Addressing Consent Issues in Donation After Circulatory Determination of Death

Given the widening gap between the number of individuals on transplant waiting lists and the availability of donated organs, as well as the recent plateau in donations based on neurological criteria (i.e., brain death), there has been a growing interest in expanding donation after circulatory determination of death. While the prevalence of this form of organ donation continues to increase, many thorny ethical issues remain, often creating moral distress in both clinicians and families. In this article, we address one of these issues, namely, the challenges surrounding patient and surrogate informed consent for donation after circulatory determination of death. First we discuss several general concerns regarding consent related to this form of organ donation, and then we address additional issues that are unique to three different patient categories: adult patients with medical decision-making capacity or potential capacity, adult patients who lack capacity, and pediatric patients.     

On Wittgenstein's Kantian solution of the problem of philosophy

In 1931 Wittgenstein wrote: ‘the limit of language manifests itself in the impossibility of describing the fact that corresponds to (is the translation of) a sentence without simply repeating the sentence’. Here, Wittgenstein claims, ‘we are involved?…?with the Kantian solution of the problem of philosophy’. This paper shows how this remark fits with Wittgenstein's early account of the substance of the world, his account of logic, and ultimately his view of philosophy. By contrast to the currently influential resolute reading of the Tractatus, the paper argues that the early Wittgenstein did not aim at destroying the idea of a limit of language, but that the notion lies at the very heart of Wittgenstein's early view. In doing so, the paper employs and defends the Kantian interpretation of Wittgenstein's early philosophy.     

Psychological availability and work engagement: The moderating role of sex and race

This study sought to determine the relationship of sex and race as moderators of psychological availability on work engagement in various South African organisations. Participants were 1 059 employees predominantly from the corporate sector in Gauteng province (females = 61%, blacks = 36%). Cross-sectional survey data were collected from the employees using the Psychological Conditions Scale and the Utrecht Work Engagement Scale (UWES). Moderated hierarchical regression analyses tested the prediction of work engagement from psychological availability, while controlling for the sex and race of employees. Psychological availability increased the level of work engagement for both men and women, the relationship, however, was stronger for women as compared to men. White employees were less work engaged compared to other race group members. Psychological availability was higher for the black, Indian, and coloured employees compared to white employees. The results confirmed the positive relationship of psychological availability on work engagement, and that sex and race differences exist for employees in a developing country.     

如何克服边界条件：来自记忆强度影响记忆去稳定的分子机制的启示

长时记忆在激活后首先会变得不稳定(去稳定过程), 继而会经历一个再巩固过程重新稳定下来以维持记忆的关联性。在再巩固期间给予电击、药理或行为训练以干预记忆再巩固, 可以更改原有记忆的强度或内容。这有望成为临床上治疗病理性记忆的一种方法。然而, 一些边界条件(记忆痕迹强、时间久远等)导致记忆在简单激活后不能去稳定, 不会经历再巩固过程, 使干预再巩固的方法无法发挥作用。动物实验表明, 通过药理学地调控参与记忆去稳定的分子的活动以促进记忆去稳定, 可以成功克服边界条件。可见, 边界条件不是绝对的。未来研究可进一步探索更多、更优的促进记忆去稳定并克服边界条件的方法, 提升干预记忆再巩固疗法的临床应用潜能。     

Stable Causal Relationships Are Better Causal Relationships

We report three experiments investigating whether people's judgments about causal relationships are sensitive to the robustness or stability of such relationships across a range of background circumstances. In Experiment 1, we demonstrate that people are more willing to endorse causal and explanatory claims based on stable (as opposed to unstable) relationships, even when the overall causal strength of the relationship is held constant. In Experiment 2, we show that this effect is not driven by a causal generalization's actual scope of application. In Experiment 3, we offer evidence that stable causal relationships may be seen as better guides to action. Collectively, these experiments document a previously underappreciated factor that shapes people's causal reasoning: the stability of the causal relationship.     

Does Semantics Need Normativity? Comments on Allan Gibbard,Meaning and Normativity

In the book Gibbard proposes, first, that statements about meaning are normative statements and, second, that they can be given an expressivist treatment, along the lines of Gibbard’s preferred metaethics. In my paper, I examine the first step: The claim that meaning statements are to be construed as being normative, as involving ‘oughts’. Gibbard distinguishes two versions of the normativity of meaning thesis – a weak version, according to which every means implies an ought, and a strong version, according to which for every means, there is an ought that implies it. I argue that neither thesis withstands scrutiny. The weak thesis depends on assumptions about the notion of semantic correctness that the anti-normativist rejects, and the strong thesis does not solve the problems Gibbard wants it to solve: the problems of indeterminacy and meaning skepticism. I conclude that semantics does not need normativity.     

Illness representations in patients with multimorbid long-term conditions: Qualitative study

Most research on illness representations explores how patients view single conditions, but many patients report more than one long-term condition (known as multimorbidity). It is not known how multimorbidity impacts on patient illness representations. This exploratory qualitative study examined patients’ representations of multimorbid long-term conditions and sought to assess how models of illness representation might need modification in the presence of multimorbidity. We explored two major issues: (1) the impact of multimorbidity on patient representations of their individual conditions and (2) the representation of multimorbidity itself. Twenty eight adults with at least two long-term conditions (mean of 4) were interviewed. The presence of multimorbidity impacted on patient illness representations in relation to the dimensions of identity, perceived cause, coherence and consequences. Representations of multimorbidity itself concerned representations of the burden of medication and perceived priorities among conditions and synergies and antagonisms between conditions and their management. The results have implications for the measurement of multimorbidity (through scales such as the Illness Perception Questionnaire) and the use of illness representations in the design and delivery of interventions to improve health behaviour and outcomes of patients with multiple long-term conditions.     

Detail-oriented cognitive style and social communicative deficits,within and beyond the autism spectrum: Independent traits that grow into developmental interdependence

At the heart of debates over underlying causes of autism is the “Kanner hypothesis” that autistic deficits in social reciprocity, and a cognitive/perceptual ‘style’ favouring detail-oriented cognition, co-vary in autistic individuals. A separate line of work indicates these two domains are normally distributed throughout the population, with autism representing an extremity. This realisation brings the Kanner debate into the realm of normative co-variation, providing more ways to test the hypothesis, and insights into typical development; for instance, in the context of normative functioning, the Kanner hypothesis implies social costs to spatial/numerical prowess. In light of this growing body of research, we review relevant factor analytic and correlational, behavioural studies. Findings are then synthesised into three themes: an alternative triad of primary autistic trait categories – Social Interaction Deficits, Cognitive Inflexibility, and Sensory Abnormalities – that more accurately reflects the factor structure of autistic traits; continuity between clinical and non-clinical autism-spectrum trait presentation; and indications that although social and non-social autistic traits may be initially independent, Kanner-like co-variance emerges behaviourally from dynamic trait interactions over the course of development. A dynamic developmental model subsuming these patterns is offered, and its advantages demonstrated in a novel account of ritualistic behaviours: as developmentally emergent, compensatory mechanisms for interactions between cognitive inflexibility and sensory abnormalities. We conclude with the broader imperative that behavioural scientists appealing for directly and exclusively genetic links may instead benefit from a developmental framing within their own discipline.     

Burnout during a long-term rehabilitation: comparing low burnout,high burnout – benefited,and high burnout – not benefited trajectories

Abstract

To focus rehabilitation activities among burnout clients more effectively, it is important to investigate who benefits from burnout interventions. This study (N=85) aimed at identifying burnout trajectories in terms of benefit, that is, subgroups of clients who share similar mean levels and changes in burnout during a one-year rehabilitation intervention (17 days in total) with a six-month follow-up. After identifying the burnout trajectories, the relations of the trajectories with factors describing the clients, antecedents, and consequences of burnout during the one-year intervention were examined. Three burnout trajectories were identified by growth mixture modeling: (a) low burnout (n=39), (b) high burnout – benefited (n=29), and (c) high burnout – not benefited (n=17). Positive changes were detected in antecedents and consequences among the clients in the low burnout and high burnout – benefited trajectories. Recovery from burnout was associated with increased job resources and decreased job demands, as well as with increased job satisfaction and decreased depression. It seems that more precise targeting of rehabilitation is needed since the trajectories revealed not only clients with mild symptoms, but also clients who probably received this treatment too late.