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Introduction: Poor communication is a leading root cause of preventable maternal mortality in the United States. Communication challenges are compounded with the presence of biases, including racism. Hospital administrators and clinicians are often aware that communication is a problem, but understanding where to intervene can be difficult to determine. While clinical leadership routinely reviews incident reports and acts on them to improve care, we hypothesized that reviewing incident reports in a systematic way might reveal thematic patterns, providing targeted opportunities to improve communication in direct interaction with patients and within the healthcare team itself. Methods: We abstracted incident reports from the Women's Health service and linked them with patient charts to join patient's race/ethnicity, birth outcome, and presence of maternal morbidity and mortality to the incident report. We conducted a qualitative content analysis of incident reports using an inductive and deductive approach to categorizing communication challenges. We then described the intersection of different types of communication challenges with patient race/ethnicity and morbidity outcomes. Results: The use of incident reports to conduct research on communication was new for the health system. Conversations with health system‐level stakeholders were important to determine the best way to manage data. We developed a thematic codebook based on prior research in healthcare communication. We found that we needed to add codes that were equity focused, as this was missing from the existing codebook. We also found that clinical and contextual expertise was necessary for conducting the analysis—requiring more resources to conduct coding than initially estimated. We shared our findings back with leadership iteratively during the work. Conclusions: Incident reports represent a promising source of health system data for rapid improvement to transform organizational practice around communication. There are barriers to conducting this work in a rapid manner, however, that require further iteration and innovation. [ABSTRACT FROM AUTHOR]

Establishing and maintaining mutual understanding in everyday conversations is crucial. To do so, people employ a variety of conversational devices, such as backchannels, repair, and linguistic entrainment. Here, we explore whether the use of conversational devices might be influenced by cross-linguistic differences in the speakers' native language, comparing two matched languages-Danish and Norwegian-differing primarily in their sound structure, with Danish being more opaque, that is, less acoustically distinguished. Across systematically manipulated conversational contexts, we find that processes supporting mutual understanding in conversations vary with external constraints: across different contexts and, crucially, across languages. In accord with our predictions, linguistic entrainment was overall higher in Danish than in Norwegian, while backchannels and repairs presented a more nuanced pattern. These findings are compatible with the hypothesis that native speakers of Danish may compensate for its opaque sound structure by adopting a top-down strategy of building more conversational redundancy through entrainment, which also might reduce the need for repairs. These results suggest that linguistic differences might be met by systematic changes in language processing and use. This paves the way for further cross-linguistic investigations and critical assessment of the interplay between cultural and linguistic factors on the one hand and conversational dynamics on the other., (© 2023 Cognitive Science Society LLC.)

Languages show substantial variability between their speakers, but it is currently unclear how the structure of the communicative network contributes to the patterning of this variability. While previous studies have highlighted the role of network structure in language change, the specific aspects of network structure that shape language variability remain largely unknown. To address this gap, we developed a Bayesian agent-based model of language evolution, contrasting between two distinct scenarios: language change and language emergence. By isolating the relative effects of specific global network metrics across thousands of simulations, we show that global characteristics of network structure play a critical role in shaping interindividual variation in language, while intraindividual variation is relatively unaffected. We effectively challenge the long-held belief that size and density are the main network structural factors influencing language variation, and show that path length and clustering coefficient are the main factors driving interindividual variation. In particular, we show that variation is more likely to occur in populations where individuals are not well-connected to each other. Additionally, variation is more likely to emerge in populations that are structured in small communities. Our study provides potentially important insights into the theoretical mechanisms underlying language variation., (© 2024 Cognitive Science Society LLC.)

When interlocutors repeatedly describe referents to each other, they rapidly converge on referring expressions which become increasingly systematized and abstract as the interaction progresses. Previous experimental research suggests that interactive repair mechanisms in dialogue underpin convergence. However, this research has so far only focused on the role of other-initiated repair and has not examined whether self-initiated repair might also play a role. To investigate this question, we report the results from a computer-mediated maze task experiment. In this task, participants communicate with each other via an experimental chat tool, which selectively transforms participants' private turn-revisions into public self-repairs that are made visible to the other participant. For example, if a participant, A, types "On the top square," and then before sending, A revises the turn to "On the top row," the server automatically detects the revision and transforms the private turn-revisions into a public self-repair, for example, "On the top square umm I meant row." Participants who received these transformed turns used more abstract and systematized referring expressions, but performed worse at the task. We argue that this is due to the artificial self-repairs causing participants to put more effort into diagnosing and resolving the referential coordination problems they face in the task, yielding better grounded spatial semantics and consequently increased use of abstract referring expressions., (© 2023 The Authors. Cognitive Science published by Wiley Periodicals LLC on behalf of Cognitive Science Society (CSS).)

Humans can attribute beliefs to others. However, it is unknown to what extent this ability results from an innate biological endowment or from experience accrued through child development, particularly exposure to language describing others' mental states. We test the viability of the language exposure hypothesis by assessing whether models exposed to large quantities of human language display sensitivity to the implied knowledge states of characters in written passages. In pre-registered analyses, we present a linguistic version of the False Belief Task to both human participants and a large language model, GPT-3. Both are sensitive to others' beliefs, but while the language model significantly exceeds chance behavior, it does not perform as well as the humans nor does it explain the full extent of their behavior-despite being exposed to more language than a human would in a lifetime. This suggests that while statistical learning from language exposure may in part explain how humans develop the ability to reason about the mental states of others, other mechanisms are also responsible., (© 2023 The Authors. Cognitive Science published by Wiley Periodicals LLC on behalf of Cognitive Science Society (CSS).)

Inspired by early proposals in philosophy, dominant accounts of language posit a central role for mutual knowledge, either encoded directly in common ground, or approximated through other cognitive mechanisms. Using existing empirical evidence from language and memory, we challenge this tradition, arguing that mutual knowledge captures only a subset of the mental states needed to support communication. In a novel theoretical proposal, we argue for a cognitive architecture that includes separate, distinct representations of the self and other, and a cognitive process that compares these representations continuously during conversation, outputting both similarities and differences in perspective. Our theory accounts for existing data, interfaces with findings from other cognitive domains, and makes novel predictions about the role of perspective in language use. We term this new account the Multiple Perspectives Theory of mental states in communication., (© 2023 The Authors. Cognitive Science published by Wiley Periodicals LLC on behalf of Cognitive Science Society (CSS).)

Are there individual tendencies in convergence, such that some speakers consistently converge more than others? Similarly, are there natural "leaders," speakers with whom others converge more? Are such tendencies consistent across different linguistic characteristics? We use the Switchboard Corpus to perform a large-scale convergence study of speakers in multiple conversations with different interlocutors, across six linguistic characteristics. Because each speaker participated in several conversations, it is possible to look for individual differences in speakers' likelihood of converging and interlocutors' likelihood of eliciting convergence. We only find evidence for individual differences by interlocutor, not by speaker: There are natural leaders of convergence, who elicit more convergence than others across characteristics and across conversations. The lack of similar evidence for speakers who converge more than others suggests that social factors have a stronger effect in mediating convergence than putative individual tendencies in producing convergence, or that such tendencies are characteristic-specific., (© 2020 Cognitive Science Society, Inc.)

We investigate the extent to which pragmatic versus conceptual factors can affect a speaker's decision to mention or omit different components of an event. In the two experiments, we demonstrate the special role of pragmatic factors related to audience design in speakers' decisions to mention conceptually "peripheral" event components, such as sources (i.e., starting points) in source-goal motion events (e.g., a baby crawling from a crib to a toybox). In particular, we found that pragmatic factors related to audience design could not only drive the decision to omit sources from mention, but could also motivate speakers to mention sources more often than needed. By contrast, speaker's decisions to talk about goals did not appear to be fundamentally driven by pragmatic factors in communication. We also manipulated the animacy of the figure in motion and found that participants in our studies treated both animate and inanimate source-goal motion events in the same way, both linguistically and in memory. We discuss the implications of our work for message generation across different communicative contexts and for future work on the topic of audience design., (© 2021 Cognitive Science Society LLC.)

It is widely held that there are important differences between indicative conditionals (e.g., "If the authors are linguists, they have written a linguistics paper") and subjunctive conditionals (e.g., "If the authors had been linguists, they would have written a linguistics paper"). A central difference is that indicatives and subjunctives convey different stances toward the truth of their antecedents. Indicatives (often) convey neutrality: for example, about whether the authors in question are linguists. Subjunctives (often) convey the falsity of the antecedent: for example, that the authors in question are not linguists. This paper tests prominent accounts of how these different stances are conveyed: whether by presupposition or conversational implicature. Experiment 1 tests the presupposition account by investigating whether the stances project-remain constant-when embedded under operators like negations, possibility modals, and interrogatives, a key characteristic of presuppositions. Experiment 2 tests the conversational-implicature account by investigating whether the stances can be cancelled without producing a contradiction, a key characteristic of implicatures. The results provide evidence that both stances-neutrality about the antecedent in indicatives and the falsity of the antecedent in subjunctives-are conveyed by conversational implicatures., (© 2021 The Authors. Cognitive Science published by Wiley Periodicals LLC on behalf of Cognitive Science Society (CSS).)

Aim: To synthesize suicide prevention strategies for older adults. The review question was Which suicide prevention strategies are useful for older adults? Design: Integrative review. Data sources: Academic Search Premier, CINAHL, Ovid PsycINFO and PubMed were searched for articles published between January 2009 and December 2019. Review methods: An integrative review of quantitative, qualitative and theoretical papers with a qualitative thematic analysis. Results: Key aspects of the included studies contributed to the formulation of four themes: (1) Recognizing older adults' physical and/or mental health problems and referring them for help and treatment, (2) Designing an educational programme, (3) Communication and dialogue about warning signs and (4) Social support and awareness of causing significant others emotional pain. The findings indicate an urgent need to identify effective suicide prevention strategies for older adults. [ABSTRACT FROM AUTHOR]

The language we use over the course of conversation changes as we establish common ground and learn what our partner finds meaningful. Here we draw upon recent advances in natural language processing to provide a finer-grained characterization of the dynamics of this learning process. We release an open corpus (>15,000 utterances) of extended dyadic interactions in a classic repeated reference game task where pairs of participants had to coordinate on how to refer to initially difficult-to-describe tangram stimuli. We find that different pairs discover a wide variety of idiosyncratic but efficient and stable solutions to the problem of reference. Furthermore, these conventions are shaped by the communicative context: words that are more discriminative in the initial context (i.e., that are used for one target more than others) are more likely to persist through the final repetition. Finally, we find systematic structure in how a speaker's referring expressions become more efficient over time: Syntactic units drop out in clusters following positive feedback from the listener, eventually leaving short labels containing open-class parts of speech. These findings provide a higher resolution look at the quantitative dynamics of ad hoc convention formation and support further development of computational models of learning in communication., (© 2020 Cognitive Science Society, Inc.)

Since its inception, Shannon's information theory has attracted interest for the study of language and music. Recently, a wide range of converging studies have shown how efficient communication pervades language, from phonetics to syntax. Efficient principles imply that more resources should be assigned to highly informative items. For instance, average information content was shown to be a better predictor of word length than frequency, revisiting the famous Zipf's law. However, in spite of the success of the efficient communication framework in the study of language and speech, very little work has investigated its relevance in the analysis of music. Here, we examine the organization of harmonic information in two large corpora of Western music, one made of MIDI files directly sequenced from scores, and the other made of MIDI recordings of live performances of highly skilled piano players. We show that there is a clear positive relationship between (contextual) information content of harmonic sequences and two essential musical properties, namely duration and loudness: the more unexpected a harmonic event is, the longer and the louder it is., (© 2020 Cognitive Science Society, Inc.)

A pragmatic account of referential communication is developed which presents an alternative to traditional Gricean accounts by focusing on cooperativeness and efficiency, rather than informativity. The results of four language-production experiments support the view that speakers can be cooperative when producing redundant adjectives, doing so more often when color modification could facilitate the listener's search for the referent in the visual display (Experiment 1a). By contrast, when the listener knew which shape was the target, speakers did not produce redundant color adjectives (Experiment 1b). English speakers used redundant color adjectives more often than Spanish speakers, suggesting that speakers are sensitive to the differential efficiency of prenominal and postnominal modification (Experiment 2). Speakers were also cooperative when using redundant size adjectives (Experiment 3). Overall, these results show how discriminability affects a speaker's choice of referential expression above and beyond considerations of informativity, supporting the view that redundant speakers can be cooperative., (© 2019 The Authors. Cognitive Science published by Wiley Periodicals, Inc. on behalf of Cognitive Science Society (CSS).)

Coordination between speakers in dialogue requires balancing repetition and change, the old and the new. Interlocutors tend to reuse established forms, relying on communicative precedents. Yet linguistic interaction also necessitates adaptation to changing contexts or dynamic tasks, which might favor abandoning existing precedents in favor of better communicative alternatives. We explored this tension using a maze game task in which individual participants and interacting pairs had to describe figures and their positions in one of two possible maze types: a regular maze, in which the grid-like structure of the maze is highlighted, and an irregular maze, in which specific parts of the maze are salient. Participants repeated this task several times. Both individuals and interacting pairs were affected by the different maze layouts, initially using more idiosyncratic description schemes for irregular mazes and more systematic schemes for regular mazes. Interacting pairs, but not individuals, abandoned their unsystematic initial descriptions in favor of a more systematic approach, which was better adapted for repeated interaction. Our results show communicative conventions are initially shaped by context, but interaction opens up the possibility for change if better alternatives are available., (© 2019 Cognitive Science Society, Inc.)

Aim: To explore how the expression of positive emotions during the interaction between patients and providers can cultivate the patient‐provider relationship. Design: We conducted a realist review guided by the Realist and Meta‐narrative Evidence Syntheses: Evolving Standards. Methods: We systematically searched CINAHL, MEDLINE, PsychINFO and Scopus from inception to March 2019. Study selection and data extraction were performed blinded in pairs. From 3146 abstracts blinded in pairs, 15 papers were included and analysed. From each included paper, we extracted contexts, mechanisms and outcomes that were relevant to answer our research questions, creating a configuration between these elements (CMO configuration). Results: Our findings suggest that in the contexts of person orientation and positive outlook, patient‐provider relationships improve by communication conveying and eliciting positive emotions. We found six underlying mechanisms for this that form either direct or indirect pathways between the context and the outcome. [ABSTRACT FROM AUTHOR]

Introduction: This paper provides a critical reflection from both the researcher and public contributor (PC) perspective on the benefits and the learnings taken from involving PCs in research related to Parkinson's. Approach to Patient and Public Involvement (PPI): This paper reports on how PCs shaped the design and development of the PRIME‐UK research programme study materials through input into information leaflets, consent forms and other patient‐facing documents used across three studies within the PRIME‐UK research programme. The PRIME‐UK research programme is designed to improve the quality of life of people with Parkinson's and this project included three studies: a cross‐sectional study, a randomised control trial and a qualitative study. We captured these impacts using Public Involvement Impact Logs, which provide a framework allowing researchers and PCs to report on the learnings, immediate outcomes and impacts from PPI. For this project, the impact logs enabled us to provide reflections from PCs and researchers on the process of involving 'the public' in Parkinson's research. Findings: This paper builds on existing evidence of the range of benefits and challenges that emerge from working with patients and the public in Parkinson's research; this includes reflecting on the changes made to the study materials and benefits for the people involved. Four themes emerged from the reflections that were common to the researchers and PCs; these were the importance of providing a supportive environment; recognition of the benefit of the evaluation of the impact of PPI; acknowledgement that engagement of PPI can make a positive difference to the research process and that timely communication and the use of face‐to‐face communication, where available, is key. Furthermore, we demonstrate how impact logs provide a useful and straightforward tool for evaluating public involvement practices and supporting the feedback process. Conclusion: We offer key recommendations for involving patients and the public in Parkinson's research and suggest approaches that could be implemented to capture the impacts of public involvement. Public Contribution: Public contributors (PCs) were involved in the design and development of the participant information leaflets, consent forms and other patient‐facing documents used for studies within the PRIME‐UK research programme. In addition, PCs evaluated their involvement using impact logs and co‐authored this paper. [ABSTRACT FROM AUTHOR]

Background: Liver disease is a growing health concern and a major cause of death. It causes multiple symptoms, including financial, psychological and social issues. To address these challenges, palliative care can support people alongside active treatment, and towards the end of life, but little is known about the care experiences of individuals with liver disease in the United Kingdom. This review aimed to explore the palliative and end‐of‐life care experiences of people with liver disease in the United Kingdom. Method: A systematic review was conducted using a five‐stage process and following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. Searches were across Web of Science, Scopus, EBSCO and grey literature until 10 May 2023. The review was registered through International Prospective Register of Systematic Reviews (PROSPERO). NVivo 12.5 was used to facilitate data analysis (systematic review registration: PROSPERO CRD42022382649). Results: Of 6035 papers (excluding duplicates) found from searches, five met the inclusion criteria of primary research related to adults with liver disease receiving palliative and/or end‐of‐life care in the United Kingdom, published in English. Reflexive thematic analysis of the data was conducted. The themes identified were the experiences of people with liver disease of relating to healthcare professionals, using services, receiving support, and experiences of information and communication. These were connected by an overarching concept of disempowerment versus empowerment, with the notion of person‐centred care as an important feature. Conclusion: This review has found variations in the care experiences of people with advanced liver disease towards the end of life and an overall lack of access to specialist palliative care services. Where services are designed to be person‐centred, experiences are more empowering. Further research is needed but with recognition that it is often unclear when care for people with liver disease is palliative or end‐of‐life. Patient and Public Contribution: An online public involvement workshop was held on 18 April 2023 through Voice (2023). This included four people with liver disease and four carers to discuss the review findings and to design a qualitative research study to further explore the topic. [ABSTRACT FROM AUTHOR]

When people talk about kinship systems, they often use co-speech gestures and other representations to elaborate. This paper investigates such polysemiotic (spoken, gestured, and drawn) descriptions of kinship relations, to see if they display recurring patterns of conventionalization that capture specific social structures. We present an exploratory hypothesis-generating study of descriptions produced by a lesser-known ethnolinguistic community to the cognitive sciences: the Paamese people of Vanuatu. Forty Paamese speakers were asked to talk about their family in semi-guided kinship interviews. Analyses of the speech, gesture, and drawings produced during these interviews revealed that lineality (i.e., mother's side vs. father's side) is lateralized in the speaker's gesture space. In other words, kinship members of the speaker's matriline are placed on the left side of the speaker's body and those of the patriline are placed on their right side, when they are mentioned in speech. Moreover, we find that the gesture produced by Paamese participants during verbal descriptions of marital relations are performed significantly more often on two diagonal directions of the sagittal axis. We show that these diagonals are also found in the few diagrams that participants drew on the ground to augment their verbo-gestural descriptions of marriage practices with drawing. We interpret this behavior as evidence of a spatial template, which Paamese speakers activate to think and communicate about family relations. We therefore argue that extending investigations of kinship structures beyond kinship terminologies alone can unveil additional key factors that shape kinship cognition and communication and hereby provide further insights into the diversity of social structures., (© 2024 The Author(s). Cognitive Science published by Wiley Periodicals LLC on behalf of Cognitive Science Society (CSS).)

Introduction: To guide good practices in patient and public involvement (PPI), several calls have been made to share detailed accounts of practical experiences. We describe our collaboration with young people with a chronic condition (YPCC) in the development, testing and implementation of the digital communication tool MyBoT (Map your Burden of Treatment). Methods: MyBoT was developed by a team of academic researchers, some of whom were practising care providers, YPCC and designers. In addition to the two co‐researchers in the research team, various groups of YPCC were involved in decision‐making through participation in a design session, workshops and a dialogue session. The Involvement Matrix was used to reflect on the PPI of all YPCC. Results: Initially, the two co‐researchers were involved in the roles of informer and co‐thinker, but their decision‐making power within the study increased over time. In the final stages of the study, the co‐researchers and researchers became partners. The other YPCC who participated in the different sessions and workshops were co‐thinkers in all stages of the study. Conclusion: The PPI of two YPCCs as co‐researchers within the research team ensured continuous involvement, whereas the PPI of various groups of YPCCs guaranteed a representative and inclusive approach. Researchers play an essential role in bringing all perspectives together, integrating them within the technical and financial constraints and ultimately building a tool that is tailored to its users' needs. Patient or Public Contribution: YPCC played a significant role in the present study. Two YPCC—who are also co‐authors of this paper—were involved in all stages of this project as members of the research team. In addition, various YPCCs were involved in the development, testing and implementation stage of MyBoT by organizing design sessions, workshops and a dialogue session. [ABSTRACT FROM AUTHOR]

The present study aims to explore the forms paternalistic communication can take in doctor-patient interactions and how they should be considered from a normative perspective. In contemporary philosophical debate, the problem with paternalism is often perceived as either undermining autonomy (the autonomy problem) or the paternalist viewing their judgment as superior (the superiority problem). In either case, paternalism is problematized mainly in a general, theoretical sense. In contrast, this paper investigates specific doctor-patient encounters, revealing distinct types of paternalistic communication. For this study, I reviewed videorecorded encounters from a Norwegian hospital to detect paternalism-specifically, doctors overriding patients' expressed preferences, presumably to benefit or protect the patients. I identified variations in paternalistic communication styles-termed paternalist modes-which I categorized into four types: the fighter, the advocate, the sympathizer, and the fisher. Drawing on these findings, I aim to nuance the debate on paternalism. Specifically, I argue that each paternalist mode carries its own normative implications and that the autonomy and the superiority problems manifest differently across the modes. Furthermore, by illustrating paternalism in communication through real-life cases, I aim to reach a more comprehensive understanding of what we mean by paternalistic doctors., (© 2024 The Authors. Bioethics published by John Wiley & Sons Ltd.)

Background: Involving consumers in systematic reviews can make them more valuable and help achieve goals around transparency. Systematic reviews are technically complex and training can be needed to enable consumers to engage with them fully. The Cochrane Common Mental Disorders group sought to engage people with lived experience of mental health problems in the Voice of Experience College, three workshops introducing them to systematic review methods and to opportunities to contribute as Cochrane consumers. We aimed to collectively evaluate the College from the perspective of both facilitators and consumers, to critically reflect on the experience, and to identify how the College could be sustained and spread to other review groups. Methods: This study was a longitudinal qualitative and collaborative evaluation, structured around normalisation process theory. Both facilitators and consumers were involved in not only providing their perspectives but also reflecting on these together to identify key learning points. Results: The workshops were positively evaluated as being engaging and supportive, largely due to the relational skills of the facilitators, and their willingness to engage in joint or two‐way learning. The College suffered from a lack of clarity over the role of consumers after the College itself, with a need for greater communication to check assumptions and clarify expectations. This was not achieved due to pandemic disruptions, which nevertheless demonstrated that resources for involvement were not prioritised as core business during this period. Conclusions: Soft skills around communication and support are crucial to effective consumer engagement. Sustaining involvement requires sustained communication and opportunities to reflect together on opportunities and challenges. This requires committed resources to ensure involvement activity is prioritised. This is critical as negative experiences later in the involvement journey can undermine originally positive experiences if contributors are unclear as to what their involvement can lead to. Open discussions about this are necessary to avoid conflicting assumptions. The spread of the approach to other review groups could be achieved by flexibly adapting to group‐specific resources and settings, but maintaining a core focus on collaborative relationships as the key mechanism of engagement. Patient and Public Contribution: Public contributors were collaborators throughout the evaluation process and have co‐authored the paper. [ABSTRACT FROM AUTHOR]

Background: Patients with advanced incurable cancer face difficult decisions about palliative treatment options towards their end of life. However, they are often not provided with the appropriate information and support that is needed to make informed decisions. This review aimed to identify contexts and mechanisms associated with communication tools, patient decision‐aids and shared decision‐making (SDM) approaches that influence patient outcomes. Methods: We used a realist review method to search for published studies of patients (adults > 18) with advanced cancer who were expected to make a decision about palliative treatment and/or supportive care in consultation with healthcare practitioners. We appraised and synthesised literature describing the contexts of (when and how) decision aids and SDM approaches are used, and how these contexts interact with mechanisms (resources and reasoning) which impact patient outcomes. Stakeholders including academics, palliative healthcare professionals (HCPs) and people with lived experience of supporting people with advanced incurable cancer contributed to identifying explanatory accounts. These accounts were documented, analysed and consolidated to contribute to the development of a programme theory. Results: From the 33 included papers, we consolidated findings into 20 explanatory accounts to develop a programme theory that explains key contexts and mechanisms that influence patient and SDM. Contexts include underlying patients' and HCPs' attitudes and approaches. These need to be understood in relation to key mechanisms, including presenting information in multiple formats and providing adequate time and opportunities to prepare for and revisit decisions. Contexts influenced mechanisms which then influence the levels of patient decisional satisfaction, conflict and regret. Conclusions: Our programme theory highlights mechanisms that are important in supporting shared treatment decisions for advanced noncurative cancer. The findings are informative for developing and evaluating interventions to improve understanding and involvement in SDM for patients with advanced incurable cancer. Patient and Public Contribution: We included patient and public involvement (PPI) representatives in four stakeholder meetings. PPI helped to define the scope of the review, identify their unique experiences and perspectives, synthesise their perspectives with our review findings, make decisions about which theories we included in our programme theory and develop recommendations for policy and practice and future research. [ABSTRACT FROM AUTHOR]

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When attempting to manage a large social system, it is necessary to have an overview of how the society functions and how economic theories describe this functioning. Recent discussions of higher orders of cybernetics are helping to define a multi‐disciplinary, multi‐level point of view. Knowledge from several disciplines is needed—systems science, management, engineering, cognitive studies and the various social science disciplines all have contributions to make. In this paper, we apply cybernetic ideas to further develop economic theories. The paper also uses economics to illustrate ideas in cybernetics. Similar thinking can be applied to other disciplines thus advancing the unification of science. The paper illustrates a transdisciplinary approach to knowledge development. The implications of the paper are improved understanding among scholars from several disciplines. The intent is to expand the range of conceptual possibilities available for problem‐solving. [ABSTRACT FROM AUTHOR]

In his critique of Luhmann's sociology, Habermas (1987) argued that individuation and socialization are possible on the basis of linguistic structures. This critique touches the blind spot of sociological systems theory as a meta-biology. Whereas the paradigm shift from action theory towards communication theory was fully reflected in Luhmann's sociology, the difference between the self-organization of social systems and the autopoiesis of biological systems remained underspecified. Social systems allow for communication about observations from within the system and/or from another perspective. Observers are able to participate both in the variation and in the selection; Giddens (1976) introduced in this context the metaphor of a ‘double hermeneutics’. Through language the distinction between uncertainty and meaningful information is communicated reflexively, and the consequent codification may be changed without becoming confused. The implied communicative competences can be specified from the perspective of communication theory. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Interdisciplinary teams are on the rise as scientists attempt to address complex environmental issues. While the benefits of team science approaches are clear, researchers often struggle with its implementation, particularly for new team members. The challenges of large projects often weigh on the most vulnerable members of a team: trainees, including undergraduate students, graduate students, and post‐doctoral researchers. Trainees on big projects have to navigate their role on the team, with learning project policies, procedures, and goals, all while also training in key scientific tasks such as co‐authoring papers. To address these challenges, we created and participated in a project‐specific, graduate‐level team science course. The purposes of this course were to: (1) introduce students to the goals of the project, (2) build trainees' understanding of how big projects operate, and (3) allow trainees to explore how their research interests dovetailed with the overall project. Additionally, trainees received training regarding: (1) diversity, equity & inclusion, (2) giving and receiving feedback, and (3) effective communication. Onboarding through the team science course cultivated psychological safety and a collaborative student community across disciplines and institutions. Thus, we recommend a team science course for onboarding students to big projects to help students establish the skills necessary for collaborative research. Project‐based team science classes can benefit student advancement, enhance the productivity of the project, and accelerate the discovery of solutions to ecological issues by building community, establishing a shared project vocabulary, and building a workforce with collaborative skills to better answer ecological research questions. [ABSTRACT FROM AUTHOR]

Despite its public visibility and impact on policy, the activity of expert communication rarely receives more than a passing mention in codes of scientific integrity. This paper makes the case for an ethics of expert communication, introducing a framework where expert communication is represented as an intrinsically ethical activity of a deliberative agent. Ethical expert communication cannot be ensured by complying with various requirements, such as restricting communications to one's area of expertise or disclosing conflicts of interest. Expert communication involves morally laden trade-offs that must be weighed by a deliberative agent. A basic normative framework is introduced, and concrete provisions are proposed for codes of scientific integrity., (© 2023 The Authors. Bioethics published by John Wiley & Sons Ltd.)

In recent years, a multitude of datasets of human-human conversations has been released for the main purpose of training conversational agents based on data-hungry artificial neural networks. In this paper, we argue that datasets of this sort represent a useful and underexplored source to validate, complement, and enhance cognitive studies on human behavior and language use. We present a method that leverages the recent development of powerful computational models to obtain the fine-grained annotation required to apply metrics and techniques from Cognitive Science to large datasets. Previous work in Cognitive Science has investigated the question-asking strategies of human participants by employing different variants of the so-called 20-question-game setting and proposing several evaluation methods. In our work, we focus on GuessWhat, a task proposed within the Computer Vision and Natural Language Processing communities that is similar in structure to the 20-question-game setting. Crucially, the GuessWhat dataset contains tens of thousands of dialogues based on real-world images, making it a suitable setting to investigate the question-asking strategies of human players on a large scale and in a natural setting. Our results demonstrate the effectiveness of computational tools to automatically code how the hypothesis space changes throughout the dialogue in complex visual scenes. On the one hand, we confirm findings from previous work on smaller and more controlled settings. On the other hand, our analyses allow us to highlight the presence of "uninformative" questions (in terms of Expected Information Gain) at specific rounds of the dialogue. We hypothesize that these questions fulfill pragmatic constraints that are exploited by human players to solve visual tasks in complex scenes successfully. Our work illustrates a method that brings together efforts and findings from different disciplines to gain a better understanding of human question-asking strategies on large-scale datasets, while at the same time posing new questions about the development of conversational systems., (© 2023 The Authors. Cognitive Science published by Wiley Periodicals LLC on behalf of Cognitive Science Society (CSS).)

Objective: This article addresses the persistent challenge of Delayed Hospital Discharge (DHD) and aims to provide a comprehensive overview, synthesis, and actionable, sustainable plan based on the synthesis of the systematic review articles spanning the past 24 years. Our research aims to comprehensively examine DHD, identifying its primary causes and emphasizing the significance of effective communication and management in healthcare settings. Methods: We conducted the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) method for synthesizing findings from 23 review papers published over the last two decades, encompassing over 700 studies. In addition, we employed a practical and comprehensive framework to tackle DHD. Rooted in Linderman's model, our approach focused on continuous process improvement (CPI), which highlights senior management commitment, technical/administrative support, and social/transitional care. Our proposed CPI method comprised several stages: planning, implementation, data analysis, and adaptation, all contributing to continuous improvement in healthcare delivery. This method provided valuable insights and recommendations for addressing DHD challenges. Findings: Our DHD analysis revealed crucial insights across multiple dimensions. Firstly, examining causes and interventions uncovered issues such as limited discharge destinations, signaling unsustainable solutions, and inefficient care coordination. The second aspect explored the patient and caregiver experience, emphasizing challenges linked to staff uncertainty and negative physical environments, with notable attention to the underexplored area of caregiver experience. The third theme explored organizational and individual factors, including cognitive impairment and socioeconomic influences. The findings emphasized the importance of incorporating patients' data, recognizing its complexity and current avoidance. Finally, the role of transitional and social care and financial strategies was scrutinized, emphasizing the need for multicomponent, context‐specific interventions to address DHD effectively. Conclusion: This study addresses gaps in the literature, challenges prevailing solutions, and offers practical pathways for reducing DHD, contributing significantly to healthcare quality and patient outcomes. The synthesis introduces the vital CPI stage, enhancing Linderman's work and providing a pragmatic framework to eradicate delayed discharge. Future efforts will address practitioner consultations to enhance perspectives and further enrich the study. Patient or Public Contribution: Our scoping review synthesizes and analyzes existing systematic review articles and emphasizes offering practical, actionable solutions. While our approach does not directly engage patients, it strategically focuses on extracting insights from the literature to create a CPI framework. This unique aspect is intentionally designed to yield tangible benefits for patients, service users, caregivers, and the public. Our actionable recommendations aim to improve hospital discharge processes for better healthcare outcomes and experiences. This detailed analysis goes beyond theoretical considerations and provides a practical guide to improve healthcare practices and policies. [ABSTRACT FROM AUTHOR]

An important cause of stunting is limited consumption of complementary foods, in terms of both quantities and nutrients. Although existing studies show a positive association between fathers' engagement and children's diet, programmes designed to improve complementary feeding practices often only target mothers. In response to this, maternal behaviour change communication (BCC), paternal BCC and food voucher programmes were designed and implemented in Ethiopia using a clustered randomized controlled trial design. The paternal BCC programme included gender‐equal messages to increase fathers' participation in childcare, household labour and decision making. The research reported in this paper is an examination of the BCC programmes, characterizing the behavioural, normative and control beliefs of both mothers and fathers in BCC households compared to those in control households. In this study, a total of 40 participants were included, with 13 mother–father pairs in the BCC + food voucher group, and seven pairs in the control group. Each participant was interviewed separately. We found that BCC mothers showed more gender‐equal tendencies than the control mothers despite being more rural in location. By contrast, the beliefs of BCC and control fathers were similar overall, suggesting men are more resistant to gender‐equal BCC. More work is needed to develop and test effective methods for changing fathers' beliefs and practices. Key messages: Mothers in behaviour change communication (BCC) group mothers held more gender‐equal beliefs than control mothers, while BCC and control fathers shared similar views, suggesting a male resistance to gender equality.Mothers found fathers' involvement in childcare socially acceptable but often perceived them as inexperienced, which limited their participation.Control mothers' traditional view on household chores maintained the conventional labour division, influencing fathers' involvement.Fathers typically resisted maternal control of resources; however, they agreed that the more knowledgeable should lead decision‐making. BCC mothers showed greater confidence in making household decisions as effectively as fathers. [ABSTRACT FROM AUTHOR]

The paper reviews the evolution of Interactive Management, later referred to as Structured Democratic Dialogue, starting from the early 1970s up to this date. The authors propose a generational classification scheme consisting of five periods based primarily on whether some or all stages of the process were implemented synchronously or asynchronously and whether the participants' presence was physical, virtual or hybrid. Other aspects such as modifications in the steps of the process; the evolution of the software; domains of applications; file management; methods of collecting or recording contributions, votes, clarifications and preparation of reports; and key players are also considered and reported within the context of the primary scheme. The paper considers key advances achieved at each generational stage in terms of process or software, discusses associated challenges and concludes with a view towards the future of the emerging fifth generation. [ABSTRACT FROM AUTHOR]

Introduction: The implementation and evaluation of patient participation to obtain high‐quality transitional care for older people is an international priority. Intermediate care (IC) services are regarded as an important part of the patient's pathway from the specialist to the primary care levels, bridging the gap between the hospital and the home. Patients may experience varying capacities and conditions for patient participation. Yet, few tools for evaluating patients' preferences for patient participation within IC services are at hand. Accordingly, further knowledge is needed to understand and scaffold processes for patient participation in IC. Therefore, the aim of this project was to translate, validate and pilot test the Patient Preferences for Patient Participation (the 4Ps) with patients in IC services in Norway. Methods: This project comprised two phases: (1) a careful translation and cultural adaptation process, followed by a content validity trial among 15 patients and staff in Norwegian IC and (2) a cross‐sectional survey of the instrument with 60 patients admitted to IC. Results: The translation between Swedish and Norwegian required no conceptual or contextual adaptations. The subsequent cross‐sectional study, designed as a dialogue between the patients and staff, revealed that only 50% of the participants received a sufficient level of patient participation based on their preferences, mostly indicating that patients were receiving less‐than‐preferred conditions for engaging in their health and healthcare issues. Conclusion: The 4Ps instrument was deemed suitable for measuring patient participation based on patient preferences in the IC context and was feasible for both healthcare professionals and patients to complete in an interview when arriving at and leaving services. This may support person‐centred communication and collaboration, calling for further research on what facilitates patient participation and the implementation of person‐centred services for patients in IC. Patient or Public Contribution: First, the current paper is part of the IPIC study (i.e., the implementation of patient participation in IC). Influenced by a James Lind Alliance process, the study addresses research uncertainties identified by patients, next of kin, staff and researchers in the cocreation process. Second, cognitive interviewing was conducted with 15 representatives of the target population: seven patients receiving IC services, one home‐dwelling previous IC patient (altogether four women and four men, most of them 80 years or older) and seven healthcare staff working in IC services. The interviews determined the relevance, comprehensiveness and clarity of the 4Ps. Finally, 60 patients admitted to IC took part in the cross‐sectional study. [ABSTRACT FROM AUTHOR]

Introduction: Disparities in the uptake of routine and COVID‐19 vaccinations have been observed in migrant populations, and attributed to issues of mistrust, access and low vaccine confidence. Participatory research approaches and behaviour change theory hold the potential for developing tailored vaccination interventions that address these complex barriers in partnership with communities and should be explored further. Methods: This study used a theory‐informed, community‐based participatory research approach to co‐design a culturally tailored behaviour change intervention aimed at increasing COVID‐19 vaccine uptake among Congolese migrants in London, United Kingdom (2021–2022). It was designed and led by a community‐academic partnership in response to unmet needs in the Congolese community as the COVID‐19 pandemic started. Barriers and facilitators to COVID‐19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in‐depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the capability, opportunity, motivation, behaviour model to identify target behaviours and strategies to include in interventions. Interventions were co‐designed and tailored in workshops involving Congolese migrants. Results: Thirty‐two Congolese adult migrants (24 (75%) women, mean 14.3 (SD: 7.5) years in the United Kingdom, mean age 52.6 (SD: 11.0) years) took part in in‐depth interviews and 16 (same sample) took part in co‐design workshops. Fourteen barriers and 10 facilitators to COVID‐19 vaccination were identified; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences and environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivations and social opportunities. Strategies included culturally tailored behaviour change techniques based on education, persuasion, modelling, enablement and environmental restructuring, which resulted in a co‐designed intervention comprising community‐led workshops, plays and posters. Findings and interventions were disseminated through a community celebration event. Conclusions: Our study demonstrates how behavioural theory can be applied to co‐designing tailored interventions with underserved migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities' unique cultural needs and realities. Patient or Public Contribution: Patient and public involvement (PPI) were embedded in the participatory study design and approach, with community members co‐producing all stages of the study and co‐authoring this paper. An independent PPI board (St George's Migrant Health Research Group Patient and Public Involvement Advisory Board) comprising five adult migrants with lived experience of accessing healthcare in the United Kingdom were also consulted at significant points over the course of the study. [ABSTRACT FROM AUTHOR]

Despite the rapid growth of sustainable innovations in bioplastics for packaging industries, their diffusion into established markets has so far been hampered by ambiguous and asymmetrical communication between bioplastics producers and consumers (both businesses and end consumers), particularly related to bioplastics materials and their waste disposal procedures. This study looks into the communication processes, identifies barriers and investigates business strategies that can be adopted by bioplastic packaging industries to influence consumer adoption and proper disposal behaviour of bioplastic packaging. Based on a systematic review of 68 journal articles and guided by the signalling theory, the study found that connections with various signallers at the end‐of‐life of bioplastic packaging materials are required beyond the purview of the industrial sectors utilising the packaging. The paper proposes a conceptual framework incorporating new signal constructs specific to consumer‐facing sustainable innovation. The framework extends the signalling theory to be used as part of the bioplastic packaging industry's business strategy. The paper also emphasises the importance of altering the communication mechanisms in order to boost bioplastics industrial practices, which will subsequently contribute to the reduction of the detrimental impacts of fossil‐based plastics on the environment. [ABSTRACT FROM AUTHOR]

Childhood malnutrition, which is endemic in rural areas of low‐income countries, leads to a host of deleterious outcomes such as poor cognitive development, low educational attainment and lower lifetime wages. Promoting the consumption of eggs among young children has emerged as a promising strategy to combat childhood malnutrition, though pathways to scale remain unclear. In this paper, we evaluate the impact of a social and behaviour change communication (SBCC) campaign combined with a program in which rural families purchased chickens on credit (poultry + SBCC; n = 769) relative to an arm in which families only received the poultry intervention (poultry only; n = 750), using a difference‐in‐difference estimation strategy with propensity score matching. The SBCC consisted of radio messages, in‐person training, text message reminders and posters. We found a relatively modest but statistically significant increase in the number of times per week respondents in the poultry + SBCC arm reported feeding eggs to children of 0.28 (p = 0.02) compared to the poultry‐only arm. The increase in egg feeding, however, was more pronounced for boys (0.42, p < 0.01) than for girls (0.14, p = 0.26). In addition, the campaign increased egg feeding more for those who were already feeding eggs to children (0.63, p < 0.01) than those who were not engaging in those practices at baseline (0.26, p < 0.01). However, the difference in these differences was not statistically significant. Future campaigns should ensure higher saturation of messaging and include specific messaging around the importance of feeding girls as well as boys. Campaigns seeking to scale up egg feeding quickly could potentially target the easier‐to‐reach segment of caregivers who already occasionally feed eggs to children though these might not be the neediest group. Key messages: A multi‐pronged social and behaviour change communication campaign increased egg consumption among young children in rural Rwanda.While the egg consumption gains were modest, the social behaviour change campaign was not fully implemented due to COVID‐19 and other challenges, so it is possible that a more fully implemented campaign could achieve greater impacts.Effects appeared to be most pronounced for boys and those who were already feeding eggs to children. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to evaluate the nurses' experiences with the Nursing Crisis Meetings and to identify nurses' needs regarding the future governance structure. Design: Qualitative study. Methods: Two focus groups were conducted in February 2022 with participants of the Nursing Crisis Meetings (N = 15). We used thematic analysis to describe themes. Results: We identified five themes: opportunity to speak up, call for nursing leadership, call for control over practice and autonomy, development of a governance infrastructure and development of the professional nurse role. Conclusion: Nurses experienced the Nursing Crisis Meetings to be a positive and empowering infrastructure, which facilitates the unique opportunity to speak up and share experiences and concerns. This new infrastructure is a promising strategy to engage nurses during a pandemic and to build on a professional governance structure. Impact: This paper highlights the need for nurses to speak up and be engaged during the COVID‐19 pandemic and gives a practical example of how to put this infrastructure into practice. [ABSTRACT FROM AUTHOR]

This paper examines the challenges posed to third sector organizations by major external crises that from time to time beset national and global communities. In so doing, it unpacks the multiple characteristics and complexities of concepts and related issues involved in organizational crisis management and resilience. This reveals the importance of shared sensemaking, issue identification, response types and implementation, organizational coping and adaptation, exploiting strategic opportunities, and conditioners of organizational resilience. Related insights are drawn from selected empirical studies involving non‐profit organizational crisis responses to a range of major crisis events. Accountability and management control implications are induced, and a relevant ongoing agenda for accounting research is presented. [ABSTRACT FROM AUTHOR]

Introduction: People living with dementia experience communication difficulties. Personal information documents, or healthcare passports, enable communication of information essential for the care of a person with dementia. Despite the potential for providing person‐centred care, personal information documents are not ubiquitously used. The Capability Opportunity Motivation—Behaviour (COM‐B) model can be used to understand factors determining individuals' behaviours. Objectives: This study aimed to identify the barriers to and facilitators of the use of healthcare passports for people living with dementia through a systematic review methodology. Methods: A systematic search of six electronic databases was undertaken. Grey literature was searched using three databases. All study types reporting barriers to or facilitators of the use of personal information documents in the care of adults living with dementia in high‐income countries were included. Study quality was assessed using the NICE Quality Appraisal Checklist. Thematic synthesis was used to develop descriptive themes, which were subsequently mapped to the COM‐B framework. Results: Nineteen papers were included. Themes included training, awareness, embedding the process in norms and appreciating the value of the personal information documents. A broad range of barriers and facilitators was identified within each COM‐B domain. Conclusion: This framework provides a starting point for evidence‐informed initiatives to improve the use of personal information documents in the care of people with dementia. Patient and Public Contribution: This is a review of studies and did not involve patients or the public. Review results will guide evaluation of a local personal information document, which will be designed with input from the Dementia Champions Network (includes carers and other stakeholders). [ABSTRACT FROM AUTHOR]

Introduction: Involving youth with severe communication disabilities in health research is foregrounded in a perspective of rights and participation. Researchers aligned with a participatory and inclusive research agenda recommend that involving youth in health research should be a deliberate and well‐planned process. However, limited examples exist of how researchers can facilitate the involvement of youth with severe communication disabilities in research projects. Method: The aim of this paper was to describe the application of the Involvement Matrix as a conceptual framework to guide the three phases of a research project with youth with severe communication disabilities. Results: Six youth aged 19–34 years consented to be involved in the project. All youth had a severe communication disability and used augmentative and alternative communication (AAC) to support their involvement in the research project. The Involvement Matrix provided a structure to delineate four involvement roles in three research phases: In Phase 1, youth were listeners to research information and advisors in the needs analysis. In Phase 2, as advisors and decision‐makers, youth provided their opinions on selecting picture communication symbols for health materials. In Phase 3, as partners, they were copresenters at an online youth forum. Conclusion: The Involvement Matrix was used to plan and implement the involvement of youth with severe communication disabilities in codeveloping health materials for use during the COVID‐19 pandemic. The Involvement Matrix can be applied together with AAC to enable meaningful involvement of youth in a health research project as listeners, advisors, decision‐makers and partners. Patient or Public Contribution: This study project was codeveloped with youth with severe communication disabilities who use AAC in South Africa. A person with lived experience was involved as an advisor to the health material development process and in the drafting of the manuscript. [ABSTRACT FROM AUTHOR]

This paper analyses the online text comments in the online trading platform and identifies the abnormal and contradictory comments. Firstly, the abnormal contradiction detection and analysis model of online text reviews is constructed based on fuzzy ontology to identify the abnormal and contradictory online text reviews. Secondly, the fuzzy emotional ontology and emotional tendency analysis method identify abnormal and contradictory online text reviews. The online text review anomaly detection and analysis model constructed enriches the process and method of online review anomaly identification. [ABSTRACT FROM AUTHOR]

Mental health chatbots (MHCBs) designed to support individuals in coping with mental health issues are rapidly advancing. Currently, these MHCBs are predominantly used in commercial rather than clinical contexts, but this might change soon. The question is whether this use is ethically desirable. This paper addresses a critical yet understudied concern: assuming that MHCBs cannot have genuine emotions, how this assumption may affect psychotherapy, and consequently the quality of treatment outcomes. We argue that if MHCBs lack emotions, they cannot have genuine (affective) empathy or utilise countertransference. Consequently, this gives reason to worry that MHCBs are (a) more liable to harm and (b) less likely to benefit patients than human therapists. We discuss some responses to this worry and conclude that further empirical research is necessary to determine whether these worries are valid. We conclude that, even if these worries are valid, it does not mean that we should never use MHCBs. By discussing the broader ethical debate on the clinical use of chatbots, we point towards how further research can help us establish ethical boundaries for how we should use mental health chatbots. [ABSTRACT FROM AUTHOR]

A method of transmission of highly confidential information in power communication network based on digital watermarking technology is proposed in order to reduce the leakage risk of power information and achieve the purpose of safe transmission of private information. This method establishes the data topology model of power communication network and connects the data receiving and sending terminals. Digital watermarking technology is used to embed digital watermarking in the information to be transmitted, encrypt the private information, and optimize the DES encryption algorithm to encrypt the information twice, so as to realize the safe transmission of information. The experimental results show that the digital watermark embedding rate, DES encryption rate, DES decryption rate and watermark extraction rate of the proposed method are all above 90 Mbps, and the file transfer time of 3965Byte is less than 5s, leakage risk rate and packet loss rate are 0.0001% and 0.006%, respectively, which effectively protects the security of high privacy information in the power communication network and prevents information leakage. [ABSTRACT FROM AUTHOR]

This conceptual paper explores the surprising impact exerted by third elements on the escalation and de‐escalation of conflicts in business families. To this end, we draw on core concepts of Batesonian cybernetic theory to perform a reconceptualisation of pertinent literature on changing conflict dynamics gathered in family business research and consultancy. Based on this reconceptualisation, we identify explanations and key mechanisms for the impact of third elements on conflict dynamics. Our study thus contributes to research at the interface of family business research, conflict research and cybernetic theory development. [ABSTRACT FROM AUTHOR]

The notion of moral expertise poses a variety of challenges concerning both the question of existence of such experts and their identification by laypeople. I argue for a view of ethics expertise, based on moral understanding instead of on moral knowledge, that is less robust than genuine moral expertise and that does not rely on deference to testimony. I propose identification criteria that focus mainly on the awareness and communication of implicit biases and situated ignorance. According to the account of ethics expertise presented in this paper, the expert's testimony is not an epistemic reason for the layperson's belief, but merely an epistemic influence. The epistemic reasons for the layperson's belief are largely independent from the expert. But there is still some epistemic risk involved in the proposed method of knowledge transfer, and therefore criteria for the identification of a trustworthy expert are necessary. The risk involved in knowledge transfer can be both due to willful manipulation and due to the expert's implicit biases and situated ignorance. While willful manipulation cannot really be avoided, the influence from biases and ignorance can be minimized. I argue that the best way to do this is if the expert is aware of their own biases and ignorance and communicates them. Combined with evidence of the expert's education in moral philosophy and experience with the topic in question, this gives the layperson the best chance to identify someone who can really help them consider all relevant aspects of a situation and come to a better justified decision. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) based clinical decision support systems (CDSS) are becoming ever more widespread in healthcare and could play an important role in diagnostic and treatment processes. For this reason, AI‐based CDSS has an impact on the doctor–patient relationship, shaping their decisions with its suggestions. We may be on the verge of a paradigm shift, where the doctor–patient relationship is no longer a dual relationship, but a triad. This paper analyses the role of AI‐based CDSS for shared decision‐making to better comprehend its promises and associated ethical issues. Moreover, it investigates how certain AI implementations may instead foster the inappropriate paradigm of paternalism. Understanding how AI relates to doctors and influences doctor–patient communication is essential to promote more ethical medical practice. Both doctors' and patients' autonomy need to be considered in the light of AI. [ABSTRACT FROM AUTHOR]

Background: People with literacy needs can experience many challenges in accessing, understanding and using health services and health information. Such challenges can adversely impact patient‐provider interactions and ultimately, health outcomes. Healthcare providers need to be aware of health literacy (HL) to address the demands of healthcare systems, improve their interactions with communities and patients and promote patient engagement for improved health outcomes. Methods: This paper reports on a process of patient and public involvement (PPI) with participants in an adult literacy programme acting as PPI contributors to identify priority areas for a local hospital HL action plan and to develop a protocol for a PPI process with other groups. A qualitative community‐based participatory research study design informed by principles of PPI was undertaken, drawing on the tools of participatory and visual methods, open discussion and workshop format to facilitate a process of co‐creation. Three workshops with six PPI contributors took place to identify issues to be included in the hospital action plan. PPI contributors identified issues and grouped these into priority areas using discussion and ranking procedures. Results: Key areas prioritised for HL action by the PPI contributors were: verbal communication, emphasising the patient's right to understand, and improved understanding of medication use. These were incorporated into the action plan. The workshop format and process were deemed acceptable to the group and input on improvements will be incorporated into further work in this area. Conclusion: PPI acts as a lever in the knowledge translation process. Genuine engagement with service users can meaningfully contribute to relevant and sustainable changes to services as well as foster the empowerment of service users. Patient or Public Contribution: Members of the public with literacy needs actively participated in the co‐creation of a HL action plan for a local hospital and in the development of a protocol for a patient and public process for HL research. [ABSTRACT FROM AUTHOR]

Policy PointsMany studies have explored the impact of message strategies to build support for policies that advance racial equity, but few studies examine the effects of richer stories of lived experience and detailed accounts of the ways racism is embedded in policy design and implementation.Longer messages framed to emphasize social and structural causes of racial inequity hold significant potential to enhance support for policies to advance racial equity.There is an urgent need to develop, test, and disseminate communication interventions that center perspectives from historically marginalized people and promote policy advocacy, community mobilization, and collective action to advance racial equity. Context: Long‐standing racial inequities in health and well‐being are shaped by racialized public policies that perpetuate disadvantage among Black, Brown, Indigenous, and people of color. Strategic messaging can accelerate public and policymaker support for public policies that advance population health. We lack a comprehensive understanding of lessons learned from work on policy messaging to advance racial equity and the gaps in knowledge it reveals. Methods: A scoping review of peer‐reviewed studies from communication, psychology, political science, sociology, public health, and health policy that have tested how various message strategies influence support and mobilization for racial equity policy domains across a wide variety of social systems. We used keyword database searches, author bibliographic searches, and reviews of reference lists from relevant sources to compile 55 peer‐reviewed papers with 80 studies that used experiments to test the effects of one or more message strategies in shaping support for racial equity–related policies, as well as the cognitive/emotional factors that predict their support. Findings: Most studies report on the short‐term effects of very short message manipulations. Although many of these studies find evidence that reference to race or use of racial cues tend to undermine support for racial equity–related policies, the accumulated body of evidence has generally not explored the effects of richer, more nuanced stories of lived experience and/or detailed historical and contemporary accounts of the ways racism is embedded in public policy design and implementation. A few well‐designed studies offer evidence that longer‐form messages framed to emphasize social and structural causes of racial inequity can enhance support for policies to advance racial equity, though many questions require further research. Conclusions: We conclude by laying out a research agenda to fill numerous wide gaps in the evidentiary base related to building support for racial equity policy across sectors. [ABSTRACT FROM AUTHOR]