83 resultados para Analisys Methodological
em Helda - Digital Repository of University of Helsinki
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The aim of the present study was to advance the methodology and use of time series analysis to quantify dynamic structures in psychophysiological processes and thereby to produce information on spontaneously coupled physiological responses and their behavioral and experiential correlates. Series of analyses using both simulated and empirical cardiac (IBI), electrodermal (EDA), and facial electromyographic (EMG) data indicated that, despite potential autocorrelated structures, smoothing increased the reliability of detecting response coupling from an interindividual distribution of intraindividual measures and that especially the measures of covariance produced accurate information on the extent of coupled responses. This methodology was applied to analyze spontaneously coupled IBI, EDA, and facial EMG responses and vagal activity in their relation to emotional experience and personality characteristics in a group of middle-aged men (n = 37) during the administration of the Rorschach testing protocol. The results revealed new characteristics in the relationship between phasic end-organ synchronization and vagal activity, on the one hand, and individual differences in emotional adjustment to novel situations on the other. Specifically, it appeared that the vagal system is intimately related to emotional and social responsivity. It was also found that the lack of spontaneously synchronized responses is related to decreased energetic arousal (e.g., depression, mood). These findings indicate that the present process analysis approach has many advantages for use in both experimental and applied research, and that it is a useful new paradigm in psychophysiological research. Keywords: Autonomic Nervous System; Emotion; Facial Electromyography; Individual Differences; Spontaneous Responses; Time Series Analysis; Vagal System
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Failures in industrial organizations dealing with hazardous technologies can have widespread consequences for the safety of the workers and the general population. Psychology can have a major role in contributing to the safe and reliable operation of these technologies. Most current models of safety management in complex sociotechnical systems such as nuclear power plant maintenance are either non-contextual or based on an overly-rational image of an organization. Thus, they fail to grasp either the actual requirements of the work or the socially-constructed nature of the work in question. The general aim of the present study is to develop and test a methodology for contextual assessment of organizational culture in complex sociotechnical systems. This is done by demonstrating the findings that the application of the emerging methodology produces in the domain of maintenance of a nuclear power plant (NPP). The concepts of organizational culture and organizational core task (OCT) are operationalized and tested in the case studies. We argue that when the complexity of the work, technology and social environment is increased, the significance of the most implicit features of organizational culture as a means of coordinating the work and achieving safety and effectiveness of the activities also increases. For this reason a cultural perspective could provide additional insight into the problem of safety management. The present study aims to determine; (1) the elements of the organizational culture in complex sociotechnical systems; (2) the demands the maintenance task sets for the organizational culture; (3) how the current organizational culture at the case organizations supports the perception and fulfilment of the demands of the maintenance work; (4) the similarities and differences between the maintenance cultures at the case organizations, and (5) the necessary assessment of the organizational culture in complex sociotechnical systems. Three in-depth case studies were carried out at the maintenance units of three Nordic NPPs. The case studies employed an iterative and multimethod research strategy. The following methods were used: interviews, CULTURE-survey, seminars, document analysis and group work. Both cultural analysis and task modelling were carried out. The results indicate that organizational culture in complex sociotechnical systems can be characterised according to three qualitatively different elements: structure, internal integration and conceptions. All three of these elements of culture as well as their interrelations have to be considered in organizational assessments or important aspects of the organizational dynamics will be overlooked. On the basis of OCT modelling, the maintenance core task was defined as balancing between three critical demands: anticipating the condition of the plant and conducting preventive maintenance accordingly, reacting to unexpected technical faults and monitoring and reflecting on the effects of maintenance actions and the condition of the plant. The results indicate that safety was highly valued at all three plants, and in that sense they all had strong safety cultures. In other respects the cultural features were quite different, and thus the culturally-accepted means of maintaining high safety also differed. The handicraft nature of maintenance work was emphasised as a source of identity at the NPPs. Overall, the importance of safety was taken for granted, but the cultural norms concerning the appropriate means to guarantee it were little reflected. A sense of control, personal responsibility and organizational changes emerged as challenging issues at all the plants. The study shows that in complex sociotechnical systems it is both necessary and possible to analyse the safety and effectiveness of the organizational culture. Safety in complex sociotechnical systems cannot be understood or managed without understanding the demands of the organizational core task and managing the dynamics between the three elements of the organizational culture.
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Comprehensive two-dimensional gas chromatography (GC×GC) offers enhanced separation efficiency, reliability in qualitative and quantitative analysis, capability to detect low quantities, and information on the whole sample and its components. These features are essential in the analysis of complex samples, in which the number of compounds may be large or the analytes of interest are present at trace level. This study involved the development of instrumentation, data analysis programs and methodologies for GC×GC and their application in studies on qualitative and quantitative aspects of GC×GC analysis. Environmental samples were used as model samples. Instrumental development comprised the construction of three versions of a semi-rotating cryogenic modulator in which modulation was based on two-step cryogenic trapping with continuously flowing carbon dioxide as coolant. Two-step trapping was achieved by rotating the nozzle spraying the carbon dioxide with a motor. The fastest rotation and highest modulation frequency were achieved with a permanent magnetic motor, and modulation was most accurate when the motor was controlled with a microcontroller containing a quartz crystal. Heated wire resistors were unnecessary for the desorption step when liquid carbon dioxide was used as coolant. With use of the modulators developed in this study, the narrowest peaks were 75 ms at base. Three data analysis programs were developed allowing basic, comparison and identification operations. Basic operations enabled the visualisation of two-dimensional plots and the determination of retention times, peak heights and volumes. The overlaying feature in the comparison program allowed easy comparison of 2D plots. An automated identification procedure based on mass spectra and retention parameters allowed the qualitative analysis of data obtained by GC×GC and time-of-flight mass spectrometry. In the methodological development, sample preparation (extraction and clean-up) and GC×GC methods were developed for the analysis of atmospheric aerosol and sediment samples. Dynamic sonication assisted extraction was well suited for atmospheric aerosols collected on a filter. A clean-up procedure utilising normal phase liquid chromatography with ultra violet detection worked well in the removal of aliphatic hydrocarbons from a sediment extract. GC×GC with flame ionisation detection or quadrupole mass spectrometry provided good reliability in the qualitative analysis of target analytes. However, GC×GC with time-of-flight mass spectrometry was needed in the analysis of unknowns. The automated identification procedure that was developed was efficient in the analysis of large data files, but manual search and analyst knowledge are invaluable as well. Quantitative analysis was examined in terms of calibration procedures and the effect of matrix compounds on GC×GC separation. In addition to calibration in GC×GC with summed peak areas or peak volumes, simplified area calibration based on normal GC signal can be used to quantify compounds in samples analysed by GC×GC so long as certain qualitative and quantitative prerequisites are met. In a study of the effect of matrix compounds on GC×GC separation, it was shown that quality of the separation of PAHs is not significantly disturbed by the amount of matrix and quantitativeness suffers only slightly in the presence of matrix and when the amount of target compounds is low. The benefits of GC×GC in the analysis of complex samples easily overcome some minor drawbacks of the technique. The developed instrumentation and methodologies performed well for environmental samples, but they could also be applied for other complex samples.
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The neurotransmitter serotonin (5-HT) modulates many functions important for life, e.g., appetite and body temperature, and controls development of the neural system. Disturbed 5-HT function has been implicated in mood, anxiety and eating disorders. The serotonin transporter (SERT) controls the amount of effective 5-HT by removing it from the extracellular space. Radionuclide imaging methods single photon emission tomography (SPET) and positron emission tomography (PET) enable studies on the brain SERTs. This thesis concentrated on both methodological and clinical aspects of the brain SERT imaging using SPET. The first study compared the repeatability of automated and manual methods for definition of volumes of interest (VOIs) in SERT images. The second study investigated within-subject seasonal variation of SERT binding in healthy young adults in two brain regions, the midbrain and thalamus. The third study investigated the association of the midbrain and thalamic SERT binding with Bulimia Nervosa (BN) in female twins. The fourth study investigated the association of the midbrain and hypothalamic/thalamic SERT binding and body mass index (BMI) in monozygotic (MZ) twin pairs. Two radioligands for SERT imaging were used: [123I]ADAM (studies I-III) and [123I]nor-beta-CIT (study IV). Study subjects included young adult MZ and dizygotic (DZ) twins screened from the FinnTwin16 twin cohort (studies I-IV) and healthy young adult men recruited for study II. The first study validated the use of an automated brain template in the analyses of [123I]ADAM images and proved automated VOI definition more reproducible than manual VOI definition. The second study found no systematic within-subject variation in SERT binding between scans done in summer and winter in either of the investigated brain regions. The third study found similar SERT binding between BN women (including purging and non-purging probands), their unaffected female co-twins and other healthy women in both brain regions; in post hoc analyses, a subgroup of purging BN women had significantly higher SERT binding in the midbrain as compared to all healthy women. In the fourth study, MZ twin pairs were divided into twins with higher BMI and co-twins with lower BMI; twins with higher BMI were found to have higher SERT binding in the hypothalamus/thalamus than their leaner co-twins. Our results allow the following conclusions: 1) No systematic seasonal variation exists in the midbrain and thalamus between SERT binding in summer and winter. 2) In a population-based sample, BN does not associate with altered SERT status, but alterations are possible in purging BN women. 3) The higher SERT binding in MZ twins with higher BMIs as compared to their leaner co-twins suggests non-genetic association between acquired obesity and the brain 5-HT system, which may have implications on feeding behavior and satiety.
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The resources of health systems are limited. There is a need for information concerning the performance of the health system for the purposes of decision-making. This study is about utilization of administrative registers in the context of health system performance evaluation. In order to address this issue, a multidisciplinary methodological framework for register-based data analysis is defined. Because the fixed structure of register-based data indirectly determines constraints on the theoretical constructs, it is essential to elaborate the whole analytic process with respect to the data. The fundamental methodological concepts and theories are synthesized into a data sensitive approach which helps to understand and overcome the problems that are likely to be encountered during a register-based data analyzing process. A pragmatically useful health system performance monitoring should produce valid information about the volume of the problems, about the use of services and about the effectiveness of provided services. A conceptual model for hip fracture performance assessment is constructed and the validity of Finnish registers as a data source for the purposes of performance assessment of hip fracture treatment is confirmed. Solutions to several pragmatic problems related to the development of a register-based hip fracture incidence surveillance system are proposed. The monitoring of effectiveness of treatment is shown to be possible in terms of care episodes. Finally, an example on the justification of a more detailed performance indicator to be used in the profiling of providers is given. In conclusion, it is possible to produce useful and valid information on health system performance by using Finnish register-based data. However, that seems to be far more complicated than is typically assumed. The perspectives given in this study introduce a necessary basis for further work and help in the routine implementation of a hip fracture monitoring system in Finland.
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This Working Paper reports the background to the first stage of the ongoing research project, The Quest for Well-being in Growth Industries: A Collaborative Study in Finland and Scotland, conducted under the auspices of the Academy of Finland research programme The Future of Work and Well-being (2008-2011). This collaborative project provides national and transnational data, analysis and outputs. The study is being conducted in the Department of Management and Organisation, Hanken School of Economics, Finland, in collaboration with Glasgow Caledonian University, University of East London, Heriot-Watt University and Reading University, UK. The project examines policies and practices towards the enhancement of work-related well-being in growth industries, and contradictory pressures and tensions posed in this situation. The overall aim is to evaluate the development, implementation and use of work-related well-being policies in four selected growth industries. These sectors – electronics, care, finance and accounting, and tourism – have been selected on the basis of European Union and national forecasts, and demographic and socio-economic trends in employment. In this working paper we outline the background to the research study, the initial research plan, and how the survey of employers has been constructed. The working paper concludes with a brief discussion of general ongoing research issues arising in the project.
Resumo:
The overlapping sound pressure waves that enter our brain via the ears and auditory nerves must be organized into a coherent percept. Modelling the regularities of the auditory environment and detecting unexpected changes in these regularities, even in the absence of attention, is a necessary prerequisite for orientating towards significant information as well as speech perception and communication, for instance. The processing of auditory information, in particular the detection of changes in the regularities of the auditory input, gives rise to neural activity in the brain that is seen as a mismatch negativity (MMN) response of the event-related potential (ERP) recorded by electroencephalography (EEG). --- As the recording of MMN requires neither a subject s behavioural response nor attention towards the sounds, it can be done even with subjects with problems in communicating or difficulties in performing a discrimination task, for example, from aphasic and comatose patients, newborns, and even fetuses. Thus with MMN one can follow the evolution of central auditory processing from the very early, often critical stages of development, and also in subjects who cannot be examined with the more traditional behavioural measures of auditory discrimination. Indeed, recent studies show that central auditory processing, as indicated by MMN, is affected in different clinical populations, such as schizophrenics, as well as during normal aging and abnormal childhood development. Moreover, the processing of auditory information can be selectively impaired for certain auditory attributes (e.g., sound duration, frequency) and can also depend on the context of the sound changes (e.g., speech or non-speech). Although its advantages over behavioral measures are undeniable, a major obstacle to the larger-scale routine use of the MMN method, especially in clinical settings, is the relatively long duration of its measurement. Typically, approximately 15 minutes of recording time is needed for measuring the MMN for a single auditory attribute. Recording a complete central auditory processing profile consisting of several auditory attributes would thus require from one hour to several hours. In this research, I have contributed to the development of new fast multi-attribute MMN recording paradigms in which several types and magnitudes of sound changes are presented in both speech and non-speech contexts in order to obtain a comprehensive profile of auditory sensory memory and discrimination accuracy in a short measurement time (altogether approximately 15 min for 5 auditory attributes). The speed of the paradigms makes them highly attractive for clinical research, their reliability brings fidelity to longitudinal studies, and the language context is especially suitable for studies on language impairments such as dyslexia and aphasia. In addition I have presented an even more ecological paradigm, and more importantly, an interesting result in view of the theory of MMN where the MMN responses are recorded entirely without a repetitive standard tone. All in all, these paradigms contribute to the development of the theory of auditory perception, and increase the feasibility of MMN recordings in both basic and clinical research. Moreover, they have already proven useful in studying for instance dyslexia, Asperger syndrome and schizophrenia.
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XVIII IUFRO World Congress, Ljubljana 1986.
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My Ph.D. dissertation presents a multi-disciplinary analysis of the mortuary practices of the Tiwanaku culture of the Bolivian high plateau, situated at an altitude of c. 3800 m above sea level. The Tiwanaku State (c. AD 500-1150) was one of the most important pre-Inca civilisations of the South Central Andes. The book begins with a brief introductory chapter. In chapter 2 I discuss methodological and theoretical developments in archaeological mortuary studies from the late 1960s until the turn of the millennium. I am especially interested in the issue how archaeological burial data can be used to draw inferences on the social structure of prehistoric societies. Chapter 3 deals with the early historic sources written in the 16th and 17th centuries, following the Spanish Conquest of the Incas. In particular, I review information on how the Incas manifested status differences between and within social classes and what kinds of burial treatments they applied. In chapter 4 I compare the Inca case with 20th century ethnographic data on the Aymara Indians of the Bolivian high plateau. Even if Christianity has affected virtually every level of Aymara religion, surprisingly many traditional features can still be observed in present day Aymara mortuary ceremonies. The archaeological part of my book begins with chapter 5, which is an introduction into Tiwanaku archaeology. In the next chapter, I present an overview of previously reported Tiwanaku cemeteries and burials. Chapter 7 deals with my own excavations at the Late Tiwanaku/early post-Tiwanaku cemetery site of Tiraska, located on the south-eastern shore of Lake Titicaca. During the 1998, 2002, and 2003 field seasons, a total of 32 burials were investigated at Tiraska. The great majority of these were subterranean stone-lined tombs, each containing the skeletal remains of 1 individual and 1-2 ceramic vessels. Nine burials have been radiocarbon dated, the dates in question indicating that the cemetery was in use from the 10th until the 13th century AD. In chapter 8 I point out that considerable regional and/or ethnic differences can be noted between studied Tiwanaku cemetery sites. Because of the mentioned differences, and a general lack of securely dated burial contexts, I feel that at present we can do no better than to classify most studied Tiwanaku burials into three broad categories: (1) elite and/or priests, (2) "commoners", and (3) sacrificial victims and/or slaves and/or prisoners of war. On the basis of such indicators as monumental architecture and occupational specialisation we would expect to find considerable status-related differences in tomb size, grave goods, etc. among the Tiwanaku. Interestingly, however, such variation is rather modest, and the Tiwanaku seem to have been a lot less interested in expending considerable labour and resources in burial facilities than their pre-Columbian contemporaries of many parts of the Central Andes.
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The dissertation analyzes and elaborates upon the changing map of U.S. ethno-racial formation from the vantage point of North American Studies, multi-disciplinary cultural studies, and the criticism of visual culture. The focus is on four contemporary Mexican American (Chicana) women photographers, whose art production is discussed, on the one hand, in the context of the Euro-American history of photographic genres and, on the other hand, in the context of so-called decolonizing cultural and academic discourses produced by Mexican Americans themselves. The manuscript consists of two parts. Part I outlines the theoretical and methodological domain of the study, positioning it in the interstices of American studies, European postmodern criticism, postcolonial feminist theory, and the theories of visual culture, particularly of art photography. In addition, the main issues and paradigms of Chicano Studies (Mexican American ethnic studies) are introduced. Part II consists of seven essays, each of which discusses rather independently a particular photographic work or a series of photographs, formulating and defending arguments about their meaning, position in the history of photographic genres, and their cultural and socio-political significance. The study closes with a discussion about ethno-racial identity formation and the role of Chicana photography therein - in embodying and reproducing new subjectivities, alternative categories of knowledge, and open ended historical narratives. It is argued that, symbolically, the "Wild Zone" of gendered and race-specific knowledge becomes associated with the body of the mother, a recurrent image in Chicana art works under discussion. Embedded in this image, the construction of an alternative notion of a family thus articulates the parameters of a matrifocal ethno-racial community unified by the proliferation of differences rather than by conformities typical of nationalistic ideologies. While focusing on art photography, the study as a whole simultaneously constructs, from a European vantage point, a "thick" description of Mexican American history, identities, communities, cultural practices, and self-representations about which very little is known in Finland.
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Väitöskirja analysoi espanjan kielen dekonstruktioita ruumiin metaforista ja troopeista koostuvassa aineistossa chileläisen kirjailijan Diamela Eltitin (1949 -) neljässä romaanissa: Lumpérica (1983), Vaca sagrada (1991), El infarto del alma (1994) ja Los trabajadores de la muerte (1998). Näkökulma on kielen muutoksessa Eltitin proosassa 1980- ja 1990-luvuilla alkaen kokeellisesta huippuvaiheesta 1983, jolloin hän julkaisi esikoisromaaninsa Lumpérica. Tutkimus korostaa Eltitin romaanien historiallista arvoa, kirjallisuuden tapaa murtaa kielen rakenteita ja sitä miten tämä murros kytkeytyy taideteoreettiseen muutokseen kulttuuridiskursseissa. Tutkimus tarkastelee Eltitin kehityskaarta kenraali Augusto Pinochetin sotilasvallankaappauksesta 1973 halki sotilashallituksen kauden (1973-1990) aina kansalaisyhteiskunnan vahvistumiseen ja vuoteen 1998. Tutkimus analysoi ruumiin troopeista ja metaforista koostuvaa tutkimusaineistoa lingvistiikan, kirjallisuustieteen, historian ja sukupuolen tutkimuksen monitieteisessä viitekehyksessä. Sen vuoksi väitöskirja liittyy espanjalaisen filologian, yleisen kirjallisuustieteen, Latinalaisen Amerikan tutkimuksen ja naistutkimuksen oppiaineisiin. Kolme tärkeintä oppiteoreettista runkoa ovat lingvistinen strukturalismi, dekonstruktio ja feministiset kirjallisuusteoriat. Dekonstruktiivinen lähestymistapa tekstiin korostaa kielen merkityksen muodostumisen filosofista perustaa. Se pyrkii selvittämään, miten merkitys muodostuu kirjoittajan, tekstin ja lukijan välillä. Tekstikritiikki koostuu semanttisesta ja dekonstruktiivisesta tekstianalyysistä, jonka metodologisen mallin perusta on tanskalaisen kielitieteilijän Louis Hjelmslevin (1899-1965) kielitieteellinen malli. Väitös ei käytä mallia suoraan, vaan soveltaa sitä kaunokirjallisuuden tutkimukseen. Oppiteoreettisen viitekehyksen osalta tutkimus sijoittuu strukturalismin ja poststrukturalismin murrokseen. Tutkimus korostaa Eltitin radikaalia muotokieltä ja teatraalisuutta, hänen kielensä visuaalisuutta ja ruumiin metaforien eroottista jännitettä, mikä ilmenee mm. falloksen metaforaksi tulkitun hehkuvan valon kuvissa romaanissa Lumpérica. Vanhat kreikkalaiset myytit Éros ja Thánatos kasvavat esille länsimaisen taidehistorian perinteestä ja kontekstualisoituvat uusiksi kielikuviksi Chilen kirjallisessa maaperässä. Ne muodostavat Eltitin taiteellisen tuotannon pysyvän aihepiirin ja luovat teoksiin synkkää ja karua virettä sekä tummia ja eroottisia sävyjä. Tutkimus osoittaa, että Eltit dekonstruoi kieltä, mutta dekonstruktiot eivät ole jatkuvia eivätkä samanlaisia kaikissa romaaneissa. Kielellisten dekonstruktioiden variaatio on laaja eikä Eltit murra kielen syntaktisia ja morfologisia rakenteita kaikissa teksteissään. Tutkimuksen perusteella väitän, että Eltitin kirjoituksesta puhuttaessa useat tutkijat käyttävät epämääräisesti dekonstruktio-termiä. Useiden tutkijoiden toteamus dekonstruktiosta Diamela Eltitin kirjallisessa tuotannossa pysyvänä piirteenä on epätäsmällinen. Sen sijaan dekonstruktiivinen kirjoitus tarkoittaa Eltitillä laajasti vaihtelevaa lähestymistapaa kieleen, mikä ilmenee kehityslinjana hänen tuotannossaan ja eri tavoin jokaisessa teoksessa.
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This dissertation is a study of the forms and functions of feasts and feasting in the ancient Egyptian village of Deir el-Medina in Thebes (modern Luxor). This particular village, during the New Kingdom (c. 1550 1069 BC), was inhabited by the men (and their families) who constructed the Royal Tombs in the Valley of the Kings and the Valley of the Queens. The royal artisans were probably more literate than the average Egyptians and the numerous Ramesside Period (c. 1295 1069 BC) non-literary texts found in the excavations of the village and its surroundings form the source material for this study. In this study, the methods used are mainly Egyptological and the references to feasts and feasting are considered in view of what is known of New Kingdom Egypt, Thebes, and Deir el-Medina. Nevertheless, it is the use of the methodological concept local vernacular religion that has resulted in the division of the research findings into two sections, i.e., references to feasts celebrated both in and outside the community and other references to feasts and feasting in the village. When considering the function of the feasts celebrated at Deir el-Medina, a functional approach to feasts introduced by anthropologists and archaeologists is utilized. The Deir el-Medina feasts which were associated with the official religion form a festival calendar of feasts celebrated annually on the same civil calendar day. The reconstructed festival calendar of Deir el-Medina reflects the feasts celebrated around Thebes or, at least, in Western Thebes. The function of the nationally and regionally observed feasts (which, at least at Deir el-Medina, resulted in a work-free day) may have been to keep people content so that they would continue to work which was to the advantage of the king and the elite surrounding him. Local feasts appear to have been observed more irregularly at Deir el-Medina or perhaps according to the lunar calendar. Feasts celebrated by the community as a whole served to maintain the unity of the group. In addition to feasts celebrated by the entire community, the inhabitants of Deir el-Medina could mark their own personal feasts and organize small gatherings during public feasts. Through such feasts, an individual man might form alliances and advance his chances of a favourable marriage or of acquiring a position on the work crew.
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The aim of this dissertation is to discuss the concept of choice in the most important collection of Islamic traditions, Sahih al-Bukhari. The author of the collection, Muhammad ibn Isma'il al-Bukhari, lived between 810-870. My starting point is the collection of texts as it is now in its normative, established form. I read the hadiths as pieces of reality, not as statements about reality. The historicity of the texts has no role at all in my analysis. Part I sketches out the hagiography of the life and work of the author and provides a short history of the development of hadith literature and the processes of collecting and classifying the texts are discussed briefly. Part one ends with the presentation of my way of using rhetorical analysis as a methodological tool. Part II introduces my analysis of the concept of choice. It is divided into ten chapters, each concentrating on one hadith cluster. Part II ends with a discussion of the philosophy of free will and predestination in early Islam. Hadith literature is often considered as a representative of predestinarian theology compared to the Qur'an which emphasises the reponsibility of people of their own acts. In my conclusions I suggest that accoding to the texts in Sahih al-Bukhari, people do deal with real choices in their lives. The collection includes both strictly predestinarian texts but it also compises texts which claim that people are demanded to make real choices, even choices concerning life and death.