BackgroundEverybody has the right to decide whether to receive specific medical treatment or not and to provide their free, prior and informed consent to do so. As dementia progresses, people with Alzheimer’s dementia (PwAD) can lose their capacity to provide informed consent to complex medical treatment. When the capacity to consent is lost, the autonomy of the affected person can only be guaranteed when an interpretable and valid advance directive exists. Advance directives are not yet common in Germany, and their (...) validity is often questionable. Once the dementia diagnosis has been made, it is assumed to be too late to write an advance directive. One approach used to support the completion of advance directives is ‘Respecting Choices’®—an internationally recognised, evidence-based model of Advance Care Planning (ACP), which, until now, has not been evaluated for the target group of PwAD. This study’s aims include (a) to investigate the proportion of valid advance directives in a memory clinic population of persons with suspected AD, (b) to determine the predictors of valid advance directives, and (c) to examine whether the offer of ACP can increase the proportion of valid advance directives in PwAD.MethodWe intend to recruit at leastN = 250 participants from two memory clinics in 50 consecutive weeks. Of these, the first 25 weeks constitute the baseline phase (no offer of ACP), the following 25 weeks constitute the intervention phase (offer of ACP). The existence and validity of an advance directive will be assessed twice (before and after the memory clinic appointment). Moreover, potential predictors of valid advance directives are assessed.DiscussionThe results of this study will enhance the development of consent procedures for advance directives of PwAD based on the ACP/Respecting Choices (R) approach. Therefore, this project contributes towards increasing the autonomy and inclusion of PwAD and the widespread acceptance of valid advance directives in PwAD.Trial RegistrationDRKS, DRKS00026691, registered 15th of October 2021,https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00026691. (shrink)

BackgroundThe UN Convention on the Rights of Persons with Disabilities, and the reformed guardianship law in Germany, require that persons with a disability, including people with dementia in Alzheimer’s disease (PwAD), are supported in making self-determined decisions. This support is achieved through communication. While content-related communication is a deficit of PwAD, relational aspects of communication are a resource. Research in supported decision-making (SDM) has investigated the effectiveness of different content-related support strategies for PwAD but has only succeeded in improving understanding, (...) which, although one criterion of capacity to consent, is not sufficient to ensure overall capacity to consent. The aim of the ‘spatial intervention study’ of the DECIDE project is to examine an innovative resource-oriented SDM approach that focuses on relational aspects. We hypothesise that talking to PwAD in their familiar home setting (as opposed to a clinical setting) will reduce the complexity of the decision-making process and enhance overall capacity to consent. MethodsPeople with a suspected or confirmed diagnosis of dementia in Alzheimer’s disease will be recruited from two memory clinics (N = 80). We will use a randomised crossover design to investigate the intervention effect of the decision-making place on capacity to consent. Besides reasoning capacity, which is part of overall capacity to consent and will be the primary outcome, various secondary outcomes (e.g., other aspects of capacity to consent, subjective task complexity, decisional conflict) and suspected moderating or mediating variables (e.g., meaning of home, demographic characteristics) will be assessed.DiscussionThe results of the study will be used to develop a new SDM strategy that is based on relational resources for PwAD. If a change in location achieves the anticipated improvement in capacity to consent, future research should focus on implementing this SDM strategy in a cost-effective manner in clinical practice.Trial registration: DRKS00030799. (shrink)

Highlights: -/- • Breastfeeding and breastfeeding support can contribute to mitigating climate change. • Achieving global nutrition targets will save more emissions than fuel-switching. • Breastfeeding support programmes support a just transition. • This work can support the expansion of mitigation options in energy system models. -/- Abstract: -/- Renewable gas has been proposed as a solution to decarbonise industrial processes, specifically heat demand. As part of this effort, the breast-milk substitutes industry is proposing to use renewable gas as a (...) substitute for fossil natural gas. However, decarbonising the industrial processing of breast-milk substitutes can increase social license for these products, potentially undermining breastfeeding. World Health Organisation nutrition targets aim to increase exclusive breastfeeding to at least 50% globally by 2025 to improve maternal, infant, and young child health and nutrition. This target will have implications for the energy transition. A weakness of existing energy models is that demands for end-use products such as breast-milk substitutes are typically not considered explicitly. This paper develops an analytical framework for explicitly representing infant feeding methods in energy systems models. We compare the emissions saved in Ireland from decarbonising the industrial processing of breast-milk substitutes with renewable gas with the emissions saved by an increase in exclusive breastfeeding to 50% in both Ireland and a key export market, China. We demonstrate that the emissions saved from achieving the minimum global breastfeeding target are greater than when renewable gas is used to displace natural gas in the production of breast-milk substitutes in Ireland. We discuss the decarbonisation of breast-milk substitutes in relation to the principle of justice as non-maleficence, a principle based on the commitment to avoid harm, a novel application of a principle of justice. We conclude that breastfeeding support can be considered a demand-side measure for mitigating climate change by reducing the demand for energy services to produce breast-milk substitutes. A key recommendation is to position breastfeeding support as both a public health and a climate justice issue that is relevant for a just transition. The framework developed for this paper could be applied to support the inclusion of a wider range of mitigation options with social justice outcomes in energy system models. [Open access]. (shrink)

Biodiversity is a valuable resource that supports sustainability within agricultural systems, yet in contradiction to this agriculture is recognised as a contributor to biodiversity loss. Agricultural advisory services are institutions that support sustainable agricultural development, employing a variety of approaches including farmer discussion groups in doing so. This study evaluates the impact of a farmland biodiversity management (FBM) communication strategy piloted within Irish farmer discussion groups. A sensemaking lens was applied in this objective to gain an understanding of how this (...) strategy could create an actionable space for FBM promotion amongst farmers. The strategy was piloted with six Irish dairy farmer discussion groups, after which focus groups were conducted with members of these groups. Additionally, baseline and endline surveys were completed by the members to determine their knowledge, attitude and on-farm practices relating to FBM. Analysis of the focus group data identified that the communication strategy supported the affordance of sensemaking with respect to FBM. Analysis of the data from the baseline and endline surveys relating to knowledge, attitudes and practices found that engaging with the communication strategy promoted farmers to improve their attitude in relation to FBM. Results from this study provide important lessons for agricultural advisory services to support farmers in incorporating FBM into the overall management of their farms and, in turn, to promote the improvement of farmland biodiversity and contribute to a sustainable future. (shrink)

The ability of managers to identify and interpret challenges in the external environment is one of the micro-foundations of dynamic capabilities. The underlying literature on strategic issue interpretation suggests that interpreting environmental challenges as opportunities rather than threats is more likely to lead to proactive and innovative responses, but there are also potentially positive effects of threat interpretation, for instance high levels of commitment and risk-seeking behaviour. In this paper, I use the context of climate change to explore the link (...) between threat interpretation and innovation in more detail. I use exploratory cluster analysis and illustrative case studies to develop a set of propositions to explain when threat interpretation can in fact encourage innovation. I identify two ethical mechanisms that positively mediate the relationship between threat interpretation and innovation: enlarged concept of responsibility to society and moral legitimacy. The paper contributes to the literature by identifying the importance of ethics in linking managerial interpretation to innovation, particularly in the context of global environmental and social challenges. (shrink)

Tenenbaum and Griffiths (2001) have proposed that their Bayesian model of generalisation unifies Shepard’s (1987) and Tversky’s (1977) similarity-based explanations of two distinct patterns of generalisation behaviours by reconciling them under a single coherent task analysis. I argue that this proposal needs refinement: instead of unifying the heterogeneous notion of psychological similarity, the Bayesian approach unifies generalisation by rendering the distinct patterns of behaviours informationally relevant. I suggest that generalisation as a Bayesian inference should be seen as a complement to, (...) instead of a replacement of, similarity-based explanations. Furthermore, I show that the unificatory powers of the Bayesian model of generalisation can contribute to the selection of one of these models of psychological similarity. (shrink)

Several philosophers and psychologists have characterized belief in conspiracy theories as a product of irrational reasoning. Proponents of conspiracy theories apparently resist revising their beliefs given disconfirming evidence and tend to believe in more than one conspiracy, even when the relevant beliefs are mutually inconsistent. In this paper, we bring leading views on conspiracy theoretic beliefs closer together by exploring their rationality under a probabilistic framework. We question the claim that the irrationality of conspiracy theoretic beliefs stems from an inadequate (...) response to disconfirming evidence and internal incoherence. Drawing analogies to Lakatosian research programs, we argue that maintaining a core conspiracy belief can be Bayes-rational when it is embedded in a network of auxiliary beliefs, which can be revised to protect the more central belief from disconfirmation. We propose that the (ir)rationality associated with conspiracy belief lies not in a flawed updating method, but in their failure to converge toward well-confirmed, stable belief networks in the long run. This approach not only reconciles previously disjointed views, but also points toward more specific hypotheses explaining why some agents may be prone to adopting beliefs in conspiracy theories. (shrink)

Shepard’s (1987) universal law of generalisation (ULG) illustrates that an invariant gradient of generalisation across species and across stimuli conditions can be obtained by mapping the probability of a generalisation response onto the representations of similarity between individual stimuli. Tenenbaum and Griffiths (2001) Bayesian account of generalisation expands ULG towards generalisation from multiple examples. Though the Bayesian model starts from Shepard’s account it refrains from any commitment to the notion of psychological similarity to explain categorisation. This chapter presents the conceptual (...) spaces theory (Gärdenfors 2000, 2014) as a mediator between Shepard’s and Tenenbaum & Griffiths’ conflicting views on the role of psychological similarity for a successful model of categorisation. It suggests that the conceptual spaces theory can help to improve the Bayesian model while finding an explanatory role for psychological similarity. (shrink)

Several philosophers and psychologists have characterized belief in conspiracy theories as a product of irrational reasoning. Proponents of conspiracy theories apparently resist revising their beliefs given disconfirming evidence and tend to believe in more than one conspiracy, even when the relevant beliefs are mutually inconsistent. In this paper, we bring leading views on conspiracy theoretic beliefs closer together by exploring their rationality under a probabilistic framework. We question the claim that the irrationality of conspiracy theoretic beliefs stems from an inadequate (...) response to disconfirming evidence and internal incoherence. Drawing analogies to Lakatosian research programs, we argue that maintaining a core conspiracy belief can be Bayes-rational when it is embedded in a network of auxiliary beliefs, which can be revised to protect the more central belief from disconfirmation. We propose that the irrationality associated with conspiracy belief lies not in a flawed updating method, but in a failure to converge toward wellconfirmed, stable belief networks in the long run. This approach not only reconciles previously disjointed views, but also points toward more specific descriptions of why agents may be prone to adopting beliefs in conspiracy theories. (shrink)

Tenenbaum and Griffiths (Behavioral and Brain Sciences 24(4):629–640, 2001) have proposed that their Bayesian model of generalisation unifies Shepard’s (Science 237(4820): 1317–1323, 1987) and Tversky’s (Psychological Review 84(4): 327–352, 1977) similarity-based explanations of two distinct patterns of generalisation behaviours by reconciling them under a single coherent task analysis. I argue that this proposal needs refinement: instead of unifying the heterogeneous notion of psychological similarity, the Bayesian approach unifies generalisation by rendering the distinct patterns of behaviours informationally relevant. I suggest that (...) generalisation as a Bayesian inference should be seen as a complement to, instead of a replacement of, similarity-based explanations. Furthermore, I show that the unificatory powers of the Bayesian model of generalisation can contribute to the selection of one of these models of psychological similarity. (shrink)

Children acquire complex concepts like DOG earlier than simple concepts like BROWN, even though our best neuroscientific theories suggest that learning the former is harder than learning the latter and, thus, should take more time (Werning 2010). This is the Complex- First Paradox. We present a novel solution to the Complex-First Paradox. Our solution builds on a generalization of Xu and Tenenbaum’s (2007) Bayesian model of word learning. By focusing on a rational theory of concept learning, we show that it (...) is easier to infer the meaning of complex concepts than that of simple concepts. (shrink)

Monitoring the environment for visual events while performing a concurrent task requires adjustment of visual processing priorities. By use of Bundesen's (1990) Theory of Visual Attention (TVA), we investigated how monitoring for an object-based brief event affected distinct components of visual attention in a concurrent task. The perceptual salience of the event was varied. Monitoring reduced the processing speed in the concurrent task, and the reduction was stronger when the event was less salient. The monitoring task neither affected the temporal (...) threshold of conscious perception nor the storage capacity of visual short-term memory nor the efficiency of top-down controlled attentional selection. (shrink)

The notions of psychological similarity and probabilistic learning are key posits in cognitive, computational, and developmental psychology and in machine learning. However, their explanatory relationship is rarely made explicit within and across these research fields. This opinionated review critically evaluates how these notions can mutually inform each other within computational cognitive science. Using probabilistic models of concept learning as a case study, I argue that two notions of psychological similarity offer important normative constraints to guide modelers’ interpretations of representational primitives. (...) In particular, the two notions furnish probabilistic models of cognition with meaningful interpretations of what the associated subjective probabilities in the model represent and how they attach to experiences from which the agent learns. Similarity representations thereby provide probabilistic models with cognitive, as opposed to purely mathematical, content. (shrink)

Philosophical orthodoxy holds that pains are mental states, taking this to reflect the ordinary conception of pain. Despite this, evidence is mounting that English speakers do not tend to conceptualize pains in this way; rather, they tend to treat pains as being bodily states. We hypothesize that this is driven by two primary factors—the phenomenology of feeling pains and the surface grammar of pain reports. There is reason to expect that neither of these factors is culturally specific, however, and thus (...) reason to expect that the empirical findings for English speakers will generalize to other cultures and other languages. In this article we begin to test this hypothesis, reporting the results of two cross-cultural studies comparing judgments about the location of referred pains between two groups—Americans and South Koreans—that we might otherwise expect to differ in how they understand pains. In line with our predictions, we find that both groups tend to conceive of pains as bodily states. (shrink)

Proponents of the predictive processing (PP) framework often claim that one of the framework’s significant virtues is its unificatory power. What is supposedly unified are predictive processes in the mind, and these are explained in virtue of a common prediction error-minimisation (PEM) schema. In this paper, I argue against the claim that PP currently converges towards a unified explanation of cognitive processes. Although the notion of PEM systematically relates a set of posits such as ‘efficiency’ and ‘hierarchical coding’ into a (...) unified conceptual schema, neither the frameworks’ algorithmic specifications nor its hypotheses about their implementations in the brain are clearly unified. I propose a novel way to understand the fruitfulness of the research program in light of a set of research heuristics that are partly shared with those common to Bayesian reverse engineering. An interesting consequence of this proposal is that pluralism is at least as important as unification to promote the positive development of the predictive mind. (shrink)

The feature-matching approach pioneered by Amos Tversky remains a groundwork for psychological models of similarity and categorization but is rarely explicitly justified considering recent advances in thinking about cognition. While psychologists often view similarity as an unproblematic foundational concept that explains generalization and conceptual thought, long-standing philosophical problems challenging this assumption suggest that similarity derives from processes of higher-level cognition, including inference and conceptual thought. This paper addresses three specific challenges to Tversky’s approach: (i) the feature-selection problem, (ii) the problem (...) of cognitive implausibility, and (iii) the problem of unprincipled tweaking. It subsequently supports key insights from Tversky’s account based on recent developments in Bayesian modeling of cognition. A novel computational view of similarity as inference is proposed that addresses each challenge by considering the contrast class as constitutive of similarity and selecting for highly informative features. In so doing, this view illustrates the ongoing promise of the feature-matching approach in explaining perception, generalization and conceptual thought by grounding them in principles of probabilistic inference. (shrink)

Despite a recent wave in global recognition of the rights of transgender and gender-diverse populations, referred to in this text by the umbrella label of trans*, international law continues to presume a cisgender binary definition of gender — dismissing the lived realities of trans* individuals throughout the world. This gap in international legal recognition and protection has fundamental implications for health, where trans* persons have been and continue to be subjected to widespread discrimination in health care, longstanding neglect of health (...) needs, and significant violations of bodily autonomy. (shrink)

Constitutionalism offers a governance order a set of normative values including, amongst others, the rule of law, divisions of power and democratic legitimacy. These normative values regulate the relationship between constituent and constituted power holders. Such normative constitutional legal orders are commonplace in domestic systems but the global constitutionalisation debate seeks to identify a constitutional narrative beyond the state. This book considers the manner in which the global constitutionalisation debate has neglected constitutionalism within its proposals. It examines the role normative (...) constitutionalism plays within a constitutionalisation process, and considers the use of community at both the domestic and global governance levels to identify the holders of constituent and constituted power within a constitutional order. In doing so this analysis offers an alternative narrative for global constitutionalisation based within normative constitutionalism. (shrink)

Since classical antiquity debates about tyranny, tyrannicide and preventing tyranny's re-emergence have permeated governance discourse. Yet within the literature on the global legal order, tyranny is missing. This book creates a taxonomy of tyranny and poses the question: could the global legal order be tyrannical? This taxonomy examines the benefits attached to tyrannical governance for the tyrant, considers how illegitimacy and fear establish tyranny, asks how rule by law, silence and beneficence aid in governing a tyranny. It outlines the modalities (...) of tyranny: scale, imperialism, gender, and bureaucracy. Where it is determined that a tyranny exists, the book examines the extent of the right and duty to effect tyrannicide. As the global legal order gathers ever more power to itself, it becomes imperative to ask whether tyranny lurks at the global scale. (shrink)

Abstract:Nicholas Winding Refn regularly appears to offer men as his audience's main point of identification. Yet these men are predominantly transgressive characters who frequently, if not constantly, frustrate spectator-identification and consequently linger on the periphery of cinematic paradigms. In three stages, this article analyses how Refn's violent male characters affect spectatorship. First, it considers the unstable subject mechanisms for spectator-identification afforded by classical Hollywood cinema. Second, it examines Julia Kristeva's psychoanalytical theorization of the abject and outlines the relevance of her (...) concepts to Refn's narratives. Third, it conducts a close textual analysis of Bronson (2008) and Drive (2011), arguing that the disregard for symbolic order demonstrated by Refn's male protagonists and their concomitant embrace of the death drive inhibit spectator-identification. This analysis ultimately aims to demonstrate the import of Kristeva's theories to a more comprehensive understanding of the abject's complex relationship to Refn's œuvre and to spectator-identification in cinema. (shrink)

Substantive renderings of tyranny, hegemony or anarchy as governance forms within international law seldom appear. When invoked, tyranny and anarchy are presented as exceptional while hegemony, in accounts often borrowed from international relations scholarship, is defined as mundane and a natural explanation of international legal governance. This article puts forward substantive accounts of all three—tyranny, anarchy and hegemony—and utilises these to understand a single event, the airstrikes against Syria after the use of chemical weapons by the Assad Government in 2018. (...) This event is first described in detail. The article examines the current use of the three theories in international legal theory and considers their substantive content. Next, these three theories are applied both singularly and in combination to the events in Syria to demonstrate what can be observed about international law through their deployment. This article shows the value of understanding the operation of international law through each of these prisms in their substantive form but also, and most markedly, what can be understood when all three frames are combined to explore a single event. (shrink)

The freedom to choose for oneself is a part of what it means to be a human being.Jackson J In England and Wales, the Mental Capacity Act 20...

BackgroundUse of modified texture diets—thickening of liquids and modifying the texture of foods—in the hope of preventing aspiration, pneumonia and choking, has become central to the current management of dysphagia. The effectiveness of this intervention has been questioned. We examine requirements for a valid informed consent process for this approach and whether the need for informed consent for this treatment is always understood or applied by practitioners.Main textValid informed consent requires provision of accurate and balanced information, and that agreement is (...) given freely by someone who knows they have a choice. Current evidence, including surveys of practitioners and patients in different settings, suggests that practice in this area is often inadequate. This may be due to patients’ communication difficulties but also poor communication—and no real attempt to obtain consent—by practitioners before people are ‘put on’ modified texture diets. Even where discussion occurs, recommendations may be influenced by professional misconceptions about the efficacy of this treatment, which in turn may poison the well for the informed consent process. Patients cannot make appropriate decisions for themselves if the information provided is flawed and unbalanced. The voluntariness of patients’ decisions is also questionable if they are told ‘you must’, when ‘you might consider’ is more appropriate. Where the decision-making capacity of patients is in question, inappropriate judgements and recommendations may be made by substitute decision makers and courts unless based on accurate information.ConclusionResearch is required to examine the informed consent processes in different settings, but there is ample reason to suggest that current practice in this area is suboptimal. Staff need to reflect on their current practice regarding use of modified texture diets with an awareness of the current evidence and through the ‘lens’ of informed consent. Education is required for staff to clarify the importance of, and requirements for, valid informed consent and for decision making that reflects people’s preferences and values. (shrink)

Research using explicit measures has linked decreased positive future thinking, but not increased negative future thinking, with clinical depression. However, individuals may be unable or unwilling to express thoughts about the future, and can be unaware of implicit beliefs that can influence their behavior. Implicit measures of cognition may shed light on the role of future thinking in depression. To our knowledge, the current study presents the first implicit measure of positive and negative future thinking. A sample of 71 volunteers (...) completed both implicit and explicit measures of positive and negative future thinking. The findings indicate differences in the evaluation of both positive and negative future events between the two groups. However, group differences were more pronounced on the implicit measure. These findings point to the potential utility of an implicit measure of future thinking in mental health research and clinical practice. (shrink)

This paper explores comedy as a queer pedagogical form that subverts problematic representational tropes of queerness pervading mainstream depictions of queer experience. Articulating ‘form’ less as a fixed arrangement of characters, images, objects, and ideas, and more as a kind of formation that positions these in dynamic relation to the wider context in which comedies are encountered, we mobilise the idea of queer pedagogical forms to capture how comedy can foster new modes of thinking about and embodying queerness for, and (...) with, audiences. Drawing on specific examples from Schitt’s Creek and Derry Girls, we document the potential of specific comedic modalities (e.g. irony, sarcasm, irreverence, and slapstick) to foster alternative representations of queerness, in which normative tropes are poked fun at, problematised, and reimagined. Through these examples, we demonstrate how comedies can enable us to ‘laugh ourselves out of the closets’ we live by, feel, navigate, and embody. (shrink)

Healthcare professionals who feel psychologically safe believe it is safe to take interpersonal risks such as voicing concerns, asking questions and giving feedback. Psychological safety is a complex phenomenon which is influenced by organizational, team and individual level factors. However, it has primarily been assessed as a team-level phenomenon. This study focused on understanding healthcare professionals' individual experiences of psychological safety. We aim to gain a fuller understanding of the influence team leaders, interpersonal relationships and individual characteristics have on individuals' (...) psychological safety and their decisions to engage in voice or silence behavior. Thirty-four interviews were conducted with healthcare professionals from across five teams working within an acute, suburban hospital. Hybrid inductive-deductive thematic analysis focused on identifying themes which captured the complexities of individuals' varied experiences of psychological safety. The themes identified were: “Personal Characteristics,” “Past Experiences,” “Individual Perceptions of Being Valued,” and “Judged Appropriateness of Issues/Concerns.” These themes are explored within the context of motivating and inhibiting factors associated with the influence of leadership, interpersonal relationships and individual characteristics on experiences of psychological safety and voice behavior. These results extend existing theoretical frameworks guiding our understanding of psychological safety by accounting for the variation in individuals' experiences and studying these significant influences on voice behavior. Important considerations for the development of interventions to enhance psychological safety are discussed. (shrink)

Last year, as some of you may recall, I took it upon my chairly shoulders to solve the problem of causation, where this problem can be stated this way: What is causation? According to the analysis I offered, C is a cause of E if and only if C makes E happen. I am happy to report that, in the year since delivering this account of causation, no objections have arisen. The critics have been silenced. Indeed, my colleague Dan Hausman, (...) the Herbert Simon Professor of Philosophy, reports that he is no longer satisfied with the view he expressed in his recent book on causation, and I have no doubt that his change of mind is due in no small part to my seminal contribution to this subject. If you would permit me a joke, I think I “made happen” a change in Dan’s mind. I should also mention that we are now fortunate to have amongst us Carolina Sartorio, whose own analysis of causation, arrived at independently, seems but a stylistic variant of my own. Where I see causes as things that make things happen, she sees them as things that make a difference. I think, but can’t be certain, that our analyses come to the same thing. Perhaps if she hadn’t muddied the waters with all those numbered propositions and ‘ifs’ and ‘thens’ we could settle the matter. (shrink)

Ac cord ing to the cen tral hy poth e sis of this pa per, late cap i tal ism is ac com pa nied by a pro - found re def i ni tion of the con di tion of the cit i zen. Ac cord ing to Mar shall, cit i zen ship was linked to dis trib u tive equal ity, and the ex is tence of a com - mon cul ture. It..