Actual Intent Research Articles

Patient’s perception of cancer treatment outcomes in geriatric age groups: A retrospective analysis from a tertiary care centre in India.

e13774 Background: Geriatric population forms a significant part of the total cancer patients in any given country and their expectations, their needs and challenges are different from younger patients. Patients may perceive their “chances” differently from what is expected with cancer treatment. In our analysis we aimed to look at such perceived intent of therapy in geriatric patients and factors that might influence these perceptions. Methods: We retrospectively looked at data of comprehensive geriatric assessment (CGA) which is maintained by the geriatric clinic at our institute. Patients are referred to our geriatric clinic after their joint clinic meetings and after their meetings with their primary oncologists. We identified 2962 patients who underwent CGA and collected data of age, gender, social support, marital status, education level, actual intent of therapy, patients’ perception of intent, their desire of disclosure of disease status. We also collected objective scores of GDS, GAD 7, TUG and ECOG performance status. Descriptive statistics were performed to find out the factors significantly affecting patient’s perception of intent of therapy. Results: The median age of our cohort was 68 years (Interquartile range- 64-72 years). Results are shown (Table). 70.6% wanted full disclosure of disease. Out of 1404 patients who were in palliative setting, 40.2 percent patient had misperception of treatment. Conclusions: Our data highlights the significant impact of patient’s general wellbeing both physical and mental on the perception of their treatment goals. It brings forth the need to address these issues along with cancer therapy in an already vulnerable geriatric population. Our data also highlights the desire to know about the disease status in majority which may empower terminal patients to spend their time and energy on things they value. A nearly 41% misperception in palliative patients is indicative of an urgent need for better communication practices to help patients be more aware of outcomes and thus may be able to put more quality in the limited time they have. [Table: see text]

MEDIATORS OR MAGICIANS? THE MEDIATOR’S PSYCHOLOGICAL CRAFT IN MIRACULOUSLY RESOLVING MOST COMPLEX LEGAL DISPUTES AMICABLY

There are so many cases in Indian Judiciary for which after a period of time, even the litigants give up the hope of them being resolved. But when the same cases get referred to Mediation, it has been witnessed that quite often they end up not just settling amicably but the parties at disputes also come back together. When the conflict is same, the parties in the conflict are same then what does actually change is the process and approach that was used to solve the dispute. Mediation is the ship that travels at the will and self-determination of the parties and the reaches to its shore. But like every ship needs a captain for it to travel in the both, the peaceful oceans and the cross through the fierce storm, Mediation also is impossible without a skillful Mediator who plays the role of the captain in this process. The Mediator uses his skill to help the parties get a clear vision through the storm of their dispute and helps them analyze how deep they are in waters. What are the chances of their survival if they travel solo and what if they come together. The Mediator helps the parties realize their actual intent and whether they want to continuously keep travelling at the ocean or actually reach the shore too. For all of this self-deliberation of the parties, the Mediator has to keep an extremely balanced state of mind and emotion to actually make this happen. The Mediator has to be very cautious about the length and breadth of his role and the extent to which he gets involved. This paper discusses about the soft skills and crucial role that the Mediator plays that shifts the psychology of the parties from dispute to amicable settlements even after hating and fighting with each other for years.

Al‐Azhar and the Salafis in Egypt: Contestation of two traditions

<scp>Al‐Azhar</scp> and the Salafis in Egypt: Contestation of two traditions

Facial Emotion Recognition Using Swarm Optimized Multi-Dimensional DeepNets with Losses Calculated by Cross Entropy Function

The human face forms a canvas wherein various non-verbal expressions are communicated. These expressional cues and verbal communication represent the accurate perception of the actual intent. In many cases, a person may present an outward expression that might differ from the genuine emotion or the feeling that the person experiences. Even when people try to hide these emotions, the real emotions that are internally felt might reflect as facial expressions in the form of micro expressions. These micro expressions cannot be masked and reflect the actual emotional state of a person under study. Such micro expressions are on display for a tiny time frame, making it difficult for a typical person to spot and recognize them. This necessitates a place for Machine Learning, where machines can be trained to look for these micro expressions and categorize them once they are on display. The study’s primary purpose is to spot and correctly classify these micro expressions, which are very difficult for a casual observer to identify. This research improves upon the accuracy of the recognition by using a novel learning technique that not only captures and recognizes multimodal facial micro expressions but also has features for aligning, cropping, and superimposing these feature frames to produce highly accurate and consistent results. A modified variant of the deep learning architecture of Convolutional Neural Networks combined with the swarm-based optimality technique of the Artificial Bee Colony Algorithm is proposed to effectively get an accuracy of more than 85% in identifying and classifying these micro expressions in contrast to other algorithms that have relatively less accuracy. One of the main aspects of processing these expressions from video or live feeds is aligning the frames homographically and identifying these concise bursts of micro expressions, which significantly increases the accuracy of the outcomes. The proposed swarm-based technique handles this in the research to precisely align and crop the subsequent frames, resulting in much superior detection rates in identifying the micro expressions when on display.

Kazakhstan, Ukraine, and Russia

Despite independent Kazakhstan’s close ties to Russia based on geographic proximity, economic interdependence, formal treaties of mutual cooperation, and a shared linguistic and historic heritage, the viability of these ties is being tested by events of the past year and in particular, by the Russian invasion of Ukraine. Due to the widespread proficiency in the Russian language in all three countries, through internet access and social media, the people of Kazakhstan are able to access not only the Russian perspective of the war, but also that of the Ukrainian people. Internationally, Kazakhstan’s leaders are attempting to maintain a delicate balance vis-à-vis Russia, ensuring on the one hand that their alliance based on mutual interests and a common history is not endangered, yet needing on the other hand to appear credible and responsible in the eyes of European and Western powers in view of their long-term strategic plans for Kazakhstan’s development as a major player in Eurasian affairs. The analysis by Maerz (2019) posits that autocratic regimes such as those in Russia and Central Asia tend to use democratic terms in a way which only simulates pluralism by camouflaging their actual intent. All parties to international negotiations, including interpreters, need to be aware of these linguistic practices to properly understand and convey the actual message. The delicacy of this balancing act highlights the need for translators and interpreters employed at international negotiations and encounters to be aware of the historical precedents as well as the current ideologies and contemporary status of relations between the parties involved. Translations cannot be rendered solely according to linguistic equivalents, as identical terms can transmit divergent meanings when seen through the lens of a different heritage or ideology. The stakes at such international encounters are extraordinarily high: nothing less than stability, prosperity, and world peace. This argues for the importance of offering professional development opportunities for translators and interpreters to maintain their awareness of the nuanced issues in play. There is a need to acknowledge the crucial role and need of these professional communicators to constantly maintain their knowledge of the social and political context.

That was not what I was aiming at! Differentiating human intent and outcome in a physically dynamic throwing task.

Recognising intent in collaborative human robot tasks can improve team performance and human perception of robots. Intent can differ from the observed outcome in the presence of mistakes which are likely in physically dynamic tasks. We created a dataset of 1227 throws of a ball at a target from 10 participants and observed that 47% of throws were mistakes with 16% completely missing the target. Our research leverages facial images capturing the person's reaction to the outcome of a throw to predict when the resulting throw is a mistake and then we determine the actual intent of the throw. The approach we propose for outcome prediction performs 38% better than the two-stream architecture used previously for this task on front-on videos. In addition, we propose a 1D-CNN model which is used in conjunction with priors learned from the frequency of mistakes to provide an end-to-end pipeline for outcome and intent recognition in this throwing task.

Trust Me, I’m Trolling: Irony and the Alt-Right’s Political Aesthetic

Trust Me, I’m Trolling: Irony and the Alt-Right’s Political Aesthetic

Systematic survey of the causal language use in systematic reviews of observational studies: a study protocol

IntroductionSometimes, observational studies may provide important evidence that allow inferences of causality between exposure and outcome (although on most occasions only low certainty evidence). Authors, frequently and perhaps usually at...

Omniscient gods and precision and intent in rituals: the case of Orthodox Judaism

ABSTRACT Social scientists who study the minds of gods claim that the omniscient gods of monotheistic religions are aware of the intent of their followers, unlike gods who are not omniscient. For this reason, omniscient gods do not place emphasis on their followers’ precision in carrying out rituals, focusing rather on the intent and/or identity of the practitioners. The present article challenges this perception by focusing on several spheres of Orthodox Judaism in Israel. In each of these spheres, less attention is paid to the actual intent and identity of those practising the ritual, with far more attention directed to not only the actual execution of the ritual, but also the precision with which it is executed. Moreover, when rituals of healing are involved, imprecise or incomplete execution of such rituals can be used to explain their failure.

Popularity of pet otters on YouTube: evidence of an emerging trade threat

In response to growing reports of otters in the pet trade, and suggestions that the popularity of pet otters on social media may be driving demand, we collated YouTube videos of pet otters to test for trends in the number of videos published, their exposure (number of views) and popularity. We used English-language search terms to provide a global overview, as well as local language search terms for four South East Asian countries identified as being of potential importance in the pet otter trade (Indonesia, Malaysia, Thailand and Vietnam), and Japan. We found that not only had the number of videos depicting pet otters increased in the last two to three years (2016–2018), but that their popularity and/or engagement had also increased. Notwithstanding some country-level differences in the details of effects observed, the greatest increases in both the number of videos produced and their popularity occurred in Indonesia and Japan. At a global-level, commercial “viral” video sites appeared to be influential in terms of posting highly popular pet otter videos. At a national level, potentially influential videos tended to be produced by four or five individual otter owners. The appearance of phrases such as “I want one” in the comments section of the English-language videos, although not necessarily a statement of actual intent, suggests that these videos may be driving demand amongst their viewers and followers; similar analyses of video comments in each local language are warranted. Our results show an increase in social media activity that may not only be driving the apparent increase in popularity, but also amplifying awareness of the availability of these animals as pets, as well as creating and perpetuating the (erroneous) perception of otters as a suitable companion animal. At a global level, there are welfare concerns associated with otters in the pet trade, and, in South East Asia specifically, there are serious conservation concerns. We recommend increased regulation of these activities on social media, increased public awareness of the negative impacts of the pet trade on otters, and increased international protection. Specifically, we suggest the need to uplist both small-clawed and smooth-coated otters (Aonyxcinereus and Lutrogaleperspicillata, respectively) to CITES Appendix 1.

CONVERGENCE PROGRAMMES AS AN ECONOMIC POLICY TOOL WITHIN THE EUROPEAN UNION

The article presents the results of research indicating to what extent the convergence programmes submitted to the European Commission prove country’s willingness to improve the fiscal policy in a desired way and to what extent they constitute a mere fulfilment of a formal duty without any actual intent to achieve the indicated macroeconomic parameters. The conducted analyses allow to conclude that the European countries, while preparing the prognostic documents, have a tendency to hide the scale of the fiscal imbalance that reflects a lack of consistency between the current balance of the sector and an increase in the public debt. The results of quantitative and qualitative research indicate that, regardless of the implemented regulatory solutions at the EU level in the framework of the modified Stability and Growth Pact, certain flaws of the tools used for economic policy coordination at the European level are still visible.

Pedagogía de la resistencia: la negación como pieza de (de) formación

In this article, the authors propose a reflection on the idea of negativity in a critical and philosophical perspective that can approach in other ways the meanings and purposes of the formation of both the individual and the thought in current times. The denial, or yet, a philosophy of negativity (Adorno, 2009) is presented as a breeding ground for a reconfiguration of the pedagogical ideal and its possibilities to question the anthropological and historical features of what is introduced to us as the truth. The attitude of resistance is, in this text, a key component to the possibility of this philosophy of negativity, which allows us to expand our horizon of thinking and action. The actual intent couldn’t be further from an irrefutable conclusion, quite the contrary. We intend to inspire a provocative debate that destabilizes both the idea of the selfconscious individual and of how they relate with the world. We understand that this is a way to open possibilities to other experiences and narratives about the process of formation and (de)formation in the education.

Strength Pareto fitness assignment for pseudo-relevance feedback: application to MEDLINE

Because of users’ growing utilization of unclear and imprecise keywords when characterizing their information need, it has become necessary to expand their original search queries with additional words that best capture their actual intent. The selection of the terms that are suitable for use as additional words is in general dependent on the degree of relatedness between each candidate expansion term and the query keywords. In this paper, we propose two criteria for evaluating the degree of relatedness between a candidate expansion word and the query keywords: (1) co-occurrence frequency, where more importance is attributed to terms occurring in the largest possible number of documents where the query keywords appear; (2) proximity, where more importance is assigned to terms having a short distance from the query terms within documents. We also employ the strength Pareto fitness assignment in order to satisfy both criteria simultaneously. The results of our numerical experiments on MEDLINE, the online medical information database, show that the proposed approach significantly enhances the retrieval performance as compared to the baseline.

The effect of supplemental estrogen on the outcomes of NSCLC patients in the SEER-Medicare database.

2590 Background: Women with lung cancer have better survival regardless of treatment type. Estrogen has been shown to have cancer-specific and non-cancer effects. However, there is conflicting data on the effect of estrogen hormone therapy on lung cancer incidence and mortality in women. We used the SEER-Medicare database to examine the association of estrogen use with overall and cancer cause specific survival in elderly women with non-small cell lung cancer (NSCLC). Methods: Patients in our cohort were women 65+ years old; were diagnosed with Stage I-IV NSCLC between 2007 and 2012; had Part A and B coverage one year before to one year after diagnosis without supplemental coverage from a HMO; had Part D coverage during the 6 months prior to diagnosis; were not in a nursing home at diagnosis. Using an intention to treat analysis, drug use was defined as having at least one Part D claim for estrogen within six months prior to diagnosis. Event free survival was assessed using a multivariate Cox proportional hazard model accounting for the patient (age, socioeconomic status, race, Charlson score) and tumor (stage, site, histology) characteristics. Results: There were 10,562 patients in our cohort. 688 used estrogen and 9,874 did not. The median age was 75 years with median overall survival of 1.0 year. There was a significant difference in age, socioeconomic status, race, Charlson score, stage, site, and tumor histology between the two groups (p &lt; 0.05 for all). Estrogen use was associated with a significant improvement in overall and cause specific survival on univariate and multivariate regression (see table). Conclusions: Estrogen was associated with a significant improvement in survival. Limitations of this study are inherent to a retrospective claims-based database without knowledge of actual drug use or intent. [Table: see text]

Consensus Ad Idem: A Plea for Objectivity in Telephonic Contracts

Consensus Ad Idem, legally defined as „meeting of minds‟, at the time of the formation of a contract, warrants a cardinal jurisprudential question which transcends its mere literal meaning. In Indian Contract Law, the trend has followed the test of objectivity, whereby it is not the actual intent of the party or parties that enter into the contract that is the subject of judicial evaluation, but it is what a reasonable man would deliberate in the peculiar circumstances of the case. However, the evaluation of telephonic conversations merit intrinsic jurisprudential insight. While applying the objective test, the questions that arise are - is there legal certainty of assent to a contract over telephonic conversations i.e. whether there is free consent. Do the parties have the capacity to contract over telephone? What are the liabilities of the telephone operator and his legal bond to the contract between two or more contracting parties? Does it amount to violation of the fundamental rights to freedom of speech and expression and the right to privacy? The authors attempt to provide an objective analysis of communication in contracts over telephonic means and the constitutional environment embedded therein. To this end, a plea for due diligence prior to the formation of telephonic contracts shall be made in order to bring objectivity to the judicial evaluation of telephonic contracts.

The super-centralisation of the English state – Why we need to move beyond the devolution deception

In a stream of high-profile announcements, the UK central government has said that it wants to devolve power to sub-regions within England – to city regions and across the country. This article presents evidence to show that the actual intent of government policy is the reverse. Instead of promoting the creation of powerful, independent sub-regional authorities, answerable to the citizens who elected them, the government is seeking to impose a super-centralised model of decision-making in which locally elected politicians are required to comply with central directives. By drawing on work with city region leaders in England, the article develops criteria for assessing sub-regional governance. Inspirational examples of city region governance in other countries are presented. These examples show that the current super-centralisation of the English state is out of step with progressive policy making in other countries. Suggestions on how to develop real devolution in England are outlined.

Disentangling estimands and the intention-to-treat principle.

Randomized controlled trials (RCTs) aim at providing reliable estimates of treatment benefit. Missing data and nonadherence to treatment are distinct problems that can substantially impede this task. In practice, the fact that the handling of missing data due to nonadherence affects the question that is addressed is often ignored. Estimands allow precisely predefining the question of interest. Estimands are definitions of that which is being estimated with regard to population, endpoint, and handling of postrandomization events (eg, nonadherence). Depending on the situation, different estimands are of relevance. Therefore, it is important that the intention-to-treat (ITT) principle, which is considered the gold standard for analyzing RCTs, does not restrict an RCT's primary objective to only one of several relevant estimands. Although much ambiguity is involved around what is considered to constitute the ITT principle, many associate ITT with completely following up all patients and including all data of all randomized patients as allocated into the analysis. This would restrict primary objectives to estimating the effect of treatment policy and is certainly not warranted in all situations. To maintain the advantage of having the clear recommendation to follow the ITT principle while allowing for various relevant estimands as primary objective, we argue that the appropriate way forward is to define ITT as including all randomized patients into the analysis set and each patient is to be allocated to his or her randomized treatment. This definition comprises the actual intent of ITT and can be fully implemented also in settings where complete follow-up is impossible.

WILKINSON V DOWNTON REVISITED

IN OPO v Rhodes [2015] UKSC 32, the Supreme Court clarified the elements of the tort of intentional infliction of harm. Created in Wilkinson v Downton [1897] 2 Q.B. 57, the tort has long attracted the attention of academic commentators, but has rarely been argued successfully in English courts. In Wilkinson, the jury awarded the plaintiff damages for the physical suffering she endured as a result of severe shock that was caused when the defendant, playing a practical joke, falsely informed her that her husband had been injured in an accident. Wright J. held that the tort required an act be done “wilfully”, that is “calculated to cause physical harm”, and which does in fact cause “physical harm” (at 58–59). The Wilkinson formulation was subsequently endorsed by the Court of Appeal in Javier v Sweeney [1919] 2 K.B. 316 and again, 70 years later, in Khorasandjian v Bush [1993] Q.B. 727. In the latter case, the Court of Appeal emphasised that the wrongful conduct must cause “physical injury” – as distinct from “mere emotional distress” – and it must also be “calculated to cause” the same (at 735–36). Later, in Wong v Parkside Health NHS Trust [2001] EWCA Civ 172; [2003] 3 All E.R. 932, Hale L.J. appeared to qualify the mental element of the tort, observing that Wilkinson does not require actual subjective intent to cause physical harm; rather, according to her Ladyship, “calculated” means deliberately doing an act that is “likely”, all things considered, to result in the degree of physical harm that was in fact suffered (at [10]–[11]). Subsequently, Lord Hoffmann, writing the principal judgment for the House of Lords in Wainwright v Home Office [2003] UKHL 53; [2004] 2 A.C. 406, revisited both elements of the tort. He affirmed that, traditionally, it requires proof of actual harm, such as psychiatric illness, as distinct from mere distress (at [45]); and, consistently with Lady Hale's judgment in Wong, he interpreted Wilkinson as providing that the intent to cause such harm can be “imputed” to the defendant if it is an obvious consequence of a deliberate act, even though such harm may not have been subjectively appreciated or intended (at [37], [40]). Additionally, His Lordship contemplated expanding the tort to capture mere distress short of physical harm, but cautioned that, if the law was to expand to such cases (which he left to future courts to decide), “imputed intention will not do” (at [45]). Rather, mere distress should in His Lordship's view only be recoverable (if at all) where the defendant had a “genuine intention to cause distress” (at [46]).

What effect is really being measured? An alternative explanation of paradoxical phenomena in studies of osteoarthritis progression.

Many observational studies have found that risk factors for incidence of a disease may differ from risk factors for its sequelae (i.e., recurrence or progression of the disease). For example, several risk factors (such as female sex or obesity) for incident knee osteoarthritis (OA) are not associated with OA progression, and a few risk factors that increase risk of incident OA are inversely associated with OA progression (such as high bone mineral density and low levels of vitamin C) (1– 4). The paradoxical phenomena have also been identified in other diseases as well, such as the “obesity paradox,” whereby overweight or obese patients with preexisting cardiovascular disease have improved survival and a lower risk of recurrent major cardiovascular events than normal-weight patients (5). Another example is the “lipid paradox,” in which high levels of total cholesterol or low-density lipoprotein are associated with increased risk of cardiovascular disease among the general population (6), but are not, or even inversely, associated with risk of cardiovascular disease among patients with rheumatic diseases (7). While various explanations have been proposed for such paradoxical phenomena, including that risk factors for incident OA may be biologically different from those for OA progression or that findings from studies of risk factors for disease progression may be susceptible to selection bias (e.g., collider stratification bias) (8), we proposed that such paradoxical phenomena can be due to lack of clarity in the research question. Specifically, we posited that lack of clarity regarding the types of effects that can be determined from a study, i.e., total, direct, and indirect effects, may constitute a major reason why research findings for risk factors of OA progression appear paradoxical. In this work, we demonstrated the importance of carefully considering the actual intent of the research question in OA studies and ensuring that the study design allows the particular question to be answered. In the first section, we used a hypothetical randomized clinical trial (RCT) as a prototype to answer a well-defined research question and emphasize the critical characteristics of an RCT that enable one to make valid inferences. In the second section, we illustrated how an observational study can lead to incorrect inferences in the context of an ill-defined research question. We demonstrated that under such circumstances, the findings and inference may not be relevant to the investigators’ intended research question and would fail to provide insight into the prevention and treatment of disease, even if appropriate analytic methods were used. Finally, we offered a few suggestions that may help avoid such potential bias.

Magnetic Resonance Imaging in Patients with Ductal Carcinoma in Situ: Routine, Selective, or not at all?

Breast magnetic resonance imaging (MRI) has become a frequently used imaging modality for the evaluation of local extent of disease in patients with a known diagnosis of breast cancer. The sensitivity and specificity have been shown to be 93–100 and 26–91 %, respectively. While specific guidelines exist regarding the utility of screening breast MRI for high-risk patients, no such guidelines are available for patients with newly diagnosed breast cancer. As a result, the inclusion of a breast MRI as part of the diagnostic workup of patients with breast cancer occurs at variable rates and for variable indications. Most commonly, MRI is being used both to define the extent of disease in the ipsilateral breast and to determine the presence of contralateral disease. In the setting of patients with ductal carcinoma in situ (DCIS), MRI has been shown to be more sensitive than mammography. Thus, one might conclude that locoregional treatment of patients with DCIS may be more accurately planned and assessed by MRI, resulting in better outcomes and lower rates of locoregional recurrence. Pilewskie et al. report their retrospective analysis of 2,321 women who underwent breast-conserving surgery for DCIS, with or without preoperative MRI, and the resultant locoregional recurrence rates. They identified several factors associated with locoregional recurrence, including age, menopausal status, margin status, adjuvant radiation therapy, and adjuvant endocrine therapy. However, the use of preoperative MRI did not result in lower locoregional recurrence rates, regardless of the receipt of adjuvant radiation therapy. There also was no difference in the rates of contralateral breast cancer diagnoses. There are a couple of limitations inherit to their study. Because of the retrospective nature of the study, the actual intent of a chosen diagnostic test or the choice of a specific treatment course is difficult to determine. What remains unknown is why the physician ordered a preoperative MRI in the 596 patients who had it. Perhaps the patient was at higher risk secondary to underlying BRCA or other hereditary cancer syndromes or there was a clinical concern for multifocality or multicentricity based on standard imaging. The authors controlled for multiple variables in their analysis, but this is not one of them. A larger limitation is the fact that we do not know the true denominator cohort. Only patients who underwent breast-conserving surgery were included. What is missing is whether there was a separate cohort of patients who had preoperative MRI for DCIS, who were found to have multifocal or multicentric disease prohibitive of breastconserving surgery, and who then proceeded directly to mastectomy. Pilewskie et al. previously published their findings on a cohort of 352 DCIS patients, 217 of whom received preoperative MRI. They found that the additional biopsy rate in the MRI group was significantly greater (38 %) compared with the no-MRI group (7 %), resulting in additional cancer findings in 26 % of the MRI group and 33 % of the no-MRI group. Furthermore, 11.5 % of the MRI group had a change in surgical plan, predominantly from breast-conserving surgery to mastectomy. However, this only translated to a beneficial change in surgical plan for 8 of 217 (3.4 %) women in the total cohort and, conversely, a nonbeneficial (i.e., overtreatment) change in surgical plan for 17 of 217 (7.8 %). The impact on surgical decision-making and the trend towards higher mastectomy rates in patients with DCIS who undergo MRI mirrors that observed in patients with invasive breast cancers. Although the sensitivity of breast Society of Surgical Oncology 2013