Reconsidering prenatal screening: an empirical-ethical approach to understand moral dilemmas as a question of personal preferences

In contrast to most Western countries, routine offer of prenatal screening is considered problematic in the Netherlands. The main argument against offering it to every pregnant woman is that women would be brought into a moral dilemma when deciding whether to use screening or not. This paper explores whether the active offer of a prenatal screening test indeed confronts women with a moral dilemma. A qualitative study was developed, based on a randomised controlled trial that aimed to assess the decision-making process of women when confronted with a test offer. A sample of 59 women was interviewed about the different factors balanced in decision-making. Participants felt themselves caught between a need for knowledge and their unwillingness to take on responsibility. Conflict was reported between wishes, preferences and ethical views regarding parenthood; however, women did not seem to be caught in a choice between two or more ethical principles. Participants balanced the interests of the family against that of the fetus in line with their values and their personal circumstances. Therefore, we conclude that they are not so much faced with an ethical dilemma as conflicting interests. We propose that caregivers should provide the opportunity for the woman to discuss her wishes and doubts to facilitate her decision. This approach would help women to assess the meaning of testing within their parental duties towards their unborn child and their current offsprin

The Effects of Statistical Information on Risk- and Ambiguity-Attitudes, and on Rational Insurance Decisions

This is a preprint of an article to be published in Management ScienceThis paper examines the effects of statistical information about risks on risk attitudes and demand for insurance. A descriptive purpose is to obtain new insights into risk and ambiguity attitudes of the general public. A prescriptive purpose is to provide recommendations for the provision of risk information to individuals so as to help them choose their most preferred options. In an experiment, N = 476 clients of a Dutch health insurance company were given various forms of statistical information about health expenses. Average population-cost information generally increased the willingness to take insurance. Own past-costs information differentiated betwee individuals, increasing the willingness to take insurance for high-cost and risk averse clients but not for others. Detailed cost information reinforced the effects of total-cost information. Prescriptively, the drawback of adverse selection must be weighed against a desirable interaction with risk attitude, increased customer satisfaction, and increased cost awareness. Descriptively, ambiguity preference was found rather than aversion, and no risk aversion was found for loss outcomes. Both findings, obtained in a natural decision context, deviate from traditional views in risk theory but agree with prospect theory

Exploring the causes of adverse events in hospitals and potential prevention strategies

Objectives To examine the causes of adverse events (AEs) and potential prevention strategies to minimise the occurrence of AEs in hospitalised patients. Methods For the 744 AEs identified in the patient record review study in 21 Dutch hospitals, trained reviewers were asked to select all causal factors that contributed to the AE. The results were analysed together with data on preventability and consequences of AEs. In addition, the reviewers selected one or more prevention strategies for each preventable AE. The recommended prevention strategies were analysed together with four general causal categories: technical, human, organisational and patient-related factors. Results Human causes were predominantly involved in the causation of AEs (in 61% of the AEs), 61% of those being preventable and 13% leading to permanent disability. In 39% of the AEs, patient-related factors were involved, in 14% organisational factors and in 4% technical factors. Organisational causes contributed relatively often to preventable AEs (93%) and AEs resulting in permanent disability (20%). Recommended strategies to prevent AEs were quality assurance/peer review, evaluation of safety behaviour, training and procedures. For the AEs with human and patient-related causes, reviewers predominantly recommended quality assurance/peer review. AEs caused by organisational factors were considered preventable by improving procedures. Discussion Healthcare interventions directed at human causes are recommended because these play a large role in AE causation. In addition, it seems worthwhile to direct interventions on organisational causes because the AEs they cause are nearly always believed to be preventable. Organisational factors are thus relatively easy to tackle. Future research designs should allow researchers to interview healthcare providers that were involved in the event, as an additional source of information on contributing factors.

Testing the effects on information use by older versus younger women of modality and narration style in a hospital report card

BACKGROUND: Hospital report cards (HRCs) are usually presented in a textual and factual format, likely hampering information processing. OBJECTIVE: This study aimed to investigate the effects of audiovisual and narrative information in HRCs on user responses, and to test differences between older and younger women. DESIGN: A 2 (modality [textual vs. audiovisual]) × 3 (narration style [factual vs. process narrative vs. experience narrative]) online experiment was conducted. Information about breast cancer care was used as a case example. Age (younger [<65] vs. older [≥65]) was included as a potential effect modifier. SETTING AND PARTICIPANTS: A total of 631 disease‐naïve women (M (age) = 56.06) completed an online survey. The outcomes were perceived cognitive load, satisfaction, comprehension, information recall and decisional conflict. Data were analysed using AN(C)OVAs. RESULTS: Audiovisual (vs. textual) information resulted in higher information satisfaction across age groups, but was associated with lower comprehension in older women. An experience narrative (vs. factual information) increased satisfaction with attractiveness and emotional support of the information only in older women. A three‐way interaction effect was found, suggesting that older women were most satisfied with the comprehensibility of audiovisual factual or textual process narrative information. Younger women were most satisfied with the comprehensibility of audiovisual process narrative or textual factual information. DISCUSSION AND CONCLUSION: Audiovisual and narrative information in an HRC showed beneficial effects on satisfaction measures. In particular, audiovisual information could be incorporated into HRCs to increase satisfaction with information. PUBLIC CONTRIBUTION: Lay persons helped in optimizing the visuals used in the stimulus materials by checking for clarity

К определению граничных элементов в рамках модели упругого грунтового слоя

В рамках расчетной схемы основания в виде слоя конечной толщины получены функции влияния матрицы податливости метода граничных элементов. Рассмотрена модель линейного упругого изотропного основания. Область применения полученных в работе результатов – определение напряженно-деформированного состояния (НДС) грунтовых оснований и расположенных на них фундаментов зданий и сооружений.Within the framework of calculation chart of founding as a layer of eventual thickness the functions of influence of matrix of pliability of method of border elements are got. The model of the linear resilient izotropic founding is considered. An application of the results got in-process domain is determination of the tensely-deformed state(VAT) of the ground grounds and foundations of building and building located on them

Засади транскрибування китайської лексики українською мовою

Статтю присвячено проблемі уніфікації написання китайських географічних назв, власних імен та реалій українською мовою. Основним об’єктом дослідження є здатність української мови відтворювати китайські звуки. У статті розглянуто досвід транскрибування китайських слів засобами латинської та кириличної графіки, що важливо для формулювання основних принципів транскрипції з китайської на українську мову. Таких принципів у статті виділено чотири та розглянуто труднощі, які виникають під час їх застосування в процесі транскрибування. Відзначено, що ці труднощі можуть виявлятися або на рівні складу, або на рівні слова. Для вирішення проблем першого рівня, автор додає до статті таблицю складів-відповідників для китайської та української мов. А для уніфікації написання на другому рівні автор пропонує використовувати апостроф у випадку необхідності позначити межі складу, та відмінювати китайській імена й прізвища згідно норм української мови.Статья посвящается проблеме унификации написаний китайских географических названий, имен собственных и реалий в украинских текстах. Основным объектом исследования является способность украинского языка отображать китайские звуки. В статье рассматривается опыт транскрибирования китайских слов средствами латинской графики и кириллицы, что важно для формулирования основных принципов транскрипции с китайского языка на украинский. Таких принципов в статье выделено четыре, к тому же рассмотрены трудности, которые могут возникнуть при их применении в процессе транскрибирования. Отмечено, что эти трудности могут проявляться либо на уровне слога, либо на уровне слова. Для решения проблем первого уровня, автор прилагает к статье таблицу слоговых соответствий в китайском и украинском языках. А для унификации написаний на втором уровне, автор предлагает использовать апостроф в случае необходимости обозначить границы слогов, и склонять китайские имена и фамилии согласно нормам украинского языка.The article is devoted to the problem of unifying the ways to represent Chinese geographic names, persons’ names and cultural words in Ukrainian texts. The main object of the study is a capacity of Ukrainian language to reproduce Chinese sounds. It is proposed to consider an experience of transcription from Chinese into languages with Latin and Cyrillic alphabets, which is important to formulate main principles for the transcription from Chinese into Ukrainian. There are four main principles stated in the article for this pair of languages. It is also analyzed main difficulties, which occur in practice of using the transcription, based on these principles. The difficulties are divided into two groups: occurred on the level of syllable and occurred on the level of word. To solve problems on the former level, the author complicate the article with tables of Chinese syllables and there equivalents in Ukrainian. To unify writing on the latter level, the author proposes to use apostrophe if important to mark syllable bounds and change a word’s ending in Ukrainian texts according to the norms of Ukrainian grammar

Portaria n. 187, de 8 de abril de 2005

Interrompe, por necessidade do serviço, as férias de servidor do Superior Tribunal de Justiça