Experience Of Agency Research Articles

Abstract P5-08-13: Phyllodes tumours of the breast: The British Columbia cancer agency experience

Abstract Background Phyllodes tumours (PT) of the breast are uncommon fibroepithelial lesions for which optimal management remains unclear. This population-based study reports treatment and outcomes for patients with PT and evaluates characteristics that influence outcome. Methods Data were analysed on 183 patients with newly diagnosed PT referred to the BC Cancer Agency from 1999-2014. Follow-up was obtained from chart and death records and letters to general practitioners. Five-year Kaplan-Meier (KM) local recurrence (LR) and survival were compared between cohorts with benign (n=83), borderline (n=50) and malignant PT (n=49) histology. Subtype was unknown in 1 patient who did not receive surgery due to severe comorbidity. Univariate analysis was performed using Cox regression modeling. Results Median follow-up was 65 (range 0.5-197) months. Median age was 48 (range 14–87) years. Median tumour size was 4 (range 1-23) cm. Heterologous sarcomatous differentiation was seen in 15 and malignant epithelial transformation in 11 patients. Local excision was performed in 163 (89%) and mastectomy in 19 (10%) patients. Margin status after local excision were: negative (>1mm, n=121, 74%), close (≤1mm, n=21, 13%), positive (tumour touching ink, n=20, 12%), or unknown (n=1, 1%). Margin status after mastectomy were negative (n=14, 74%) or close (n=5, 26%). Tumour borders were pushing (n=62, 34%), intermediate (n=22, 12%), infiltrative (n=38, 21%) or unknown (n=60, 33%). Eleven patients with malignant PT received radiation therapy as part of initial treatment. In these cases median tumour size was 8 cm and heterologous sarcomatous differentiation was present in 46% compared to 4 cm and 16% in malignant cases who did not receive RT. LR occurred in 16 cases (5 benign, 4 borderline and 7 malignant). Distant metastases (DM) occurred in 7 patients with malignant PT leading to 6 cause specific deaths. Five-year KM outcomes among women with benign, borderline, and malignant PT were: LR 6% vs 9% vs 21%, P=0.131; overall survival 96% vs 100% vs 82%, P=0.002; and disease free survival 94% vs 91% vs 67%, P<0.001. DM-free and cause specific survival at 5 years for malignant cases were 82% and 88% respectively. Five-year KM LR among women with negative vs close vs positive margins were 8% vs 6% vs 37%, P<0.001. Corresponding rates for intermediate vs pushing vs infiltrative borders were 6% vs 6% vs 33%, P=0.006. On univariate analyses, large tumour size, postmenopausal status, malignant classification, necrosis, positive margins, and infiltrative borders were factors associated with increased risk of any type of relapse (all P≤0.014). Positive margins and infiltrative tumour border were associated with increased LR (all P≤0.006), and the latter remained significant in exploratory analyses after adjusting for margin status and PT classification. Advanced age at diagnosis and large tumour size were predictors of DM (all P≤0.001). Conclusion In this population-based series, 5-year outcomes among women with PT are comparable to those reported in the literature. Exploratory analysis suggests that infiltrative tumour borders may be used in conjunction with margin status to assess LR risk. While close margin was not associated with increased LR, re-excision is warranted for cases with positive margins. Citation Format: Rodrigues MF, Truong PT, Weir LM, Knowling MA, Wai ES. Phyllodes tumours of the breast: The British Columbia cancer agency experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-13.

The predictability of a partner’s actions modulates the sense of joint agency

When people coordinate their actions with others, they experience a sense of joint agency, i.e., shared control over actions and their consequences. The current study examined whether the predictability of others’ actions modulates joint agency. Each participant coordinated with two confederate partners to produce tone sequences that matched a metronome pace. The timing of the confederates’ actions was manipulated so that one partner’s actions were highly predictable in time and the other’s less predictable. After each sequence, participants rated their experience of joint agency on a scale from shared to independent control. People felt more shared control when they coordinated with the more predictable partner, even after controlling for their own performance accuracy and variability. Thus, people rely on predictions of others’ actions to derive a sense of joint agency during interpersonal coordination.

Practitioners' perceptions and decision‐making regarding child sexual exploitation – a qualitative vignette study

AbstractThere has been intense controversy about the appropriate response to child sexual exploitation, with debates in the UK particularly hinging on the meaning of consent and coercion. For professionals with a duty to safeguard young people from child sexual exploitation, a key site of tension is how to avoid limiting young people's experience of agency without placing them at risk. Drawing on new qualitative research findings from a vignette study designed to trace professional perception and decision‐making, this paper argues that practitioners' perceptions regarding what counts as consent are refracted through conceptions of age and choice. However, many initial perceptions of agency and its links to age were modified through the interview process. This has implications for how supervision should operate. These topics raise issues of the need for practitioners to have nuanced conceptions of consent in the context of manipulation.

Shopaholic stories: Tales of therapeutic addiction, governance, and political economy

Contemporary culture encourages shopping to abate negative emotions or alter one’s disposition. This phenomenon has become known as retail therapy. Using two types of narratives – those told by mass media and those told by individual shoppers collected through interviews – this article compiles them together to illuminate the tension between the experience of agency (the therapeutic effects of shopping) and constraint (the addictive qualities of shopping) people experience. The article argues that this tension situates shoppers, especially those who participate in retail therapy, as ideal subjects for governance in a neoliberal society that values self-regulation and relies on immaterial labour. As shoppers participate in the narratives of retail therapy, they qualify themselves as citizens.

Variations in the sense of agency during hypnotic responding: Insights from latent profile analysis.

The primary phenomenological feature of a response to hypnotic suggestion is the perception that a person is not the author of their actions and experiences. This distortion in volition during hypnotic responding, known as the classic suggestion effect, has the potential to illuminate the neurocognitive mechanisms underlying hypnosis and inform broader models of agency. Here, we sought to clarify interindividual differences in the patterns of agency that participants experience during hypnosis. We applied latent profile analysis, a finite mixture modeling method for partitioning participants into homogeneous classes, to participants’ responses to a standardized behavioral measure of hypnotic suggestibility and an experiential measure of sense of agency during hypnotic responding. The best fitting model suggested that there were 4 discrete response patterns: a low suggestible class, 2 medium suggestible classes, and 1 highly suggestible class. The 2 medium suggestible classes displayed nearly equivalent patterns of behavioral hypnotic responding but diverged in their experience of agency during hypnotic responding: 1 class experienced greater involuntariness during responding, whereas the other experienced greater effortlessness during responding. These results reinforce previous research highlighting differential patterns of hypnotic responding and complement work suggesting that there may be 2 or more phenomenologically distinct modes of hypnotic responding. They also have a number of implications for the measurement of hypnotic responding and for the use of low and medium suggestible individuals in experimental hypnosis research designs.

Beyond self-serving bias: diffusion of responsibility reduces sense of agency and outcome monitoring.

Diffusion of responsibility across agents has been proposed to underlie decreased helping and increased aggression in group behaviour. However, few studies have directly investigated effects of the presence of other people on how we experience the consequences of our actions. This EEG study investigated whether diffusion of responsibility simply reflects a post-hoc self-serving bias, or rather has direct effects on how we process the outcomes of our actions, and our experience of agency over them. Participants made voluntary actions whose outcomes were more or less negative. Presence of another potential agent reduced participants’ sense of agency over those outcomes, even though it was always obvious who caused each outcome. Further, presence of another agent reduced the amplitude of feedback-related negativity evoked by outcome stimuli, suggesting reduced outcome monitoring. The presence of other agents may lead to diffusion of responsibility by weakening the neural linkage between one’s actions and their outcomes.

Alienation: Differential Psychopathology of Ego-Disturbances

Alienation, i. e. disorders of the inner experience of integrity, continuity, and agency, represents a feature of both psychotic and non-psychotic disorders. Thereby, ego disturbances are thought to be specific for schizophrenia. Depersonalisation, in contrast, has been reported in schizophrenia as well as a neurotic, probably distinct syndrome. The differentiation of psychotic vs. non-psychotic alienation is often all but trivial. The present paper provides an overview of the historical roots and the psychopathological conceptualizations of alienation. Clinically relevant features of psychotic alienation are highlighted. Experience of passivity, loss of authenticity and disturbances of striving and volition appear as psychotic characteristics.

Outcome of primary cutaneous anaplastic large cell lymphoma: a 20-year British Columbia Cancer Agency experience.

Primary cutaneous anaplastic large cell lymphoma (PCALCL) is a rare CD30+ lymphoproliferative disorder with excellent outcomes reported despite frequent cutaneous relapses. Limited information exists on the development of systemic lymphoma. The British Columbia Cancer Agency (BCCA) Lymphoid Cancer Database was searched to identify all adults diagnosed with PCALCL from 1993 to 2013. From 2005, the BCCA endorsed radiotherapy (RT) alone for limited stage with data failing to support chemotherapy. Forty-seven patients were identified with a male predominance (n=31, 66%), median age of 64years and predominantly limited stage (n=40, 85%). Median follow-up was 8·4years. The 5-year time to progression (TTP) was 58% (64% limited versus 29% advanced stage). The 5-year disease-specific survival (DSS) and overall survival was 86% and 75%, respectively. In an as-treated analysis, the 5-year DSS for limited stage patients was similar comparing RT to combined modality treatment or chemotherapy alone but the 5-year TTP favoured RT (82% vs. 33%, P=0·004). The 5-year cumulative risk of developing systemic lymphoma was 14%. Our results confirm the favourable prognosis of PCALCL despite a high relapse rate. Limited stage patients treated with RT alone have excellent outcomes. There is a small risk of systemic lymphoma in PCALCL.

Constitutional Structure and Judicial Deference to Agency Interpretations of Agency Rules

Chevron U.S.A. v. Natural Resources Defense Council, Inc. settled the now familiar principle of federal administrative law that a reviewing court must accept an agency's “reasonable” interpretation of a gap or ambiguity in a statute the agency is charged with administering. Less familiar is Bowles v. Seminole Rock & Sand Co., in which the Supreme Court explained that “the ultimate criterion” for judicial construction of an ambiguous regulation “is the administrative interpretation, which becomes of controlling weight unless it is plainly erroneous or inconsistent with the regulation.” Under that principle, a reviewing court must accept a “plausible construction of the . . . regulation,” even if it is not “the best or most natural one by grammatical or other standards.”The Chevron and Seminole Rock principles are superficially similar, but they presents vastly different structure incentives in the administrative state. Chevron affords an administrative agency deference to its interpretation of a statute enacted by Congress; hence, ambiguity in such a statute gives discretion to to Congress’s constitutional rival, the Executive Branch. In contrast, if Seminole Rock tells us that an agency's rules mean whatever it says they mean (unless the reading is plainly erroneous), the agency effectively secures the power of self-interpretation. This authority permits an agency to fill in regulatory gaps or ambiguities of its own making and relieves the agency of the cost of imprecision that it has produced. This state of affairs makes it that much less likely that an agency will give clear notice of its policies either to those who participate in the rulemaking process prescribed by the Administrative Procedure Act (APA) or to the regulated public. Seminole Rock deference also contradicts a major premise of our constitutional scheme and of contemporary separation of powers case law — that a fusion of lawmaking and law-exposition is especially dangerous to our liberties.From that starting point, this Article argues that the Court should replace Seminole Rock with a standard that imposes an independent judicial check on the agency's determination of regulatory meaning. In particular, it argues that courts should evaluate agency interpretations of regulations under the standard of judicial review prescribed by Skidmore v. Swift & Co. Under Skidmore, a court gives an agency interpretation the weight it deserves in light of the “thoroughness evident in the [agency's] consideration, the validity of its reasoning, its consistency with earlier and later pronouncements, and all those factors which give it the power to persuade, if lacking power to control.” That approach would restore an independent judicial check on the agency's interpretation of its own regulations while also recognizing that agency experience and expertise may be valuable in the interpretive process and that courts should be open to persuasion when an agency advances a well-reasoned interpretation of its rules.

Your Smartphone Is Watching You: Evocative Objects of Influence and Fear of Breakdown

In his seminal paper on the origin of “The Influencing Machine,” Victor Tausk discussed the structure of a paranoid delusion that expressed itself through the fear of influence by a mystical and capricious machine. Today, we can speak about a different delusional structure that chooses digital objects for its manifestation. While Tausk's influencing machine largely controls the mind and body with little experience of agency by the passive ego as a subject, today's smart digital machines have become an external part of the mind. Yet the delusion of the influencing machine is much more ubiquitous and nuanced than what Tausk presented, and is not restricted to the schizophrenic or psychotic. It may be even seen as simply the manifest content of an unconscious phantasy that universally inhabits our psychic space, taking different forms depending on the culture of the time and the type of psychopathology. We present a detailed clinical vignette of a young college student whose fear of breakdown and the loss of...

“Not Without a Will; Not a Child; Certainly Not a Thing”: The Birth of an “I”

This paper focuses on Freud’s subjective presence in the room as a major curative aspect in his one-session consultation with Margarethe. It is suggested that embedded in Freud’s way of listening, active encouragement, and authoritative intervention, there was a mutual impact and recognition that may have created space for an experience of agency to develop within the mind of the patient. Whereas Freud’s influence on the patient is obvious, a close look at the encounter illustrates that the patient felt that she had her own impact on Freud. In other words, in a not-so-classically Freudian way, Freud may have been (or allowed himself to be) touched and moved by the patient, which in turn fostered the development of her subjective self and the transformative nature of this one session.

Social Transmission of Experience of Agency: An Experimental Study.

The sense of controlling one’s own actions is fundamental to normal human mental function, and also underlies concepts of social responsibility for action. However, it remains unclear how the wider social context of human action influences sense of agency. Using a simple experimental design, we investigated, for the first time, how observing the action of another person or a robot could potentially influence one’s own sense of agency. We assessed how observing another’s action might change the perceived temporal relationship between one’s own voluntary actions and their outcomes, which has been proposed as an implicit measure of sense of agency. Working in pairs, participants chose between two action alternatives, one rewarded more frequently than the other, while watching a rotating clock hand. They judged, in separate blocks, either the time of their own action, or the time of a tone that followed the action. These were compared to baseline judgements of actions alone, or tones alone, to calculate the perceptual shift of action toward outcome and vice versa. Our design focused on how these two dependent variables, which jointly provide an implicit measure of sense of agency, might be influenced by observing another’s action. In the observational group, each participant could see the other’s actions. Multivariate analysis showed that the perceived time of action and tone shifted progressively toward the actual time of outcome with repeated experience of this social situation. No such progressive change occurred in other groups for whom a barrier hid participants’ actions from each other. However, a similar effect was observed in the group that viewed movements of a human-like robotic hand, rather than actions of another person. This finding suggests that observing the actions of others increases the salience of the external outcomes of action and this effect is not unique to observing human agents. Social contexts in which we see others controlling external events may play an important role in mentally representing the impact of our own actions on the external world.

The Sense of Agency Is More Sensitive to Manipulations of Outcome than Movement-Related Feedback Irrespective of Sensory Modality.

The sense of agency describes the ability to experience oneself as the agent of one's own actions. Previous studies of the sense of agency manipulated the predicted sensory feedback related either to movement execution or to the movement’s outcome, for example by delaying the movement of a virtual hand or the onset of a tone that resulted from a button press. Such temporal sensorimotor discrepancies reduce the sense of agency. It remains unclear whether movement-related feedback is processed differently than outcome-related feedback in terms of agency experience, especially if these types of feedback differ with respect to sensory modality. We employed a mixed-reality setup, in which participants tracked their finger movements by means of a virtual hand. They performed a single tap, which elicited a sound. The temporal contingency between the participants’ finger movements and (i) the movement of the virtual hand or (ii) the expected auditory outcome was systematically varied. In a visual control experiment, the tap elicited a visual outcome. For each feedback type and participant, changes in the sense of agency were quantified using a forced-choice paradigm and the Method of Constant Stimuli. Participants were more sensitive to delays of outcome than to delays of movement execution. This effect was very similar for visual or auditory outcome delays. Our results indicate different contributions of movement- versus outcome-related sensory feedback to the sense of agency, irrespective of the modality of the outcome. We propose that this differential sensitivity reflects the behavioral importance of assessing authorship of the outcome of an action.

Creating a Community Capacity Assessment to Identify Agency Outcomes Related to Occupational Therapy Student Community Partnerships

ABSTRACTService-learning experiences immerse students in authentic situations and build partnerships with community agencies to support the health of those we serve in practice. Most occupational therapy curriculum evaluations do not systematically capture community agency benefits. Through the use of qualitative interviews and Q Methodology, the Community Agency Capacity Questionnaire (CACQ) was developed to capture the agency experience in these partnerships. This paper describes the iterative analytic process that resulted in the CACQ with 29 statements covering 6 domains: programming, evaluation, partnership, staff, funding, and marketing. The CACQ offers a means to identify outcomes from the service-learning partners' perspective.

Sensory suppression of brain responses to self-generated sounds is observed with and without the perception of agency

Stimuli caused by our own movements are given special treatment in the brain. Self-generated sounds evoke a smaller brain response than externally generated ones. This attenuated response may reflect a predictive mechanism to differentiate the sensory consequences of one's own actions from other sensory input. It may also relate to the feeling of being the agent of the movement and its effects, but little is known about how sensory suppression of brain responses to self-generated sounds is related to judgments of agency. To address this question, we recorded event-related potentials in response to sounds initiated by button presses. In one condition, participants perceived agency over the production of the sounds, whereas in another condition, participants experience an illusory lack of agency caused by changes in the delay between actions and effects. We compared trials in which the timing of button press and sound was physically identical, but participants' agency judgment differed. Results show reduced amplitudes of the auditory N1 component in response to self-generated sounds irrespective of agency experience, whilst P2 effects correlate with the perception of agency. Our findings suggest that suppression of the auditory N1 component to self-generated sounds does not depend on adaptation to specific action-effect time delays, and does not determine agency judgments, however, the suppression of the P2 component might relate more directly to the experience of agency.

Identifying and Revealing the Importance of Decision-Making Criteria for Health Technology Assessment: A Retrospective Analysis of Reimbursement Recommendations in Ireland.

Decisions on reimbursement of health interventions in many jurisdictions are informed by health technology assessments (HTAs). Historically, the focus of these has often been cost effectiveness or cost utility, while other criteria were considered informally. More recently, there has been an increasing interest in the formal incorporation of additional criteria using multi-criteria decision analysis. Such an approach has not yet formally been part of decision-making policy in Ireland. The objective of this analysis is to demonstrate that cost effectiveness is not the only criterion influencing reimbursement decisions in Ireland. Furthermore, the aim is to reveal criteria that may have informally influenced reimbursement decisions in the past. A list of potential criteria was identified based on the literature, national guidelines and experience of the national HTA agency. Information on each of these criteria was sought for every assessment conducted in Ireland up to July 2015. A logistic regression was fitted to the data to identify influential parameters. Model selection was performed using the Bolasso method. Thirteen criteria were considered in the analysis. Two members of the HTA review team assessed the performance of the interventions against these criteria. Model selection suggests that the incremental cost-effectiveness ratio and quality of evidence could be important drivers of reimbursement recommendations in Ireland. Less important drivers suggested include the year of assessment, the level of uncertainty, as well as safety and tolerability. The analysis demonstrates that recommendations for or against the reimbursement of technologies in Ireland are not only driven by cost effectiveness. This highlights the need for more formal inclusion of criteria in the process, to improve transparency and ensure consistency.

Contaminated sites from the past: experience of the US Environmental Protection Agency.

The purpose of this paper is to provide an overview of the experience of the US Environmental Protection Agency (EPA) in cleaning up radioactively contaminated sites. In the USA, EPA regulates the radiological clean-up of uranium mill tailings sites, some Department of Energy legacy sites within the US nuclear weapons complex, and Superfund National Priorities List sites. The approach to site remediation decisions, including the determination of clean-up levels, varies according to the enabling legislation granting EPA these authorities. Past practices that gave rise to many of the existing exposure situations at legacy sites were permissible before the advent of environmental clean-up legislation. The Uranium Mill Tailings Radiation Control Act of 1978 authorised EPA to set applicable radioactivity concentration standards for soil clean-up at inactive uranium mill sites and vicinity properties. For the other categories of sites mentioned above, remediation goals are typically based on not exceeding a target excess cancer risk range established under the Comprehensive Environmental Response, Compensation, and Liability Act (also known as 'Superfund'). EPA's regulations for cleaning up various contaminated sites in existing exposure situations often result in residual doses that are typical of optimised doses in planned exposure situations. Although the clean-up levels selected may differ from those adopted in other countries, recommendations from the International Commission on Radiological Protection are reflected in the exposure assessment methodologies used in their establishment.

“Did I push myself over the edge?”: Complications of agency in psychosis onset and development

Objective: To investigate the subjective experience of agency in the onset and early development of psychosis.Method: We conducted 19 in-depth interviews with a sample of individuals with self-reported diagnoses of schizophrenia and/or affective psychosis. Interviews focused on participants’ experiences of agency and control in the onset and development of positive psychotic symptoms. Interviews were coded and transcripts analyzed by service-user researchers.Results: The majority of participants reported multiple ways in which they experienced their own agency or intentionality as involved in the initial onset of psychosis, in self-conscious engagement with symptom structure and content, and in their elaboration and development. For many, the moral implications of these felt experiences were considerable, at times leading to shame or guilt.Conclusion: Clinical accounts often stress the imposed, involuntary experience of symptoms and onset. Our project suggests that at least a subset of subjects with psychosis instead experience themselves as partly or fully “responsible” for onset, and actively involved in the shaping and elaboration of positive symptoms. In both clinical practice and future research, we argue that such complications should be explored and grappled with rather than downplayed.

Guest Editors' Introduction

Guest Editors' Introduction

Cost-Benefit Analysis and the Structure of the Administrative State: The Case of Financial Services Regulation

The viability and desirability of conducting cost-benefit analysis of financial regulation is a subject of intense academic debate. Opponents claim that such analysis is feasible for environmental regulation but not for financial regulation because of the difference in the benefits that require monetization in the respective areas. This Article argues that the recent debate misses an important part of the problem. In large part, cost-benefit analysis of financial regulation cannot currently be performed successfully because of institutional shortcomings, not analytical difficulties. Compared to Executive Branch agencies, independent agencies, like the major financial regulatory agencies, lack the capacity to do cost-benefit analyses of acceptable quality. Fortunately, there are good Executive Branch models that could be exported to the financial regulatory agencies. In particular, the Financial Stability Oversight Council could implement a robust coordinating role diffusing macroeconomic expertise, learning from the experience of the Interagency Working Group set up to estimate the damage of one ton of carbon dioxide emissions. Moreover, the President could extend to independent agencies his Executive Order vesting in the Office of Information and Regulatory Affairs the responsibility to review significant federal regulations. Though no President has yet taken this step, in part because of fears of a congressional backlash, the time might now be ripe to do so. And, the financial regulatory agencies could learn from the experience of the Environmental Protection Agency in building significant economic expertise to aid the preparation of cost-benefit analyses.The Article also considers the role of judicial review. It takes issue with the influential argument that OIRA review can serve as an alternative to judicial review, showing that such an outcome would be inconsistent with settled principles of administrative law. But OIRA review can lead to more deferential judicial review, by serving as a signal that reviewing courts are likely to find reassuring.