Despite the reported limited success of conventional treatments and growing evidence of the effectiveness of adult bariatric surgery, weight loss operations for (morbidly) obese children and adolescents are still considered to be controversial by health care professionals and lay people alike. This paper describes an explorative, qualitative study involving obesity specialists, morbidly obese adolescents, and parents and identifies attitudes and normative beliefs regarding pediatric bariatric surgery. Views on the etiology of obesity—whether it should be considered primarily a medical condition or (...) more a psychosocial problem—seem to affect the specialists’ normative opinions concerning the acceptability of bariatric procedures as a treatment option, the parents’ feelings regarding both being able to influence their child’s health and their child being able to control their own condition, and the adolescents’ sense of competence and motivation for treatment. Moreover, parents and adolescents who saw obesity as something that they could influence themselves were more in favor of non-surgical treatment and vice versa. Conflicting attitudes and normative views—e.g., with regard to concepts of disease, personal influence on health, motivation, and the possibility of a careful informed consent procedure—play an important role in the acceptability of bariatric surgery for childhood obesity. (shrink)

BackgroundPregnant people have been overlooked or excluded from clinical research, resulting in a lack of scientific knowledge on medication safety and efficacy during pregnancy. Thus far, both the opportunities to generate evidence-based knowledge beyond clinical trials and the role of pregnant people in changing their status quo have not been discussed. Some scholars have argued that for rare disease patients, for whom, just like pregnant people, a poor evidence base exists regarding treatments, solidarity has played an important role in addressing (...) the evidence gap. This paper explores whether and how the enactment of solidarity among pregnant people can be stimulated to help address the poor evidence base on medications used during pregnancy.MethodWe use the concept of solidarity formulated by Prainsack and Buyx and enrich their concept by providing an account for stimulating the enactment of solidarity. Then we apply this account to the case of pregnant people who use medication.ResultsSolidarity means enacted commitment on the part of an individual to assisting others with whom the person recognizes a similarity in a relevant respect. Although solidarity cannot be imposed, we argue that the empowerment of people is a crucial concept in understanding how solidarity can be stimulated. Empowerment in the context of pregnant people means creating awareness about their status quo, explaining how scientific research can help close the knowledge gap, and how pregnant people can themselves contribute. In particular, how pregnant people can contribute to the collection of health data to strengthen the evidence base for medications used during pregnancy.ConclusionsWe conclude that acting in solidarity can help change the status quo for pregnant people. Furthermore, we argue that the empowerment of pregnant people and other relevant stakeholders is a way to stimulate the enactment of solidarity. The process of empowerment starts by raising awareness about the lack of evidence on medications used during prengnacy and by explaining to pregnant people how they can contribute to changing the way knowledge is being generated by, for example, sharing data on the health effects of medications. (shrink)

Compared to approach motivation, avoidance motivation evokes vigilance, attention to detail, systematic information processing, and the recruitment of cognitive resources. From a conservation of energy perspective it follows that people would be reluctant to engage in the kind of effortful cognitive processing evoked by avoidance motivation, unless the benefits of expending this energy outweigh the costs. We put forward three empirically testable propositions concerning approach and avoidance motivation, investment of energy, and the consequences of such investments. Specifically, we propose that (...) compared to approach-motivated people, avoidance-motivated people (a) carefully select situations in which they exert such cognitive effort, (b) only perform well in the absence of distracters that occupy cognitive resources, and (c) become depleted after exerting such cognitive effort. (shrink)

There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with.

Individuals make decisions under uncertainty every day. Decisions are based on in- complete information concerning the potential outcome or the predicted likelihood with which events occur. In addition, individuals’ choices often deviate from the rational or mathematically objective solution. Accordingly, the dynamics of human decision making are difficult to capture using conventional, linear mathematical models. Here, we present data from a 2-choice task with variable risk between sure loss and risky loss to illustrate how a simple nonlinear dynamical system can (...) be employed to capture the dynamics of human decision making under uncertainty (i.e., multistability, bifurcations). We test the feasibility of this model quantitatively and demonstrate how the model can account for up to 86% of the observed choice behavior. The implications of using dynamical models for explaining the nonlin- ear complexities of human decision making are discussed as well as the degree to which the theory of nonlinear dynamical systems might offer an alternative framework for understanding human decision making processes. (shrink)

What is the value of an early diagnosis of dementia in the absence of effective treatment? There has been a lively scholarly debate over this question, but until now patients have not played a large role in it. Our study supplements biomedical research into innovative diagnostics with an exlporation of its meanings and values according to patients. Based on seven focusgroups with patients and their care-givers, we conclude that stakeholders evaluate early diagnostics with respect to whether and how they expect (...) it to empower their capacity to care. They value it, for instance, with respect to whether it explains experienced complaints, allows to start a process of psychological acceptance and social adaptation to the expected degeneration, contributes to dealing with anxieties, informs adequately about when to start preparing for the end of life, informs the planning of a request for euthanasia, or allows society to deal with a growing amount of dementia patients. Our study suggests that information about disease is considered ‘harmful’ or ‘premature’ when recipients feel unable to act on that information in their care. The results of this research offers input to further ethical research. It invites to adopt a care perspective in evaluation and to seek ways to prevent the ‘harm’ that such diagnostic methods can bring about. (shrink)

Reward and punishment sensitivity seem important traits in understanding behavior in general and psychopathology in particular. Though the definitions used for reward and punishment sensitivity differentiate between responsivity and motivation, the measures thus far used to assess these constructs do not. Further, specificity of the type of reward and punishment in questionnaires might result in measurement bias especially when examining the relationship with psychopathology. Therefore, we developed a stimulus-independent multidimensional questionnaire of reward and punishment sensitivity that differentiates between responsivity and (...) motivation. This study addresses the psychometric qualities of this newly developed reward and punishment responsivity and motivation questionnaire. On the basis of exploratory ordinal factor analysis that was used to examine the quality of the initial pool of 39 items, the number of items was reduced to 18. Confirmatory ordinal factor analysis on the remaining items in an independent sample supported a 18-item four-factor model, and showed acceptable to good internal reliability. The relationship between the subscales of the RPRM-Q and often used questionnaires was examined in the combined sample, which showed some first support for the ability of the new questionnaire to differentiate between responsivity and motivation to approach/avoid. The findings indicate that the RPRM-Q might be a helpful instrument to further test the relevance of punishment and reward sensitivity in psychopathology. (shrink)

Individuals make decisions under uncertainty every day based on incomplete information concerning the potential outcome of the choice or chance levels. The choices individuals make often deviate from the rational or mathematically objective solution. Accordingly, the dynamics of human decision-making are difficult to capture using conventional, linear mathematical models. Here, we present data from a two-choice task with variable risk between sure loss and risky loss to illustrate how a simple nonlinear dynamical system can be employed to capture the dynamics (...) of human decision-making under uncertainty (i.e., multi-stability, bifurcations). We test the feasibility of this model quantitatively and demonstrate how the model can account for up to 86% of the observed choice behavior. The implications of using dynamical models for explaining the nonlinear complexities of human decision-making are discussed, as well as the degree to which nonlinear dynamical systems theory might offer an alternative framework for understanding human decision-making processes. (shrink)

As part of the Dutch national science program “Professional Games for Professional Skills” we developed a stress-exposure biofeedback training in virtual reality for the Dutch police. We aim to reduce the acute negative impact of stress on performance, as well as long-term consequences for mental health by facilitating physiological stress regulation during a demanding decision task. Conventional biofeedback applications mainly train physiological regulation at rest. This might limit the transfer of the regulation skills to stressful situations. In contrast, we provide (...) the user with the opportunity to practice breathing regulation while they carry out a complex task in VR. This setting poses challenges from a technical – as well as from a user-experience perspective. We illustrate how we approach these challenges in our training and hope to contribute a useful reference for researchers and developers in academia or industry who are interested in using biosignals to control elements in a dynamic virtual environment. (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)

PurposeTo explore the mindfulness practice, its long-term effects, facilitators and barriers, in clinical clerkship students 2 years after participation in an 8-week mindfulness-based stress reduction training.MethodA qualitative study was performed by semi-structured in-depth interviews with 16 clinical clerkship students selected by purposive sampling. Students had participated in a MBSR training 2 years before and were asked about their current mindfulness practice, and the long-term effects of the MBSR training. Thematic analysis was conducted using the constant comparison method. Data saturation was (...) reached after 16 interviews.ResultsMost interviewees were still engaged in regular, predominantly informal, mindfulness practice, although some discontinued mindfulness practice and reported an “unchanged lifestyle.” Three main themes came forward; “focused attention and open awareness” during daily activities as core elements of long-term mindfulness practice; “changes in behavior and coping” that resulted from taking a pause, reflecting, recognizing automatic behavioral patterns and making space for a conscious response; “integration in personal and professional life” by enhanced enjoyment of daily activities, improved work-life-balance and making different career choices. Barriers and facilitators in starting and maintaining mindfulness practice were understanding and intention as “pre-conditions”; practical, personal, and professional factors of students in maintaining practice.ConclusionTwo years after participation in a MBSR training, many interviewees were still engaged in mindfulness practice contributing to both personal and professional changes. In light of the high clerkship demands, MBSR training could be a valuable addition to medical curricula, supporting medical students in developing necessary competencies to become well-balanced professionals. (shrink)

Integrating artificial intelligence (AI) into critical domains such as healthcare holds immense promise. Nevertheless, significant challenges must be addressed to avoid harm, promote the well-being of individuals and societies, and ensure ethically sound and socially just technology development. Innovative approaches like Embedded Ethics, which refers to integrating ethics and social science into technology development based on interdisciplinary collaboration, are emerging to address issues of bias, transparency, misrepresentation, and more. This paper aims to develop this approach further to enable future projects (...) to effectively deploy it. Based on the practical experience of using ethics and social science methodology in interdisciplinary AI-related healthcare consortia, this paper presents several methods that have proven helpful for embedding ethical and social science analysis and inquiry. They include (1) stakeholder analyses, (2) literature reviews, (3) ethnographic approaches, (4) peer-to-peer interviews, (5) focus groups, (6) interviews with affected groups and external stakeholders, (7) bias analyses, (8) workshops, and (9) interdisciplinary results dissemination. We believe that applying Embedded Ethics offers a pathway to stimulate reflexivity, proactively anticipate social and ethical concerns, and foster interdisciplinary inquiry into such concerns at every stage of technology development. This approach can help shape responsible, inclusive, and ethically aware technology innovation in healthcare and beyond. (shrink)

This article presents preliminary considerations and results from a research project designed to investigate the relation between gestures, graphic traces and perceptions. More specifically, the project aims to test the hypothesis that graphic traces, including handwriting, can set up graphetic empathy between writers and readers of traces across long temporal and spatial distances. Insofar as a graphic trace is lawfully related to the gesture by which it came into being, the trace itself will hold information about the gesture, which may (...) resonate with the sensorimotor system of a perceiver, as if they themselves performed the gesture. If this is in fact so, it will have important and hitherto unanticipated implications for our understanding of the embodiment of reading. As part of the article we will present and discuss the results of a neurophenomenological trial study through which we attempt to operationalize the gesture-trace and trace–perception relations respectively. (shrink)

It is widely recognized that police performance may be hindered by psychophysiological state changes during acute stress. To address the need for awareness and control of these physiological changes, police academies in many countries have implemented Heart-Rate Variability biofeedback training. Despite these trainings now being widely delivered in classroom setups, they typically lack the arousing action context needed for successful transfer to the operational field, where officers must apply learned skills, particularly when stress levels rise. The study presented here aimed (...) to address this gap by training physiological control skills in an arousing decision-making context. We developed a Virtual-Reality breathing-based biofeedback training in which police officers perform deep and slow diaphragmatic breathing in an engaging game-like action context. This VR game consisted of a selective shoot/don’t shoot game designed to assess response inhibition, an impaired capacity in high arousal situations. Biofeedback was provided based on adherence to a slow breathing pace: the slower and deeper the breathing, the less constrained peripheral vision became, facilitating accurate responses to the in-game demands. A total of nine male police trainers completed 10 sessions over a 4-week period as part of a single-case experimental ABAB study-design. Results showed that eight out of nine participants showed improved breathing control in action, with a positive effect on breathing-induced low frequency HRV, while also improving their in-game behavioral performance. Critically, the breathing-based skill learning transferred to subsequent sessions in which biofeedback was not presented. Importantly, all participants remained highly engaged throughout the training. Altogether, our study showed that our VR environment can be used to train breathing regulation in an arousing and active decision-making context. (shrink)

This paper argues that human psychological resilience is a central virtue in sport and in human life generally. Despite its importance, it is an overlooked virtue in philosophy of sport and classical and contemporary virtue theory. The phenomenon of human resilience has received a great deal of attention recently in other quarters, however. There is a large and instructive empirical psychological literature on resilience, but connections to virtue theory are rarely drawn and there is no agreement about what the concept (...) refers to. This paper attempts to clarify the concept of resilience and explain how it fits into and supports a traditional Aristotelian conception of virtue. It shows how resilience figures centrally in sport and can extend and enrich our understanding of virtue and success in sport and of sport's internal values. The investigations into the nature of resilience in sport can also help us to understand better sport's contributions to human culture and well-being. (shrink)

Artificial Neural Networks have reached “grandmaster” and even “super-human” performance across a variety of games, from those involving perfect information, such as Go, to those involving imperfect information, such as “Starcraft”. Such technological developments from artificial intelligence (AI) labs have ushered concomitant applications across the world of business, where an “AI” brand-tag is quickly becoming ubiquitous. A corollary of such widespread commercial deployment is that when AI gets things wrong—an autonomous vehicle crashes, a chatbot exhibits “racist” behavior, automated credit-scoring processes (...) “discriminate” on gender, etc.—there are often significant financial, legal, and brand consequences, and the incident becomes major news. As Judea Pearl sees it, the underlying reason for such mistakes is that “... all the impressive achievements of deep learning amount to just curve fitting.” The key, as Pearl suggests, is to replace “reasoning by association” with “causal reasoning” —the ability to infer causes from observed phenomena. It is a point that was echoed by Gary Marcus and Ernest Davis in a recent piece for theNew York Times: “we need to stop building computer systems that merely get better and better at detecting statistical patterns in data sets—often using an approach known as ‘Deep Learning’—and start building computer systems that from the moment of their assembly innately grasp three basic concepts: time, space, and causality.” In this paper, foregrounding what in 1949 Gilbert Ryle termed “a category mistake”, I will offer an alternative explanation for AI errors; it is not so much that AI machinery cannot “grasp” causality, but that AI machinery (qua computation) cannot understand anything at all. (shrink)

Many writers have paid tribute to its power: Shakespeare urged his audiences to use it to create a setting; Hobbes asserted that "imagination and memory are but one thing; " for Wordsworth it was "the mightiest leveler known to moral world; " and to Baudelaire it represented "the queen of truth. " Imagination as artistic, poetic, and cultural predicate remains one of the most influential ideas in the history of Western thought. It has been simultaneously feared as a dangerous, uncontrollable (...) force, and revered as the supreme visionary power. The questions of its origins, nature, function, and effects have absorbed writers, theologians, and philosophers alike. J. M. Cocking's Imagination shows how these questions have recurred, through the ages and in various cultures. Exploring this theme, from antiquity to the Renaissance, it opens with a discussion of the treatment of imagination in the writings of Aristotle and Plato. Tracing its development in the Middle Ages, Cocking pays particular attention to the parallel tradition in Islamic thought of the period. The book pursues the concept through the theories of Dante and the neo-Platonists, concluding with the High Renaissance. (shrink)

For half a century, J. I. Packer's classic has helped Christians everywhere discover the wonder, glory, and joy of knowing God. This fiftieth anniversary edition of a thought-provoking work seeks to renew and enrich our understanding of God, bringing together knowing about God and knowing God through a close relationship with Jesus Christ.

(2002). Philosophy of Science 72 (January), 198-208.

In this provocative work, J. L. Schellenberg addresses those who, influenced by science, take a negative view of religion, thinking of it as outmoded if not decadent. He promotes the view that transcendently oriented religion is developmentally immature, showing the consilience of scientific thinking about deep time with his view. From this unique perspective, he responds to a number of influential cultural factors commonly thought to spell ill for religion, showing the changes – changes favorable to religion – that are (...) now called for in how we understand them and their proper impact. Finally, he provides a defense for a new and attractive religious humanism that benefits from, rather than being hindered by, religious immaturity. In Schellenberg's view, religion can and should become a human project as monumental as science. (shrink)

International array of contributors, bringing together both traditional and more recent approaches to provide valuable insights into the poets’ use of language.Covers authors from Lucilius to Juvenal.Of the peoples of ancient Italy, only the Romans committed newly composed poems to writing, and for 250 years Latin-speakers developed an impressive verse literature.The language had traditional resources of high style, e.g., alliteration, lexical and morphological archaism or grecism, and of course metaphor and word order; and there were also less obvious resources in (...) the technical vocabularies of law, philosophy and medicine.The essays in this volume show how the poets in the classical period combined these elements, and so created a poetic medium that could comprehend satire, invective, erotic elegy, drama, lyric, and the grandest heroic epos. (shrink)

Although the theory of definability had many important antecedents—such as the descriptive set theory initiated by the French semi-intuitionists in the early 1900s—the main ideas were first laid out in precise mathematical terms by Alfred Tarski beginning in 1929. We review here the basic notions of languages, explicit definability, and grammatical complexity, and emphasize common themes in the theories of definability for four important languages underlying, respectively, descriptive set theory, recursive function theory, classical pure logic, and finite-universe logic. We review (...) the history of previous studies of the similarities and differences in the theories of definability of the first three of these four languages. A seminal role leading toward unification of the theories has been played by the separation principles introduced by Nikolai Luzin in 1927. Emphasizing analogies and driving toward further unification embracing finite-universe logic we concentrate on a simple example—the first and second separation principles for existential-universal first-order sentences . Using this as a test case for the fundamental problem of how to “finitize” arguments in classical pure logic to the finite-universe case, we are led to the analogous negative solution by using the theory of certain special graphs: a graph is - special for any positive integers m , n , p , q iff it is bipartite with m red points and n blue points and for every p -tuple of red points there is a blue point to which they are all connected . As an aside we introduce for further study a natural “Ramseyesque” increasing sequence A of positive integers, where A is the least positive integer n for which an -special graph exists. (shrink)

After measuring consumers' sentiments toward business ethical practices in mostly Christian countries, the Business Ethics Index was expanded to two Muslim countries — Turkey and Egypt. The overall BEI for both countries was on the negative range, with Egypt exhibiting the widest gap between personal ethical perceptions and vicarious ones. No difference between genders was observed.