RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

As interest in working memory is increasing at a rapid pace, an open discussion of the central issues involved is both useful and timely. This new volume compares and contrasts conceptions of working memory, with contributions from proponents of different views.

The classic model of blood pressure regulation by Guyton et al. (Annu Rev Physiol 34:13–46, 1972a; Ann Biomed Eng 1:254–281, 1972b) set a new standard for quantitative exploration of physiological function and led to important new insights, some of which still remain the focus of debate, such as whether the kidney plays the primary role in the genesis of hypertension (Montani et al. in Exp Physiol 24:41–54, 2009a; Exp Physiol 94:382–388, 2009b; Osborn et al. in Exp Physiol 94:389–396, 2009a; Exp (...) Physiol 94:388–389, 2009b). Key to the success of this model was the fact that the authors made the computer code (in FORTRAN) freely available and eventually provided a convivial user interface for exploration of model behavior on early microcomputers (Montani et al. in Int J Bio-med Comput 24:41–54, 1989). Ikeda et al. (Ann Biomed Eng 7:135–166, 1979) developed an offshoot of the Guyton model targeting especially the regulation of body fluids and acid–base balance; their model provides extended renal and respiratory functions and would be a good basis for further extensions. In the interest of providing a simple, useable version of Ikeda et al.’s model and to facilitate further such extensions, we present a practical implementation of the model of Ikeda et al. (Ann Biomed Eng 7:135–166, 1979), using the ODE solver Berkeley Madonna. (shrink)

This collection explores the core concepts of Ignacio Ellacuría's liberating philosophy; his critique of ideologies and continuity with critical theory; his philosophical anthropology and humanism; and the implications that praxis has for philosophical thought.

The prefrontal cortex is widely believed to play an important role in facilitating people's ability to switch performance between different tasks. We present a biologically‐based computational model of prefrontal cortex (PFC) that explains its role in task switching in terms of the greater flexibility conferred by activation‐based working memory representations in PFC, as compared with more slowly adapting weight‐based memory mechanisms. Specifically we show that PFC representations can be rapidly updated when a task switches via a dynamic gating mechanism based (...) on a temporal‐differences reward‐prediction learning mechanism. Unlike prior models of this type, the present model develops all of its internal representations via learning mechanisms as shaped by the demands of continuous periodic task switching. This advance opens up a new domain of research into the interactions between working memory task demands and the representations that develop to meet them. Results on a version of the Wisconsin card sorting task are presented for the full model and a number of comparison networks that test the importance of various model features. Furthermore, we show that a lesioned model produces perseverative errors like those seen in frontal patients. (shrink)

This article examines the impact of female leadership on corporate social responsibility (CSR) practices in publicly traded corporations. Our analysis finds that female leadership matters. For example, female leadership at the board level increases the likelihood of having a female CEO and the overall percentage of women executives in firms. The study measures CSR practices using the Thomson Reuters corporate responsibility ratings (TRCRR) from the Thomson Reuters ASSET4 database for 1242 firms over a 7-year period, from 2009 to 2015. Panel (...) regression estimates indicate that board gender diversity (BGD) has a positive impact on CSR, while two other measures of female leadership (presence of female CEO and percentage of female executives) were largely insignificant. We perform our analysis in the context of upper echelons theory and expand on recent studies of the impact of female leadership on CSR practices by using a different and a larger data set than previous research studies. (shrink)

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)

Individuals may differ in the general-attention executive component or in the subordinate domain-specific “slave” components of working memory. Tasks requiring sustained memory representations across attention shifts are reliable, valid indices of executive abilities. Measures emphasizing specific processing skills may increase reliability within restricted samples but will not reflect the attention component responsible for the broad predictive validity of span tasks.

The generation of isometric force at the hand can be mediated by activating a few motor modules. Stroke induces alterations in motor modules underlying steady-state isometric force generation in the human upper extremity. However, how the altered motor modules impact task performance remains unclear as stroke survivors develop and converge to the three-dimensional target force. Thus, we tested whether stroke-specific motor modules would be activated from the onset of force generation and also examined how alterations in motor modules would induce (...) changes in force representation. During 3D isometric force development, electromyographic signals were recorded from eight major elbow and shoulder muscles in the paretic arm of 10 chronic hemispheric stroke survivors and both arms of six age-matched control participants. A non-negative matrix factorization algorithm identified motor modules in four different time windows: three “exploratory” force ramping phases and the stable force match phase. Motor module similarity and between-force coupling were examined by calculating the scalar product and Pearson correlation across the phases. To investigate the association between the end-point force representation and the activation of the motor modules, principal component analysis and multivariate multiple linear regression analyses were applied. In addition, the force components regressed on the activation profiles of motor modules were utilized to model the feasible force direction. Both stroke and control groups developed exploratory isometric forces with a non-linear relationship between EMG and force. During the force matching, only the stroke group showed abnormal between-force coupling in medial-lateral and backward-forward and medial-lateral and downward-upward directions. In each group, the same motor modules, including the abnormal deltoid module in stroke survivors, were expressed from the beginning of force development instead of emerging during the force exploration. The PCA and the multivariate multiple linear regression analyses showed that alterations in motor modules were associated with abnormal between-force coupling and limited feasible force direction after stroke. Overall, these results suggest that alterations in intermuscular coordination contribute to the abnormal end-point force control under isometric conditions in the UE after stroke. (shrink)

Acute exercise consistently benefits both emotion and cognition, particularly cognitive control. We evaluated acute endurance exercise influences on emotion, domain-general cognitive control, and the cognitive control of emotion, specifically cognitive reappraisal. Thirty-six endurance runners, defined as running at least 30 miles per week with one weekly run of at least 9 miles (21 female, age 18-30 years) participated. In a repeated measures design, participants walked at 57% age-adjusted maximum heart rate (HRmax) (range 51-63%) and ran at 70% HRmax (range 64-76%) (...) for 90 minutes on two separate days. Participants completed measures of emotional state and the Stroop test of domain-general cognitive control before, every 30 minutes during, and 30 minutes after exercise. Participants also completed a cognitive reappraisal task after exercise. Functional near-infrared spectroscopy tracked changes in oxygenated and deoxygenated hemoglobin levels in the prefrontal cortex (PFC). Endurance exercise elevated positive emotion and cognitive reappraisal success. Endurance exercise reduced Stroop response time and test-evoked PFC oxygenation during exercise. Results suggest that even at relatively moderate intensities, endurance athletes benefit emotionally from running both during and after exercise, and task-related prefrontal cortex oxygenation reductions do not appear to hinder prefrontal-dependent cognitive control. (shrink)

Through network diagrams and sustained narrative, sociologist Randall Collins traces the development of philosophical thought from ancient Greece to modern ...

This study examines the impact of a social desirability response bias as a personality characteristic (self-deception and impression management) and as an item characteristic (perceived desirability of the behavior) on self-reported ethical conduct. Findings from a sample of college students revealed that self-reported ethical conduct is associated with both personality and item characteristics, with perceived desirability of behavior having the greatest influence on self-reported conduct. Implications for research in business ethics are drawn, and suggestions are offered for reducing the effects (...) of a socially desirable response bias. (shrink)

The central question for this book is whether schools should attempt to cultivate patriotism, and if so why, how, and with what conception of patriotism in mind. The promotion of patriotism has figured prominently in the history of public schooling in the United States, always with the idea that patriotism is both an inherently admirable attribute and an essential motivational basis for good citizenship. It has been assumed, in short, that patriotism is a virtue in its own right and that (...) it is a foundational aspect of civic virtue more generally. Through an integrated historical and philosophical approach, this book demonstrates that there have been many and diverse attempts to cultivate patriotism in public schools in the United States and that they have been predicated on different conceptions of patriotism, citizenship, and learning. In order to assess these assumptions and evaluate the various practices of patriotic education, we address the nature of virtue and the motivational foundations of civic responsibility, and we frame a general approach to the ethics of education. We find that the history of attempts to cultivate patriotism in schools offers both cautionary and positive lessons. We argue that there is a virtuous form of patriotism and that an inclusive and enabling just school community may contribute to its development. Yet, we conclude that patriotism is not a virtue as such. We argue that civic virtue is what schools should aim to cultivate, and that civic education should be organized around three components of civic virtue, namely civic intelligence, civic friendship, and civic competence. We hold that virtuous patriotism is an appropriate responsiveness to a country’s value, and that such responsiveness is part and parcel of civic virtue that is also responsive to what has value beyond one’s own country. The book concludes with a defense of global civic education, arguing that it should promote global civic friendship and cooperation. The book situates its understanding of patriotism in the context of nationalist, populist, and authoritarian movements in the United States and Europe, and it mounts a spirited defense of democratic institutions that should be of interest to anyone concerned about the polarization of public life and future of democracy. (shrink)

The PRC has often criticized Western human rights policies based in part on the claim that liberal democracy and human rights are nothing more than the culturally contingent by-product of Enlightenment Europe incompatible with China's cultural and political traditions and out of step with contemporary circumstances in the PRC. Recently, Richard Rorty has offered a pragmatic alternative to liberal democracy and human rights founded on the universal claims and metaphysical assumptions of the Enlightenment. At the same time, Rorty remains unabashedly (...) ethnocentric, asserting the superiority of ironic liberalism and "our" culture of rights. Whether his liberalism and rights culture stripped of its foundational and universal baggage will prove any more congenial to the development of liberal democracy and individual rights in China than its Enlightenment parent is examined here. (shrink)

This chapter argues that the objection that Socrates makes against diviners, poets, and rhapsodies having knowledge is an example of what has come to be known as an opacity objection: that is, some aspect of what would be required for them to know is unrecognised by them. This chapter contends that the opacity is of a different kind than what contemporary epistemologists have considered, and claims that Socrates’ specific version should have a place in contemporary theory of knowledge.

Using cinema to explore the visual aspects of alterity, Randall Halle analyzes how we become cognizant of each other and how we perceive and judge another person in a visual field. Halle draws on insights from philosophy and recent developments in cognitive and neuroscience to argue that there is no pure "natural" sight. We always see in a particular way, from a particular vantage point, and through a specific apparatus, and Halle shows how human beings have used cinema to (...) experiment with the apparatus of seeing for over a century. Visual alterity goes beyond seeing difference to being conscious of how one sees difference. Investigating the process allows us to move from mere perception to apperception, or conscious perception. Innovative and insightful, Visual Alterity merges film theory with philosophy and cutting-edge science to propose new ways of perceiving and knowing. (shrink)

Saint Bonaventure's Journey of the Soul into God is one of the most important works in the Christian mystical tradition. In this volume, Randall Smith provides the first comprehensive commentary in English of Bonaventure's classic text. He situates the work within its historical, intellectual, and cultural contexts.

Josiah Royce (1855?-1916) has had a major influence on American intellectual life, both popular movements and cutting-edge thought, but his name often went unmentioned while his ideas marched forward. The leading American proponent of absolute idealism, Royce has come back into fashion in recent years. With several important new books appearing, the formation of a Josiah Royce Society, and the re-organization of the Royce papers at Harvard, the time is ripe for Time, Will, and Purpose. Randall Auxier delves into (...) the primary texts written by Royce. (shrink)

It is widely believed that such old-fashioned questions have been rendered absurd by the materialism of modern empirical science, but some seemingly 'magical' properties of quantum mechanics have brought them back into serious discussion in some circles. I will examine the possibility of making miracles using well-established principles of quantum mechanics--in particular, the possibility that quantum theory allows for the most desirable ' miracle ' of all: immortality.

The edited collection Rorty and Beyond assesses and moves beyond Rorty’s legacy, bringing together leading international philosophers. The collection covers diverse territory, from his views about what we may hope for to his personal character, and everything in between.