Telling the truth: medical students' progress with an ethical skill.

BACKGROUND: Truth-telling is a complex task requiring multiple skills in communication, understanding, and empathy. Its application in the context of breaking bad news (BBN) is distressing and problematic if conducted with insufficient skills. PURPOSE: We investigated the long-term influence of a simulated patient-based teaching intervention integrating the learning of communication skills within an ethical reflection on students' ethical attitudes towards truth-telling, perceived competence and comfort in BBN. METHODS: We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year). We analysed their ethical attitudes and level of comfort and competence in BBN before, after the intervention, and during clinical rotations. RESULTS: Students' ethical attitudes towards truth-telling remained stable. Students feeling uncomfortable or incompetent improved their level of perceived comfort or competence after the intervention, but those feeling comfortable or competent became more aware of the difficulty of the situation, and consequently decreased their level of comfort and competence. CONCLUSIONS: Confronting students with a realistic situation and integrating the practice of communication skills within an ethical reflection may be effective in maintaining ethical attitudes towards truth-telling, in developing new skills and increasing awareness about the difficulty and challenges of a BBN situation.

Electric bicycles as a new active transportation modality to promote health.

GOJANOVIC, B., J. WELKER, K. IGLESIAS, C. DAUCOURT, and G. GREMION. Electric Bicycles as a New Active Transportation Modality to Promote Health. Med. Sci. Sports Exerc., Vol. 43, No. 11, pp. 2204-2210, 2011. Electrically assisted bicycles (EAB) are an emerging transportation modality favored for environmental reasons. Some physical effort is required to activate the supporting engine, making it a potential active commuting option. Purpose: We hypothesized that using an EAB in a hilly city allows sedentary subjects to commute comfortably, while providing a sufficient effort for health-enhancing purposes. Methods: Sedentary subjects performed four different trips at a self-selected pace: walking 1.7 km uphill from the train station to the hospital (WALK), biking 5.1 km from the lower part of town to the hospital with a regular bike (BIKE), or EAB at two different power assistance settings (EAB(high), EAB(std)). HR, oxygen consumption, and need to shower were recorded. Results: Eighteen sedentary subjects (12 female, 6 male) age 36 +/- 10 yr were included, with (V) over dotO(2max) of 39.4 +/- 5.4 mL.min(-1).kg(-1). Time to complete the course was 22 (WALK), 19 (EAB(high)), 21 (EAB(std)), and 30 (BIKE) min. Mean %(V) over dotO(2max) was 59.0%, 54.9%, 65.7%, and 72.8%. Mean%HR(max) was 71.5%, 74.5%, 80.3%, and 84.0%. There was no significant difference between WALK and EAB(high), but all other comparisons were different (P < 0.05). Two subjects needed to shower after EAB(high), 3 needed to shower after WALK, 8 needed to shower after EAB(std), and all 18 needed to shower after BIKE. WALK and EAB(high) elicited 6.5 and 6.1 METs (no difference), whereas it was 7.3 and 8.2 for EAB(std) and BIKE. Conclusions: EAB is a comfortable and ecological transportation modality, helping sedentary people commute to work and meet physical activity guidelines. Subjects appreciated ease of use and mild effort needed to activate the engine support climbing hills, without the need to shower at work. EAB can be promoted in a challenging urban environment to promote physical activity and mitigate pollution issues.

Helping medical students to acquire a deeper understanding of truth-telling.

PROBLEM: Truth-telling is an important component of respect for patients' self-determination, but in the context of breaking bad news, it is also a distressing and difficult task. INTERVENTION: We investigated the long-term influence of a simulated patient-based teaching intervention, integrating learning objectives in communication skills and ethics into students' attitudes and concerns regarding truth-telling. We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year). Open-ended responses were analysed to explore medical students' reported difficulties in breaking bad news. CONTEXT: This intervention was implemented during the last preclinical year of a problem-based medical curriculum, in collaboration between the doctor-patient communication and ethics programs. OUTCOME: Over time, concerns such as empathy and truthfulness shifted from a personal to a relational focus. Whereas 'truthfulness' was a concern for the content of the message, 'truth-telling' included concerns on how information was communicated and how realistically it was received. Truth-telling required empathy, adaptation to the patient, and appropriate management of emotions, both for the patient's welfare and for a realistic understanding of the situation. LESSONS LEARNED: Our study confirms that an intervention confronting students with a realistic situation succeeds in making them more aware of the real issues of truth-telling. Medical students deepened their reflection over time, acquiring a deeper understanding of the relational dimension of values such as truth-telling, and honing their view of empathy.

Truth, laws and the progress of science

In this paper I analyze the difficult question of the truth of mature scientific theories by tackling the problem of the truth of laws. After introducing the main philosophical positions in the field of scientific realism, I discuss and then counter the two main arguments against realism, namely the pessimistic meta-induction and the abstract and idealized character of scientific laws. I conclude by defending the view that well-confirmed physical theories are true only relatively to certain values of the variables that appear in the laws.

Models, truth and realism: assessing Bas van Fraassen's views on scientific representation

This paper is devoted to an analysis of some aspects of Bas van Fraassen's views on representation. While I agree with most of his claims, I disagree on the following three issues. Firstly, I contend that some isomorphism (or at least homomorphism) between the representor and what is represented is a universal necessary condition for the success of any representation, even in the case of misrepresentation. Secondly, I argue that the so-called "semantic" or "model-theoretic" construal of theories does not give proper due to the role played by true propositions in successful representing practices. Thirdly, I attempt to show that the force of van Fraassen's pragmatic - and antirealist - "dissolution" of the "loss of reality objection" loses its bite when we realize that our cognitive contact with real phenomena is achieved not by representing but by expressing true propositions about them.

A SECOND OPINION ON RELATIVE TRUTH

In 'An undermining diagnosis of relativism about truth', Horwich claims that the notion of relative truth is either explanatorily sterile or explanatorily superfluous. In the present paper, I argue that Horwich's explanatory demands set the bar unwarrantedly high: given the philosophical import of the theorems of a truth-theoretic semantic theory, Horwich's proposed explananda, what he calls acceptance facts, are too indirect for us to expect a complete explanation of them in terms of the deliverances of a theory of meaning based on the notion of relative truth. And, to the extent that there might be such an explanation in certain cases, there is no reason to expect relative truth to play an essential, ineliminable role, nor to endorse the claim that it should play such a role in order to be a theoretically useful notion.

Novel word learning ability in chronic post-stroke aphasia : variability and modality effects

Novel word learning has been rarely studied in people with aphasia (PWA), although it can provide a relatively pure measure of their learning potential, and thereby contribute to the development of effective aphasia treatment methods. The main aim of the present thesis was to explore the capacity of PWA for associative learning of word–referent pairings and cognitive-linguistic factors related to it. More specifically, the thesis examined learning and long-term maintenance of the learned pairings, the role of lexical-semantic abilities in learning as well as acquisition of phonological versus semantic information in associative novel word learning. Furthermore, the effect of modality on associative novel word learning and the neural underpinnings of successful learning were explored. The learning experiments utilized the Ancient Farming Equipment (AFE) paradigm that employs drawings of unfamiliar referents and their unfamiliar names. Case studies of Finnishand English-speaking people with chronic aphasia (n = 6) were conducted in the investigation. The learning results of PWA were compared to those of healthy control participants, and active production of the novel words and their semantic definitions was used as learning outcome measures. PWA learned novel word–novel referent pairings, but the variation between individuals was very wide, from more modest outcomes (Studies I–II) up to levels on a par with healthy individuals (Studies III–IV). In incidental learning of semantic definitions, none of the PWA reached the performance level of the healthy control participants. Some PWA maintained part of the learning outcomes up to months post-training, and one individual showed full maintenance of the novel words at six months post-training (Study IV). Intact lexical-semantic processing skills promoted learning in PWA (Studies I–II) but poor phonological short-term memory capacities did not rule out novel word learning. In two PWA with successful learning and long-term maintenance of novel word–novel referent pairings, learning relied on orthographic input while auditory input led to significantly inferior learning outcomes (Studies III–IV). In one of these individuals, this previously undetected modalityspecific learning ability was successfully translated into training with familiar but inaccessible everyday words (Study IV). Functional magnetic resonance imaging revealed that this individual had a disconnected dorsal speech processing pathway in the left hemisphere, but a right-hemispheric neural network mediated successful novel word learning via reading. Finally, the results of Study III suggested that the cognitive-linguistic profile may not always predict the optimal learning channel for an individual with aphasia. Small-scale learning probes seem therefore useful in revealing functional learning channels in post-stroke aphasia.

Influence of exercise modality on agreement between gas exchange and heart rate variability thresholds

The main purpose of this study was to investigate the level of agreement between the gas exchange threshold (GET) and heart rate variability threshold (HRVT) during maximal cardiopulmonary exercise testing (CPET) using three different exercise modalities. A further aim was to establish whether there was a 1:1 relationship between the percentage heart rate reserve (%HRR) and percentage oxygen uptake reserve (%V˙O2R) at intensities corresponding to GET and HRVT. Sixteen apparently healthy men 17 to 28 years of age performed three maximal CPETs (cycling, walking, and running). Mean heart rate and V˙O2 at GET and HRVT were 16 bpm (P<0.001) and 5.2 mL·kg-1·min-1 (P=0.001) higher in running than cycling, but no significant differences were observed between running and walking, or cycling and walking (P>0.05). There was a strong relationship between GET and HRVT, with R2 ranging from 0.69 to 0.90. A 1:1 relationship between %HRR and %V˙O2R was not observed at GET and HRVT. The %HRR was higher during cycling (GET mean difference=7%; HRVT mean difference=11%; both P<0.001), walking (GET mean difference=13%; HRVT mean difference=13%; both P<0.001), or running (GET mean difference=11%; HRVT mean difference=10%; both P<0.001). Therefore, using HRVT to prescribe aerobic exercise intensity appears to be valid. However, to assume a 1:1 relationship between %HRR and %V˙O2R at HRVT would probably result in overestimation of the energy expenditure during the bout of exercise.

Charting developmental EEG gamma changes in the auditory modality /

The oscillation of neuronal circuits reflected in the EEG gamma frequency may be fundamental to the perceptual process referred to as binding (the integration of various thoughts and perceptions into a coherent picture). The aim of our study was to expand our knowledge of the developmental course ofEEG gamma in the auditory modality. 2 We investigated EEG 40 Hz gamma band responses (35.2 to 43.0 Hz) using an auditory novelty oddball paradigm alone and with a visual-number-series distracter task in 208 participants as a function of age (7 years to adult) at 9 sites across the sagital and lateral axes (F3, Fz, F4, C3, Cz, C4, P3, Pz, P4). Gamma responses were operationally defined as change in power or a change in phase synchrony level from baseline within two time windows. The evoked gamma response was defined as a significant change from baseline occurring between 0 to 150 ms after stimulus onset; the induced gamma response was measured from 250 to 750 ms after stimulus onset. A significant evoked gamma band response was found when measuring changes in both power and phase synchrony. The increase in both measures was maximal at frontal regions. Decreases in both measures were found when participants were distracted by a secondary task. For neither measure were developmental effects noted. However, evoked gamma power was significantly enhanced with the presentation of a novel stimulus, especially at the right frontal site (F4); frontal evoked gamma phase synchrony also showed enhancement for novel stimuli but only for our two oldest age groups (16-18 year olds and adults). Induced gamma band responses also varied with task-dependent cognitive stimulus properties. In the induced gamma power response in all age groups, target stimuli generated the highest power values at the parietal region, while the novel stimuli were always below baseline. Target stimuli increased induced synchrony in all regions for all participants, but the novel stimulus selectively affected participants dependent on their age and gender. Adult participants, for example, exhibited a reduction in gamma power, but an increase in synchrony to the novel stimulus within the same region. Induced gamma synchrony was more sensitive to the gender of the participant than was induced gamma power. While induced gamma power produced little effects of age, gamma synchrony did have age effects. These results confirm that the perceptual process which regulates gamma power is distinct from that which governs the synchronization for neuronal firing, and both gamma power and synchrony are important factors to be considered for the "binding" hypothesis. However, there is surprisingly little effect of age on the absolute levels of or distribution of EEG gamma in the age range investigated.

Opening truth to imagination : the pragmatism of John Dewey and Richard Rorty

This study explores in a comparative way the works of two American pragmatist philosophers-John Dewey and Richard Rorty. I have provided a reading of their broader works in order to offer what I hope is a successful sympathetic comparison where very few exist. Dewey is often viewed as the central hero in the classical American pragmatic tradition, while Rorty, a contemporary pragmatist, is viewed as some sort of postmodern villain. I show that the different approaches by the two philosophers-Dewey's experiential focus versus Rorty's linguistic focus-exist along a common pragmatic continuum, and that much of the critical scholarship that pits the two pragmatists against each other has actually created an unwarranted dualism between experience and language. I accomplish this task by following the critical movement by each of the pragmatists through their respective reworking of traditional absolutist truth conceptions toward a more aesthetical, imaginative position. I also show how this shift or "turning" represents an important aspect of the American philosophical tradition-its aesthetic axis. I finally indicate a role for liberal education (focusing on higher nonvocational education) in accommodating this turning, a turning that in the end is necessitated by democracy's future trajectory

Method and truth in MÄ dhyamika

Abstract The study was undertaken to identify what motivates registered nurses to participate in continuing education activities. The primary questions were whether basic nursing education, employment status, clinical area, and position, as well as readiness for selfdirected learning influenced Canadian nurses' motivational orientations when deciding to participate in continuing education activities. Other individual differences (e.g., age) were also examined. The sample included 142 registered nurses employed at an urban community hospital. Three instruments were used for data collection: the Education Participation Scale, the Self-Directed Learning Readiness Scale, and a nursing survey consisting of demographic questions. Basic nursing education and employment status did not effect motivational orientation or self-directed learning readiness. Clinical area and level of position significantly influenced nurses' decisions to participate in continuing education activities. Motivational orientation had a significant relationship with selfdirected learning readiness. Implications for practice as a result of this study involves program planning and delivery. The identification of the motivational orientations of participants may assist in the development and delivery of continuing education programs that are beneficial, relevant, and address the identified learning needs of participants. Implications for future research also exist in relation to studying different groups of nurses, for example, registered nursing assistants, and investigating related issues, for example, what are the deterrents to participation in continuing education?

Truth and justice: Gen. Bernardo Reyes and his detractors.

UANL