Background Ethical challenges constitute an inseparable part of daily decision-making processes in all areas of healthcare. Ethical challenges are associated with moral distress that can lead to burnout. Clinical ethics support has proven useful to address and manage such challenges. This paper explores how prehospital emergency personnel manage ethical challenges. The study is part of a larger action research project to develop and test an approach to clinical ethics support that is sensitive to the context of emergency medicine. Methods We (...) explored ethical challenges and management strategies in three focus groups, with 15 participants in total, each attended by emergency medical technicians, paramedics, and prehospital anaesthesiologists. Focus groups were audio-recorded and transcribed verbatim. The approach to data analysis was systematic text condensation approach. Results We stratified the management of ethical challenges into actions before, during, and after incidents. Before incidents, participants stressed the importance of mutual understandings, shared worldviews, and a supportive approach to managing emotions. During an incident, the participants employed moral perception, moral judgments, and moral actions. After an incident, the participants described sharing ethical challenges only to a limited extent as sharing was emotionally challenging, and not actively supported by workplace culture, or organisational procedures. The participants primarily managed ethical challenges informally, often using humour to cope. Conclusion Our analysis supports and clarifies that confidence, trust, and safety in relation to colleagues, management, and the wider organisation are essential for prehospital emergency personnel to share ethical challenges and preventing moral distress turning into burnout. (shrink)

While corpus studies have shown that discourse connectives that convey the same coherence relation can display subtle differences, research on online discourse processing has only focused on a rather limited set of connectives. Yet, different connectives – for example, rare or polyfunctional ones – might elicit different reading patterns. In order to explore this assumption, we test the robustness of discourse processing for French native speakers by measuring the way they process causal and concessive sentences that are conveyed by either (...) an appropriate or inappropriate connective. Throughout three experiments, we change important characteristics of the connectives: we first test frequently used connectives, secondly less frequent ones, and finally less frequent connectives that are polyfunctional and for which different functions clearly compete. Our results show that the processing for incoherent items was affected for all connectives, however readers showed altered reading fluency when infrequent connectives were used. We conclude that discourse processing is quite robust and that readers are able to insert meaning conveyed by rare connectives while still showing the highest reading ease with frequent connectives. (shrink)

An ethics reflection group is one of a range of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the implementation process of interdisciplinary ERGs in psychiatric and general hospital departments in Denmark. To our knowledge, this is the first study of ERG implementation to include both psychiatric and general hospital departments. The implementation and evaluation strategies are inspired by action research, using a qualitative approach and systematic text condensation of (...) 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. The implementation process was influenced by both structural factors and factors related to clinicians having different values, interests and experiences. Structural barriers and promotors in the process to implement ERG included the following sub-categories: Organizational factors, recruitment and training of ethics facilitators, the deliberation model, planning and recruitment of participants to the ERGs, the support of the ward managers and the project group. Barriers and promotors found among clinicians included the following sub-categories: Expectations and pre-understandings of ERGs, understandings of a physician’s job, challenges experienced by ethics facilitators. At the end of the study, when it was decided that the ERGs should be continued, the implementation strategies were remodeled by the participants to meet new challenges. The study of ERG implementation identified important structural and professional barriers and promotors that are likely to be relevant to anyone wanting to implement ethics support services across various types of healthcare services. (shrink)

How does the human brain link relational concepts to perceptual experience? For example, a speaker may say “the cup to the left of the computer” to direct the listener's attention to one of two cups on a desk. We provide a neural dynamic account for both perceptual grounding, in which relational concepts enable the attentional selection of objects in the visual array, and for the generation of descriptions of the visual array using relational concepts. In the model, activation in neural (...) populations evolves dynamically under the influence of both inputs and strong interaction as formalized in dynamic field theory. Relational concepts are modeled as patterns of connectivity to perceptual representations. These generalize across the visual array through active coordinate transforms that center the representation of target objects in potential reference objects. How the model perceptually grounds or generates relational descriptions is probed in 104 simulations that systematically vary the spatial and movement relations employed, the number of feature dimensions used, and the number of matching and nonmatching objects. We explain how sequences of decisions emerge from the time‐ and state‐continuous neural dynamics, how relational hypotheses are generated and either accepted or rejected, followed by the selection of new objects or the generation of new relational hypotheses. Its neural realism distinguishes the model from information processing accounts, its capacity to autonomously generate sequences of processing steps distinguishes it from deep neural network accounts. The model points toward a neural dynamic theory of higher cognition. (shrink)

This exciting collection offers a range of perspectives from some of the most prominent feminist voices of our time, including Rosi Braidotti, Judith Butler, Claire Colebrook, Elizabeth Grosz, and Jack Halberstam. Employing experimental modes of thinking and writing, the contributors remain faithful to the feminist tradition of subversion and resistance, while refusing to submit to its political tradition of a loving sisterhood or dutiful daughterhood. Through productive disagreement and cognitive dissonance, the essays presented here reflect the specific circumstances of our (...) present, and attempt to dream and envision possible alternatives for the future. The volume thus invites us to think of the becoming of feminism itself, and the possibilities of future feminisms-to-come. (shrink)

Abordagem do protagonismo social, analisando sua relação com a informação, concluindo pela compreensão deste como objetivo do trabalho informacional, situando a mediação da informação como sua ação central. Parte da apresentação das origens conceituais em torno do protagonismo, buscando, à medida que debate as referências acerca do tema, demonstrar a relação do desenvolvimento do protagonismo social com o trabalho informacional, assim como sua posição de meta da atividade da mediação da informação, executada nas suas cinco dimensões e na condição de (...) elemento central desse trabalho. As assertivas apresentadas são resultado do estudo crítico da bibliografia da área da Ciência da Informação que aborda o protagonismo e a mediação da informação, assim como de estudos de filósofos e pensadores que abordam os aspectos sociais e políticos da comunicação e da formação de sujeitos socialmente ativos, permitindo a identificação das relações entre protagonismo e mediação da informação, como também que a mediação consciente favorece o primeiro, concluindo que o apoio ao seu desenvolvimento representa a principal responsabilidade social do trabalho com a informação. (shrink)

The issue of statelessness poses problems for the statist approach to the philosophy of immigration. Despite the fact that the statist approach claims to constrain the state’s right to exclude with human rights considerations, the arguments statists offer for the right of states to determine their own immigration policies would also justify citizenship rules that would render some children stateless. Insofar as rendering a child stateless is best characterized as a violation of human rights and insofar as some states have (...) direct responsibility for causing such harm, the problem of non-refugee stateless children points to greater constraints than most statists accept on states’ right to determine their own rules for membership. While statists can ultimately account for the right not to be rendered stateless, recognizing these additional human rights constraints ultimately weakens the core of the statist position. (shrink)

Describing actions entails that relations between objects are discovered. A pervasively neural account of this process requires that fundamental problems are solved: the neural pointer problem, the binding problem, and the problem of generating discrete processing steps from time-continuous neural processes. We present a prototypical solution to these problems in a neural dynamic model that comprises dynamic neural fields holding representations close to sensorimotor surfaces as well as dynamic neural nodes holding discrete, language-like representations. Making the connection between these two (...) types of representations enables the model to describe actions as well as to perceptually ground movement phrases—all based on real visual input. We demonstrate how the dynamic neural processes autonomously generate the processing steps required to describe or ground object-oriented actions. By solving the fundamental problems of neural pointing, binding, and emergent discrete processing, the model may be a first but critical step toward a systematic neural processing account of higher cognition. (shrink)

This essay discusses how, for Hegel, freedom can be realized in nature in a rudimentary fashion in solar systems. This solves a problem in Kant’s account of freedom, namely, the problem that Kant only gives a negative argument for why freedom is not impossible but does not give a positive account of how freedom is real. I give a novel account of Kant’s negative argument. Then, I show how, according to Hegel, solar systems can be considered as exhibiting freedom in (...) a rudimentary fashion. Finally, I lay out how Hegel systematically develops this point about the freedom of solar systems in the ‘Mechanism’-chapter of the Science of Logic. In doing so, he uses Kant’s negative argument in a ‘purified’ form to arrive at an account of an ‘intimate token-type relation’ between the planets in a solar system and the law that governs their motion. The essay as a whole provides a concrete example of how Hegel is an inheritor and radicalizer of Kant, both with respect to freedom’s reality and with respect to philosophical method. (shrink)

Fred. L. Polak explored the mechanisms of social change in terms of “future—visions” held by a community. The future, says Polak, participates actively in the present, providing part of the context within which today's decisions are made. Barbara McClintock acquired her insights in maize genetics by developing “a feeling for the organism.” New insights, she maintains, emerge through a mutual relationship between researcher and subject. Though scholars in different fields, both acknowledge the power of images in the creative process. There (...) is a difference in the extent to which each scientist perceives this power to be available to create new ideas. (shrink)

Hartmut Rosa advances an account of the temporal structure of society from the perspective of critical theory. He identifies three categories of change in the tempo of modern social life: technological acceleration, evident in transportation, communication, and production; the acceleration of social change, reflected in cultural knowledge, social institutions, and personal relationships; and acceleration in the pace of life, which happens despite the expectation that technological change should increase an individual's free time. According to Rosa, both the structural and cultural (...) aspects of our institutions and practices are marked by the "shrinking of the present," a decreasing time period during which expectations based on past experience reliably match the future. When this phenomenon combines with technological acceleration and the increasing pace of life, time seems to flow ever faster, making our relationships to each other and the world fluid and problematic. It is as if we are standing on "slipping slopes," a steep social terrain that is itself in motion and in turn demands faster lives and technology. As Rosa deftly shows, this self-reinforcing feedback loop fundamentally determines the character of modern life. (shrink)

To reduce global greenhouse gas emissions in order to limit global warming to 1.5°C, individuals and households play a key role. Behavior change interventions to promote pro-environmental behavior in individuals are needed to reduce emissions globally. This systematic literature review aims to assess the a) evidence-based effectiveness of such interventions and b) the content of very successful interventions without limiting the results to specific emitting sectors or countries. Based on the “PICOS” mnemonic and PRISMA statement, a search strategy was developed, (...) and eligibility criteria were defined. Three databases were searched to retrieve and review potential literature. As a result, 54 publications from 2010 to 2021 were included in the analysis. The results show that most interventions only have small positive effects or none at all. A total of 15 very successful interventions focused on the sectors of mobility, energy, and waste and incorporated improved structures, education, feedback, enablement or made the sustainable option the default. Six evidence-based recommendations for content, timing, and setting are deducted and given for interventions on enhancing pro-environmental behavior. In summary, although the various interventions and intervention types to promote PEB differ in their effectiveness, very successful interventions have common elements. Future research should focus on high-/low-impact and high-/low-cost behavior to develop interventions that aim at high-impact but low-cost behavior changes, or avoid low-impact but high-cost behavior. (shrink)

Uncertainty is the name of the game in philosopher Kenneth W Goodman’s attempt to apply ethics to evidence based medicine . Indeed, the book is as much about epistemology, or the study of how we learn and know about the world, as it is about ethics. Goodman’s desire is to understand what constitutes proof, or evidence, that a particular treatment is better than others. One of the ethical connections is that a failure to use such treatments is blameworthy.EBM is a (...) concept that is getting a great deal of attention these days. At least two factors drive this …. (shrink)

Taking a phrase from President Clinton’s successful presidential campaign in 1992, this book could have just as easily been called It’s About Trust, Stupid. In his book, David A Shore, PhD, associate dean and founding director of the Trust Initiative at the Harvard School of Public Health, presents a convincing argument for the importance of trust in healthcare delivery.Shore is equally convincing in arguing that people have a lack of trust in the healthcare system in the United States. To make (...) this point, he cites studies showing that while many continue to trust doctors and nurses, the trust in healthcare delivery itself …. (shrink)

The author traces the ways in which various patients and collective associations of patients come to regard themselves as the users of future stem cell technologies. The author uses Althusser’s notion of interpellation, whereby an identity is the result of the situated encounter of a subject and an authority, to analyze the ways in which patient associations’ current involvement with basic research is related to the enactment of science as a series of technology development projects. The author argues that this (...) ‘‘project-ness’’ forms a certain privileged logic that interpellates patients and their associations in specific ways. Through the listings of illnesses circulated in the mass media, which are hoped to be treatable or curable with stem cell therapies, patients come to recognize themselves as the projected users of stem cell technologies. The author fleshes out the process of this userfication and the various responses made by patients and their associations when hailed by the entrepreneurial projects of stem cell research. (shrink)

Ever decreasing numbers of applicants arrive in language departments at UK universities. In the face of this decline, and against the backdrop of higher education languages departments being reduced across the UK, it is important to investigate the supply chain of languages undergraduates in the pre-entry sector. This article reports on a collaborative action research project between Language Networks for Excellence, University of Wolverhampton, and King Edward VI College, Stourbridge. The objective was to investigate how the HE sector can effectively (...) influence and support linguists and post-16 establishments in enhancing progression to studying languages at university and how the post-16 sector can ensure they meet language students’ needs in progression to HE. The research presents a number of conclusions and recommendations, not least that, whilst support from HE for 17—18-year-old school students and their institutions is welcome and contributes to students’ confidence and skills, there may be merit in targeting students much further down the supply chain, encouraging progression to HE through tailored linguistic and motivational support strategies. (shrink)

The topic of this dissertation is the concept of nature and how Kant and Hegel each conceive of it. Both agree that ‘nature’ cannot be an empirical concept but is rather presupposed in all experience and object-related thinking. Yet, Kant holds that we can only conceive of nature as a unified whole when we conceive of it as a mechanical system. Whereas, according to Hegel, the unity of all the different kinds of natural phenomena can only be accounted for by (...) means of his dialectical method. A crucial and novel point in my reading of Kant is that the concept of nature as a mechanical system is merely a regulative ideal, i.e., an imaginary end-point of science that we only approach asymptotically. It is this point that allows me to resolve long-standing puzzles in the scholarship regarding organisms and free will. For, this point allows for a coherent reading of Kant, a reading that involves that 1) we do in fact have experience of organisms and that 2) Kant’s distinctive kind of determinism is compatible with an open future. My reading of Kant furthermore provides a uniquely suited entry-point into Hegel’s dialectical account of nature, according to which not only human beings and organisms, but even solar systems do not fit the mould of a flat-footed mechanical determinism. This allows me to show that Hegel is—in several respects—both an inheritor and radicalizer of Kant. (shrink)

In the summer of 2017, wildflower seeds were spread on a large, empty open space close to a motorway flyover just outside Copenhagen, Denmark. This was an effort to use non-mechanical methods to prepare the soil for an ‘urban forest’ to be established on the site, since the flowers’ roots would penetrate the ground and enable the planned new trees to settle. As a result, the site was transformed into a gorgeous meadow, and all summer long Copenhageners were invited to (...) come and pick the flowers. In this article, I critically examine different aspects of this project – including the role of design, the perception of nature–culture relationships, climate change, and flower-picking as an event – in relation to my personal experience of visiting this meadow both on-site and on social media. The different temporalities that clash at the site give rise to conflicting interpretations, and I suggest that the meadow can be seen as a living plant archive of the Anthropocene, both physically and digitally. In doing so, I introduce and critique key conceptual pairs, including archive/death and bloom/decay, suggested by Lee Edelman’s queer cross-reading of Jacques Derrida’s ‘Archive Fever’ and Shakespeare’s Hamlet. I thereby contrast flower motifs pertaining to the cycles of blooming, decay, and nature’s (failed) eternal return in the meadow with the expansive futurity of the digitally mediated archive. (shrink)

Mental representations have continuous as well as discrete, combinatorial properties. For example, while predominantly discrete, phonological representations also vary continuously; this is reflected by gradient effects in instrumental studies of speech production. Can an integrated theoretical framework address both aspects of structure? The framework we introduce here, Gradient Symbol Processing, characterizes the emergence of grammatical macrostructure from the Parallel Distributed Processing microstructure (McClelland, Rumelhart, & The PDP Research Group, 1986) of language processing. The mental representations that emerge, Distributed Symbol Systems, (...) have both combinatorial and gradient structure. They are processed through Subsymbolic Optimization–Quantization, in which an optimization process favoring representations that satisfy well-formedness constraints operates in parallel with a distributed quantization process favoring discrete symbolic structures. We apply a particular instantiation of this framework, λ-Diffusion Theory, to phonological production. Simulations of the resulting model suggest that Gradient Symbol Processing offers a way to unify accounts of grammatical competence with both discrete and continuous patterns in language performance. (shrink)

Nous avons cherché à identifier un aspect du refoulement du cosmopolitismel'des Lumières, complémentaire de la fabrique des identités nationales enl'Europe au XIXe siècle et dans l'entre-deux-guerres. L'idée de civilisation communel'serait maintenue par la capacité réciproque de traduction des langues nationales, dul'fait de leurs origines communes indo-européennes. L'utopie de la langue remplaceraitl'le parcours matériel des Lumières. C'est l'échec de la construction du mythe indianistel'européen et non pas son succès qui explique le dévoiement idéologique des relationsl'entre langue et nation. La promotion manquée (...) de la langue tsigane dans le mondel'académique illustre bien cet échec. Après la Première Guerre mondiale, la transformationl'du principe des nationalités en ethnopolitique fit disparaître jusqu'au souvenirl'de cette ambition commune. (shrink)

ZusammenfassungBedingt durch den demographischen Wandel wird der Anteil an alten Patienten in Kliniken und Arztpraxen zunehmen. Damit müssen sich Ärzte verstärkt auf die spezifischen Anforderungen der Behandlung von alten Patienten einstellen. Diese sind wesentlich durch die Faktoren Alter, Multimorbidität und Demenz geprägt. Die Abhandlung analysiert die hiermit gegebenen sozial- und personalethischen Implikationen für Ausbildung und Arbeitsalltag der Ärzte sowie für das Gesundheitssystem.

Rorty was one of the great dissolvers of dualisms, but strangely this iconoclasm ended when it came to liberal democracy. Here he held fast to the most stubborn of dualisms in political thought, a simple dichotomy of the public and the private, and used it, unsuccessfully, to resolve questions concerning the place of religion in modern democratic politics. Yet the philosophical basis of Rorty's pragmatism both undercuts two common ways of spelling out the relationship between religion and the polity in (...) liberalism and makes his use of the public/private dichotomy impossible. By means of an internal critique, I argue for a Habermasian corrective. (shrink)

Normative questions concerning political authority and political obligation are widely seen as central questions of political philosophy. Current global transformations require an innovative response from normative political thinking about these two topics. In light of a concrete example of the supranational forms of authority and obligation that have been and are emerging beyond the national state and beyond the traditional domains of international law, I lay out what has become the standard approach to authority and obligation and indicate why this (...) approach is inadequate in contemporary circumstances. I sketch an alternative approach and suggest how the most promising exemplar of this kind, Habermas’ discourse theory of law and politics, can better deal with the example. Having thus made plausible the advantages of the discourse theory of the alternative approach, I end with an ‘internal’ critique of Habermas’ own recent writings on the global political order. (shrink)

(No abstract is available for this citation).