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)

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)

Recognized in his day as a man of letters equaling Rousseau and Voltaire in France and rivaling Samuel Johnson, David Hume passed from favor in the Victorian age--his work, it seemed, did not pursue Truth but rather indulged in popularization. Although Hume is once more considered as one of the greatest British philosophers, scholars now tend to focus on his thought rather than his writing. To round out our understanding of Hume, M. A. Box in this book charts the interrelated (...) development of Hume's literary ambitions, theories of style, and compositional practice from his Treatise in 1739 through the Enquiries. In so doing, Box makes the case for Hume's career-long concern with the presentational modes of reaching an audience for his philosophical writings. Hume reacted to the popular failure of his masterpiece, A Treatise of Human Nature, Box suggests, by self-consciously exploring strategies in his subsequent works for agreeably bringing his readership to participate in the act of philosophizing. Combining a sensitive grasp of the ways Restoration period and eighteenth-century writers conceived the relations between rhetoric and philosophy with sound readings of particular texts, Box shows how Hume's literary concerns went beyond matters of style to involve persona, structure, and doctrine. While this book helps explain long-standing ambiguities surrounding Hume, especially by pointing out the tension between his created persona and his own voice, it also serves as an excellent introduction to his philosophy. (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)

Quantum mechanical measurements on a physical system are represented by observables - Hermitian operators on the state space of the observed system. It is an important question whether all observables may be realized, in principle, as measurements on a physical system. Dirac’s influential text ( [1], page 37) makes the following assertion on the question: The question now presents itself – Can every observable be measured? The answer theoretically is yes. In practice it may be very awkward, or perhaps even (...) beyond the ingenuity of the experimenter, to devise an apparatus which could measure some particular observable, but the theory always allows one to imagine that the measurement can be made. This Letter re-examines the question of whether it is possible, even in principle, to measure every quantum mechanical observable. Unexpectedly, ideas from com-. (shrink)

Is there an effect of depressed mood on the interpretation of ambiguity? Are depressed individuals biased to interpret ambiguous information in a negative manner? We used a cross-modal semantic priming task to look for evidence of a negative interpretative bias. Participants listened to ambiguous prime sentences (e.g., Joan was stunned by her final exam mark) and made lexical decisions to target words presented immediately after the sentence offset or after a delay of 1000 ms or 2000 ms. For the semantically (...) related targets, the target was negatively related (distress), positively related (success), or neutrally related (grades) to the ambiguous prime. The experiment was conducted with and without a negative mood induction. The expectation was that depressed participants would be more likely to consider the negative interpretations of the ambiguous primes and would therefore experience larger priming effects for negatively related targets. Although there were large priming effects for all semantically related targets, there was no evidence of a negative interpretative bias. (shrink)

The study presents the broad outlines for a relationalist interpretation of the Indian epistemological doctrine svataḥ prāmāṇya. Due to the inadequacy of the main western interpretations thereof, the paper’s approach can be considered an inference to the best explanation. Its main part is devoted to the typologization of various epistemological doctrines based on the svataḥ prāmāṇya principle in terms of strong and weak disjunctivism. Three paradigm cases of strong disjunctivism and a special variety of weak disjunctivism have thus been identified (...) in Indian epistemology, which allowed to draw a conclusion that strong disjunctivism constituted one of its general paradigms. (shrink)

Problems concerning future populations help us better understand what it is for one possible future, or world, to be morally better than another. The repugnant conclusion challenges traditional forms of consequentialism, including utilitarianism. A key issue is whether, per the traditional view, we make things morally better by creating additional people whose lives are worth living and by creating nonidentical better-off people in place of less well-off but distinct people. Or can we, instead, make things morally better only by making (...) things better for some particular person or another? Is the structure of morality aggregative in nature or instead person-affecting in nature? While the latter, non-traditional view may tempt us, it also seems to give rise to the nonidentity problem and various inconsistency objections. Can those problems be resolved? Questions raised by Parfit and others decades ago remain unsettled today but as critical as ever. (shrink)

The considerable attention to financial interests in clinical research has focused mostly on academic medical centers, even though the majority of clinical research is conducted in community practice settings. To fill this gap, this article maps the practices and policies in 73 community hospitals and several hundred specialized facilities around the country for reviewing clinical investigators’ financial relationships with research sponsors. Community hospitals face a substantially different mix of issues than academic medical centers do because their physician researchers are usually (...) not employees, and more of their studies are later-phase, multicenter trials. Accordingly, community physicians stand to benefit personally from per capita payments, but they tend to have less direct influence over research findings when compared with their academic peers. These and other contrasts require separate guidance for community-based organizations that takes into account their particular needs, circumstances, and institutional capacities. (shrink)