic and reductionist perspective. I argue that, if we rid ourselves of non‐naturalistic assumptions, we will discover theoretical and clinical resources in health psychology, social psychology, neuropsychology, and pharmacopsychology – resources which confirm that it is possible to conceptualize the study of existential concerns, and how health professionals might respond to them, in a properly scientific manner. In order to illustrate the potential usefulness of these resources, I will take palliative care as an example. (shrink)