This research examines how accuracy motivation shapes numerical estimation by altering the mental representation of the number scale. We demonstrate that accuracy instructions lead individuals to adopt a finer-grained scale, resulting in the use of more precise estimates. This shift appears to be driven by a belief that using a finer-grained scale is necessary for producing accurate estimates, even though greater resolution alone does not guarantee greater accuracy. Across four studies, we show that accuracy instructions consistently increase numerical precision without (...) improving objective estimation accuracy. We also identify an unintended consequence of this shift: adopting a finer-grained scale paradoxically constrains the magnitude of adjustments from initial estimates, even when larger revisions are warranted. These findings reveal a novel unintended consequence of emphasising accuracy, offering new insights into the mechanisms underlying anchoring effects and the broader cognitive processes involved in numerical judgement and decision-making. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

In Singapore’s multicultural society, a sizable proportion of the population subscribes to complementary and alternative medicine. In this article, we discuss the impact this has on medical practice in the context of the four principles of medical ethics. To uphold the principle of autonomy, we propose a non-judgmental approach towards patients who use CAM. Nevertheless, in order to promote health and prevent harm, the safety profiles of CAM must be studied through systematic research. In addition, the principle of justice is (...) one concerned with the fair distribution of scarce healthcare resources, while granting equal access to healthcare regardless of beliefs. Understanding CAM from an ethical perspective allows for the provision of safe, holistic, and culturally relevant care. (shrink)

Background Fifteen years have passed since the outbreak of severe acute respiratory syndrome in Hong Kong. At that time, there were reports of heroic acts among professionals who cared for these patients, whose bravery and professionalism were highly praised. However, there are concerns about changes in new generation of nursing professionals. Objective We aimed to examine the attitude of nursing students, should they be faced with severe acute respiratory syndrome patients during their future work. Research design A questionnaire survey was (...) carried out to examine the attitude among final-year nursing students to three ethical areas, namely, duty of care, resource allocation, and collateral damage. Ethical considerations This study was carried out in accordance with the requirements and recommendations of the Central Research and Ethics Committee, School of Health Sciences at Caritas Institute of Higher Education. Findings Complete responses from 102 subjects were analyzed. The overwhelming majority (96.1%) did not agree to participate in the intubation of severe acute respiratory syndrome patients if protective measures, that is, N95 mask and gown, were not available. If there were insufficient N95 masks for all the medical, nursing, and allied health workers in the hospital (resource allocation), 37.3% felt that the distribution of N95 masks should be by casting lot, while the rest disagreed. When asked about collateral damage, more than three-quarters (77.5%) said that severe acute respiratory syndrome patients should be admitted to intensive care unit. There was sex difference in nursing students’ attitude toward severe acute respiratory syndrome care during pregnancy and influence of age in understanding intensive care unit care for these patients. Interestingly, 94.1% felt that there should be a separate intensive care unit for severe acute respiratory syndrome patients. Conclusion As infection control practice and isolation facilities improved over the years, relevant knowledge and nursing ethical issues related to infectious diseases should become part of nursing education and training programs, especially in preparation for outbreaks of infectious diseases or distress. (shrink)

Background: Frailty is a natural consequence of the aging process. With the increasing aging population in Mainland China, the quality of life and end-of-life care for frail older people need to be taken into consideration. Advance Care Planning has also been used worldwide in long-term facilities, hospitals and communities to improve the quality of end-of-life care, increase patient and family satisfaction, and reduce healthcare costs and hospital admissions in Western countries. However, it has not been practiced in China. Research objective: (...) This study aimed to evaluate the effectiveness of a modified Advance Care Planning intervention in certainty of end-of-life care, preferences for end-of-life care, quality of life concerns, and healthcare utilization among frail older people. Research design: This study used a quasi-experimental design, with a single-blind, control group, pretest and repeated posttest approach. Participants and research context: A convenience sample of 74 participates met the eligibility criteria in each nursing home. A total of 148 frail older people were recruited in two nursing homes in Zhejiang Province, China. Ethical considerations: The study received ethical approval from the Clinical Research Ethics Committee, the Faculty of Medicine, and The Chinese University of Hong Kong, CREC Ref. No: 2016.059. Findings: The results indicated the Advance Care Planning programme was effective at increasing autonomy in decision making on end-of-life care issues, decreasing decision-making conflicts over end-of-life care issues, and increasing their expression about end-of-life care. Discussion: This study promoted the participants’ autonomy and broke through the inherent custom of avoiding talking about death in China. Conclusion: The modified Advance Care Planning intervention is effective and recommended to support the frail older people in their end-of-life care decision in Chinese society. (shrink)

This article reports the results of a survey, by mailed questionnaire, of the attitudes, values and practices of doctors in Singapore with respect to the doctor-patient relationship. Questionnaires were sent to a random sample of 475 doctors (261 general practitioners and 214 medical specialists), out of which 249 (52.4%) valid responses were completed and returned. The survey is the first of its kind in Singapore. Questions were framed around issues of medical paternalism, consent and patient autonomy. As the doctors were (...) exposed to Western ethical concepts in their training, we were not surprised to find that they would mostly allow patients some say in decision-making and keep patients reasonably informed. In respecting patient autonomy, they would usually seek to influence patient choice by persuasion. However, the residual "Asian-ness" of doctors in Singapore gives rise to some inconsistencies between values and practices. Many doctors still believe that a number of their patients are incapable of rational choice. There is some lack of openness in telling patients the whole truth. When patients choose to refuse treatment, many doctors are prepared to involve family members in making a consensus decision. Doctors were also asked how they made ethical judgements in the face of dilemmas, and how they would like disputes with patients to be resolved. By and large, the doctors prefer to make their own judgements rather than to rely on rules. They also wish to keep the law courts out of disputes with patients, preferring less public ways of settling disputes. (shrink)

The Deaf culture in the United States is a unique culture that is not widely understood. To members of the Deaf community in the United States, deafness is not viewed as a disease or pathology to be treated or cured; instead it is seen as a difference in human experience. Members of this community do not hide their deafness; instead they take great pride in their Deaf identity. The Deaf culture in the United States is very communitarian not individualistic. Mary (...) Beth and Dominic are a married couple in their late 20s who are genetically deaf. They are active members in the Deaf community and work as advocates for individuals who are deaf, family members of Deaf people and sign language interpreters who identify with the Deaf culture. Mary Beth and Dominic approach the fertility clinic with a request that they only want a child with the genetic gene for deafness. They would want the embryos that do not have the gene to be destroyed. This would entail creating a child who would have the gene for deafness. Medically and ethically, should the fertility clinic agree to the couple’s request? The authors argue that the couple's request should be denied and provide reasons for it from the perspectives of foundational and clinical ethics. (shrink)

It is evident, in the face of the COVID-19 pandemic that has physicians confronting death and dying at unprecedented levels along with growing data suggesting that physicians who care for dying patients face complex emotional, psychological and behavioural effects, that there is a need for their better understanding and the implementation of supportive measures. Taking into account data positing that effects of caring for dying patients may impact a physician’s concept of personhood, or “what makes you, ‘you’”, we adopt Radha (...) Krishna’s Ring Theory of Personhood (RToP) to scrutinise the experiences of physicians working in intensive care units (ICU) using a fictional scenario that was inspired by real events. The impact of death and dying, its catalysts, internal constituents, external factors, dyssynchrony, and buffers, specific to ICU physicians, were identified and explored. Such a framework allows for ramifications to be considered holistically and facilitates the curation of strategies for conflict resolution. This evaluation of the RToP acknowledges the experience and wide-ranging effects it has on ICU physicians. As such, our findings provide insight into their specific needs and highlight the importance of support on a personal and organisational level. Although further research needs to be conducted, the RToP could serve as the basis for a longitudinal assessment tool supported by the use of portfolios or mentorship due to their provision of personalised, appropriate, specific, timely, accessible and long-term support. (shrink)

Neste artigo, interrogamos os funcionamentos do conceito de platô em "Mil Platôs" (1980), a obra-prima de Deleuze e Guattari. Essa pesquisa esclarece, de forma concreta, duas linhas de pensamento, que são a epistemológica, por um lado, e a ética, por outro, enfocando os parágrafos nos quais Deleuze e Guattari usam efetivamente esse conceito. Do ponto de vista epistemológico, o conceito de platô permite praticar uma maneira de escrita rizomática e a explicação antiteleológica. Do ponto de vista ético, esse conceito, tirado (...) de Gregory Bateson, nos convida a formar a alegria contínua e global, ou a gaieté em termos espinosistas. In this paper, we question the workings of the concept of plateau in "A Thousand Plateaus" (1980), Deleuze and Guattari's chef-d'oeuvre. This research specifically clarifies two lines of thought, which are epistemological on the one hand, and ethics on the other hand, focusing on the paragraphs where Deleuze and Guattari actually employ this concept. From the epistemological point of view, the concept of plateau allows practicing a way of rhizomatic writing and anti-teleological explanation. From the point of view of ethics, this concept borrowed from Gregory Bateson invites us to form the continuous and global joy, or gaiety in Spinoza's terms. (shrink)

This chapter explores the energy injustices faced by the Orang Asli, the indigenous peoples of Peninsular Malaysia. Despite their rich cultural heritage and historical significance, the Orang Asli endure severe socio-economic marginalisation, exacerbated by inadequate access to energy. This energy poverty starkly contrasts with Malaysia’s status as a major energy producer. The chapter highlights how energy justice, which advocates for equitable access to energy resources and technologies, is crucial for addressing the disparities faced by the Orang Asli. Key issues include (...) the impact of land ownership disputes, palm oil plantations, and hydropower projects on their livelihoods and rights. The transition to renewable energy presents both opportunities and challenges, as it must be managed to avoid further marginalising the Orang Asli. The chapter calls for inclusive energy policies that reduce the energy burden on marginalised communities, ensuring their active participation in energy justice discussions. By integrating the perspectives and traditional knowledge of the Orang Asli, Malaysia can develop sustainable and equitable energy solutions that respect their human rights and cultural integrity. Achieving energy justice for the Orang Asli involves not only providing reliable electricity but also recognising their role in a sustainable future and ensuring their rights are upheld in the transition to green energy. (shrink)

Projects that challenge students to practice service leadership for civic improvement can address the aim of developing civic-mindedness in undergraduates. We conducted two qualitative studies. First, we investigated the learning experiences of four teams of undergraduate business students, who undertook semester-long course-embedded service-learning projects in partnership with four Hong Kong-based social enterprises. The students described five modes of civic engagement as project purposes, mentioned applying six types of service leadership practice for civic improvement, and described eight types of developmental outcome (...) within the domain of civic-mindedness. Comparisons suggested that besides relational support through training and guidance, empowering infrastructure, opportunities to exercise autonomy, and opportunities to demonstrate competence, three project-related features that varied between projects were important in fostering civic-mindedness. These were direct contact with grassroots-based beneficiaries; the experience of making a tangible difference; and linking the campus with the wider community. A second qualitative study indicated that course-embedded team projects with these features that were undertaken in mixed teams that included freshman and senior year business students fostered civic-mindedness for both categories of student. (shrink)

Moral psychology studies the features of cognition, judgement, perception and emotion that make human beings capable of moral action. Perspectives from feminist and race theory immensely enrich moral psychology. Writers who take these perspectives ask questions about mind, feeling, and action in contexts of social difference and unequal power and opportunity. These essays by a distinguished international cast of philosophers explore moral psychology as it connects to social life, scientific studies, and literature.

Background: People in both Taiwan and China originally descended from the Han Chinese, but the societies have been separated for approximately 38 years. Due to different political systems, variations exist in healthcare and nursing education systems in Taiwan and China. Objective: The purpose of this study was to examine the professional values of nursing students in Taiwan and China. Design: A cross-sectional design was applied in this study. The Nursing Professional Value Scale–Revised was used to measure the professional values of (...) the students. The questionnaire was distributed to eligible undergraduate students in a classroom setting. Ethical considerations: This study was approved by the Institutional Review Board at the first investigator’s university. Participants were informed that completion and return of the questionnaire was voluntary, and confidentiality was ensured by keeping the responses anonymous. Participants: A convenience sample included 292 Taiwanese students and 654 Chinese students. Findings: A total of 11 individual Nursing Professional Value Scale–Revised items showed significant differences between the two groups. These results reflect the differences in the perceived importance of these items between the groups. There was no significant difference between the two groups in the mean overall scores for the Nursing Professional Value Scale–Revised (p =.766) and three subscales (all p >.05). Conclusion: There are some differences in professional values between nursing students in Taiwan and China. Given the increasingly frequent and close interactions between Taiwan and China and the globalization of nursing, understanding these differences may help nursing educators identify students’ perceptions of their professional values and support the development of strategies to improve weaknesses in professional values. (shrink)

Liver transplantation (LT) activities during the COVID-19 pandemic have been curtailed in many countries. The impact of various policies restricting LT on outcomes of potential LT candidates is unclear. We studied all patients on the nationwide LT waitlists in Hong Kong and Singapore between January 2016 and May 2020. We used continuous time Markov chains to model the effects of different scenarios and varying durations of disruption on LT candidates.

ObjectivesWorking-age cancer patients face barriers to resuming work after treatment completion. Those resuming work contend with reduced productivity arising from persisting residual symptoms. Existing studies of return to work after cancer diagnosis were done predominantly in Western countries. Given that employment and RTW in cancer survivors likely vary regionally due to healthcare provision and social security differences, we documented rates and correlates of RTW, work productivity, and activity impairment among Chinese cancer survivors in Hong Kong at one-year post-treatment.MethodsOf 1,106 cancer (...) patients assessed at six-months post-cancer treatment, 593 previously worked; detailed work status, psychological distress, physical symptom distress, supportive care needs, health-related quality of life, and illness perception were assessed. Six months later, work productivity and activity impairment were assessed. Descriptive analyses examined RTW rate. Fully adjusted regressions determined RTW, work productivity, and activity impairment predictors.ResultsAt baseline, 39% were working, 26% on sick leave, and 35% were unemployed. Compared to patients returning to work, unemployed participants were older, likely manual/service-oriented workers, and had lower family income, chemotherapy, fewer unmet health system and information needs, poorer physical functioning, and negative illness perceptions. Sick leave participants were likely service-oriented workers, who had head and neck cancer, chemotherapy, and poor physical functioning. At FU, baseline depressive symptoms, physical symptom distress, and negative illness perceptions predicted presenteeism and work productivity loss; gynecological cancer, fewer unmet health system and information needs, and greater unmet sexuality needs predicted absenteeism; physical symptom distress, negative illness perception, and poor physical functioning predicted activity impairment.ConclusionCancer survivors who had more physically demanding jobs and poorer physical functioning delayed RTW. Unmanaged physical symptom and psychological distress hindered work productivity. (shrink)

The counseling process involves attention, emotional perception, cognitive appraisal, and decision-making. This study aimed to investigate cognitive appraisal and the associated emotional processes when reading short therapists' statements of motivational interviewing (MI). Thirty participants with work injuries were classified into the pre-contemplation (PC,n= 15) or readiness stage of the change group (RD,n= 15). The participants viewed MI congruent (MI-C), MI incongruent (MI-INC), or control phrases during which their electroencephalograms were captured. The results indicated significant Group × Condition effects in the (...) frontally oriented late positive complex (P600/LPC). The P600/LPC's amplitudes were more positive-going in the PC than in the RD group for the MI congruent statements. Within the PC group, the amplitudes of the N400 were significantly correlated (r= 0.607–0.649) with the participants' level of negative affect. Our findings suggest that the brief contents of MI statements alone can elicit late cognitive and emotional appraisal processes beyond semantic processing. (shrink)

This research article is a collaborative set of reflections and provocations stemming from the National Science Foundation (NSF) funded workshop on STS as a Critical Pedagogy, hosted online during the summer of 2021 by Shannon N. Conley and Emily York at James Madison University. The workshop occurred over four separate sessions, bringing together forty participants (including six undergraduate students who contributed as both facilitators and research assistants). Participants self-organized into panels, leading the workshop collective to engage a host of questions, (...) challenges, methods, and practices related to STS and critical pedagogy. Questions included the following. What characterizes critical STS pedagogies? How are critical STS pedagogies enabled and constrained by our institutional and disciplinary locations? What makes STS pedagogies travel? How might we imagine STS pedagogies otherwise? How do our pedagogies shape our research and engagement in the world? How might we critically interrogate the boundaries between research, teaching, service, and engagement, and what becomes visible when we do so? (shrink)