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Qurʾān
القرآن6 shownVerses named for this subject by hand come first. The rest are found by the subject’s own Arabic and English senses and are shown as lexical matches, not as anchors anyone has confirmed.
Qur'ān 42:38Arabic sense: شوري | English sense: consult, mutual consultation
وَٱلَّذِينَ ٱسۡتَجَابُواْ لِرَبِّهِمۡ وَأَقَامُواْ ٱلصَّلَوٰةَ وَأَمۡرُهُمۡ شُورَىٰ بَيۡنَهُمۡ وَمِمَّا رَزَقۡنَٰهُمۡ يُنفِقُونَ
respond to their Lord; keep up the prayer; conduct their affairs by mutual consultation; give to others out of what We have provided for them
Qur'ān 3:159Arabic sense: عزم | English sense: consult
فَبِمَا رَحۡمَةࣲ مِّنَ ٱللَّهِ لِنتَ لَهُمۡۖ وَلَوۡ كُنتَ فَظًّا غَلِيظَ ٱلۡقَلۡبِ لَٱنفَضُّواْ مِنۡ حَوۡلِكَۖ فَٱعۡفُ عَنۡهُمۡ وَٱسۡتَغۡفِرۡ لَهُمۡ وَشَاوِرۡهُمۡ فِي ٱلۡأَمۡرِۖ فَإِذَا عَزَمۡتَ فَتَوَكَّلۡ عَلَى ٱللَّهِۚ إِنَّ ٱللَّهَ يُحِبُّ ٱلۡمُتَوَكِّلِينَ
By an act of mercy from God, you [Prophet] were gentle in your dealings with them- had you been harsh, or hard-hearted, they would have dispersed and left you- so pardon them and ask forgiveness for them. Consult with them about matters, then, when you have decided on a course of action, put your trust in God: God loves those who put their trust in Him
Qur'ān 46:35Arabic sense: العزم, عزم
فَٱصۡبِرۡ كَمَا صَبَرَ أُوْلُواْ ٱلۡعَزۡمِ مِنَ ٱلرُّسُلِ وَلَا تَسۡتَعۡجِل لَّهُمۡۚ كَأَنَّهُمۡ يَوۡمَ يَرَوۡنَ مَا يُوعَدُونَ لَمۡ يَلۡبَثُوٓاْ إِلَّا سَاعَةࣰ مِّن نَّهَارِۭۚ بَلَٰغࣱۚ فَهَلۡ يُهۡلَكُ إِلَّا ٱلۡقَوۡمُ ٱلۡفَٰسِقُونَ
Be steadfast [Muhammad], like those messengers of firm resolve. Do not seek to hasten the punishment for the disbelievers: on the Day they see what they had been warned about, it will seem to them that they lingered no more than a single hour of a single day [in this life]. This is a warning. Shall any be destroyed except the defiant
Qur'ān 2:233English sense: consult
۞وَٱلۡوَٰلِدَٰتُ يُرۡضِعۡنَ أَوۡلَٰدَهُنَّ حَوۡلَيۡنِ كَامِلَيۡنِۖ لِمَنۡ أَرَادَ أَن يُتِمَّ ٱلرَّضَاعَةَۚ وَعَلَى ٱلۡمَوۡلُودِ لَهُۥ رِزۡقُهُنَّ وَكِسۡوَتُهُنَّ بِٱلۡمَعۡرُوفِۚ لَا تُكَلَّفُ نَفۡسٌ إِلَّا وُسۡعَهَاۚ لَا تُضَآرَّ وَٰلِدَةُۢ بِوَلَدِهَا وَلَا مَوۡلُودࣱ لَّهُۥ بِوَلَدِهِۦۚ وَعَلَى ٱلۡوَارِثِ مِثۡلُ ذَٰلِكَۗ فَإِنۡ أَرَادَا فِصَالًا عَن تَرَاضࣲ مِّنۡهُمَا وَتَشَاوُرࣲ فَلَا جُنَاحَ عَلَيۡهِمَاۗ وَإِنۡ أَرَدتُّمۡ أَن تَسۡتَرۡضِعُوٓاْ أَوۡلَٰدَكُمۡ فَلَا جُنَاحَ عَلَيۡكُمۡ إِذَا سَلَّمۡتُم مَّآ ءَاتَيۡتُم بِٱلۡمَعۡرُوفِۗ وَٱتَّقُواْ ٱللَّهَ وَٱعۡلَمُوٓاْ أَنَّ ٱللَّهَ بِمَا تَعۡمَلُونَ بَصِيرࣱ
Mothers suckle their children for two whole years, if they wish to complete the term, and clothing and maintenance must be borne by the father in a fair manner. No one should be burdened with more than they can bear: no mother shall be made to suffer harm on account of her child, nor any father on account of his. The same duty is incumbent on the father’s heir. If, by mutual consent and consultation, the couple wish to wean [the child], they will not be blamed, nor will there be any blame if you wish to engage a wet nurse, provided you pay as agreed in a fair manner. Be mindful of God, knowing that He sees everything you do
Qur'ān 28:66English sense: consult
فَعَمِيَتۡ عَلَيۡهِمُ ٱلۡأَنۢبَآءُ يَوۡمَئِذࣲ فَهُمۡ لَا يَتَسَآءَلُونَ
All arguments will seem obscure to them on that Day; they will not be able to consult one another
Qur'ān 58:13English sense: consult
ءَأَشۡفَقۡتُمۡ أَن تُقَدِّمُواْ بَيۡنَ يَدَيۡ نَجۡوَىٰكُمۡ صَدَقَٰتࣲۚ فَإِذۡ لَمۡ تَفۡعَلُواْ وَتَابَ ٱللَّهُ عَلَيۡكُمۡ فَأَقِيمُواْ ٱلصَّلَوٰةَ وَءَاتُواْ ٱلزَّكَوٰةَ وَأَطِيعُواْ ٱللَّهَ وَرَسُولَهُۥۚ وَٱللَّهُ خَبِيرُۢ بِمَا تَعۡمَلُونَ
Were you afraid to give charity before consulting the Prophet? Since you did not give charity, and God has relented towards you, you should [at least] observe your prayers, pay the prescribed alms, and obey God and His Messenger: God is well aware of your actions
Tafsīr
التفسير6 shownCommentary on the verses above, at most two editions per verse.
en-al-jalalayn on 42:38en-al-jalalayncommentary on an ayah this subject surfaced
and those who answer their Lord those who respond to what He has summoned them in the way of affirming His Oneness and worship of Him and observe prayer maintaining it regularly and whose courses of action those courses of action that seem good to them are a matter of counsel between them in which they consult one another and do not act hastily and who of what We have bestowed on them expend in obedience to God — such mentioned individuals constitute one category;
en-tafisr-ibn-kathir on 42:38en-tafisr-ibn-kathircommentary on an ayah this subject surfaced
So whatever you have been given is but (a passing) enjoyment for this worldly life, but that which is with Allah is better and more lasting for those who believe and put their trust in their Lord (36)And those who shun the greater sins, and Al-Fawahish, and when they are angry, they forgive (37)And those who answer the Call of their Lord, and perform the Salah, and who (conduct) their affairs by mutual consultation, and who spend of what We have bestowed on them (38)And those who, when an oppressive wrong is done to them, take revenge (39)
The Attributes of Those Who deserve that which is with Allah
Here Allah points out the insignificance of this worldly life and its transient adornments and luxuries.
فَمَا أُوتِيتُمْ مِنْ شَيْءٍ فَمَتَاعُ الْحَيَاةِ الدُّنْيَا ۖ
(So whatever you have been given is but (a passing) enjoyment for this worldly life.) means, no matter what you achieve a
en-asbab-al-nuzul-by-al-wahidi on 3:159en-asbab-al-nuzul-by-al-wahidicommentary on an ayah this subject surfaced
It was by a mercy of God that thou wert soft with them. Hadst thou been harsh and hard of heart, they would have scattered from around thee. So pardon them, ask forgiveness for them, and consult with them in the affair. And when thou art resolved, trust in God. Surely God loves those who trust. “O master of masters! O paragon of engendered beings! You are generous and lovingly kind, gentle and ever-merciful to everyone. You drive everyone by customs that hit the mark. You call everyone to the table of exaltedness and convey to everlasting felicity. You are like a father for the orphans, a husband for the widowed. You caress the familiar and you show the road to the estranged. You are mercy itself for the world's folk, a cause of generous giving to all the servants. O master, there is all of this, but take care not to see yourself. Do not consider these as your own acquisitions, for all o
en-asbab-al-nuzul-by-al-wahidi on 46:35en-asbab-al-nuzul-by-al-wahidicommentary on an ayah this subject surfaced
So be patient, as the messengers possessed of resoluteness were patient. And seek not to hurry it for them. On the day they see what they were promised, it will be as if they had not delayed for an hour of daytime. God's Messenger heard so many insults and ill words from the unbelievers and underwent so much suffering from them that he became anguished. Because of that anguish he wished in his heart that a punishment would reach them and they would taste chastisement. The Lord of the Worlds sent this verse: “So be patient... and seek not to hurry it. O MuḤammad, be patient with the torment and insults of the associaters and do not hasten to chastise and punish them. Emulate your brothers the prophets. They were patient with the sufferings and repellant things from their people. They knew that all of it was Our decree, so they did not complain or become anguished. You do the same that the
en-al-jalalayn on 3:159en-al-jalalayncommentary on an ayah this subject surfaced
It was by the mercy of God that you O Muhammad (s) were lenient with them that is that you showed indulgence toward them when they disobeyed you; had you been harsh ill-natured and fierce of heart brutish and coarse towards them they would have dispersed split away from about you. So pardon them pass over what they have done and ask forgiveness for them for their sins until I forgive them and consult them find out their opinions in the matter that is your affair in the battle and otherwise in order to win their hearts over and so that you may be emulated in this respect; and indeed the Prophet s would frequently consult them. And when you are resolved to carry out what you wish after counsel rely on God put your trust in Him and not in any counsel; for God loves those who rely on Him.
en-asbab-al-nuzul-by-al-wahidi on 2:233en-asbab-al-nuzul-by-al-wahidicommentary on an ayah this subject surfaced
Mothers shall suckle their children two whole years-for those who desire to complete the suckling. Great is that Lord who is unique in loving kindness and without peer in caressing servants. He be- stows in testing, He is loyal to assurances. If we call Him, He hears, and if we do not, He knows. He is generous, loving, love-showing, and love-increasing; gentle, defect-hiding, excuse-hearing, a good God. His bounty is beyond all bounty, His generosity beyond all generosity, His mercy greater than all mercies, His love not like other loves. The example given of utmost mercy is the mercy of mothers, but God's mercy toward His servants is more than that, and His love is not like their love. Do you not see that He commands mothers to give milk to their children for two complete years, He urges them to nurture them, and He counsels them to take care of them? He does not confine Himself to the
Ḥadīth
الحديث6 shownSound narrations only, and never matched by text. A narration appears here because a compiler filed it under a chapter this subject maps to, or because someone read it and anchored it. Each row says which.
حَدَّثَنَا مُوسَى بْنُ إِسْمَاعِيلَ، حَدَّثَنَا حَمَّادٌ، ح وَحَدَّثَنَا مُسَدَّدٌ، حَدَّثَنَا يَحْيَى، عَنْ حَمَّادِ بْنِ سَلَمَةَ، عَنْ حَكِيمٍ الأَثْرَمِ، عَنْ أَبِي تَمِيمَةَ، عَنْ أَبِي هُرَيْرَةَ، أَنَّ رَسُولَ اللَّهِ صلى الله عليه وسلم قَالَ " مَنْ أَتَى كَاهِنًا " . قَالَ مُوسَى فِي حَدِيثِهِ " فَصَدَّقَهُ بِمَا يَقُولُ " . ثُمَّ اتَّفَقَا " أَوْ أَتَى امْرَأَةً " . قَالَ مُسَدَّدٌ " امْرَأَتَهُ حَائِضًا أَوْ أَتَى امْرَأَةً " . قَالَ مُسَدَّدٌ " امْرَأَتَهُ فِي دُبُرِهَا فَقَدْ بَرِئَ مِمَّا أَنْزَلَ اللَّهُ عَلَى مُحَمَّدٍ " .
Narrated AbuHurayrah: The Prophet (ﷺ) said: If anyone resorts to a diviner and believes in what he says (according) to the version of Musa), or has intercourse with his wife (according to the agreed version) when she is menstruating, or has intercourse with his wife through her anus, he has nothing to do with what has been sent down to Muhammad (ﷺ) - according to the version of Musaddad
حَدَّثَنَا أَبُو بَكْرِ بْنُ أَبِي شَيْبَةَ، وَمُسَدَّدٌ، - الْمَعْنَى - قَالاَ حَدَّثَنَا يَحْيَى، عَنْ عُبَيْدِ اللَّهِ بْنِ الأَخْنَسِ، عَنِ الْوَلِيدِ بْنِ عَبْدِ اللَّهِ، عَنْ يُوسُفَ بْنِ مَاهَكَ، عَنِ ابْنِ عَبَّاسٍ، قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم " مَنِ اقْتَبَسَ عِلْمًا مِنَ النُّجُومِ اقْتَبَسَ شُعْبَةً مِنَ السِّحْرِ زَادَ مَا زَادَ " .
Narrated Abdullah ibn Abbas: The Prophet (ﷺ) said: If anyone acquires any knowledge of astrology, he acquires a branch of magic of which he gets more as long as he continues to do so
حَدَّثَنَا أَحْمَدُ بْنُ يُونُسَ، حَدَّثَنَا أَبُو شِهَابٍ، عَنِ ابْنِ عَوْنٍ، عَنْ مُجَاهِدٍ، عَنْ عَبْدِ الرَّحْمَنِ بْنِ أَبِي لَيْلَى، عَنْ كَعْبِ بْنِ عُجْرَةَ، قَالَ أَتَيْتُهُ يَعْنِي النَّبِيَّ صلى الله عليه وسلم فَقَالَ " ادْنُ ". فَدَنَوْتُ فَقَالَ " أَيُؤْذِيكَ هَوَامُّكَ ". قُلْتُ نَعَمْ. قَالَ " فِدْيَةٌ مِنْ صِيَامٍ أَوْ صَدَقَةٍ أَوْ نُسُكٍ ". وَأَخْبَرَنِي ابْنُ عَوْنٍ عَنْ أَيُّوبَ قَالَ صِيَامُ ثَلاَثَةِ أَيَّامٍ، وَالنُّسُكُ شَاةٌ، وَالْمَسَاكِينُ سِتَّةٌ.
Narrated Ka`b bin 'Ujra:I came to the Prophet (ﷺ) and he said to me, "Come near." So I went near to him and he said, "Are your lice troubling you?" I replied, "Yes." He said, "(Shave your head and) make expiation in the form of fasting, Sadaqa (giving in charity), or offering a sacrifice." (The sub-narrator) Aiyub said, "Fasting should be for three days, and the Nusuk (sacrifice) is to be a sheep, and the Sadaqa is to be given to six poor persons
حَدَّثَنَا عَلِيُّ بْنُ عَبْدِ اللَّهِ، حَدَّثَنَا سُفْيَانُ، عَنِ الزُّهْرِيِّ، قَالَ سَمِعْتُهُ مِنْ، فِيهِ عَنْ حُمَيْدِ بْنِ عَبْدِ الرَّحْمَنِ، عَنْ أَبِي هُرَيْرَةَ، قَالَ جَاءَ رَجُلٌ إِلَى النَّبِيِّ صلى الله عليه وسلم فَقَالَ هَلَكْتُ. قَالَ " مَا شَأْنُكَ ". قَالَ وَقَعْتُ عَلَى امْرَأَتِي فِي رَمَضَانَ. قَالَ " تَسْتَطِيعُ تُعْتِقُ رَقَبَةً ". قَالَ لاَ. قَالَ " فَهَلْ تَسْتَطِيعُ أَنْ تَصُومَ شَهْرَيْنِ مُتَتَابِعَيْنِ ". قَالَ لاَ. قَالَ " فَهَلْ تَسْتَطِيعُ أَنْ تُطْعِمَ سِتِّينَ مِسْكِينًا ". قَالَ لاَ. قَالَ " اجْلِسْ ". فَجَلَسَ فَأُتِيَ النَّبِيُّ صلى الله عليه وسلم بِعَرَقٍ فِيهِ تَمْرٌ ـ وَالْعَرَقُ الْمِكْتَلُ الضَّخْمُ ـ قَالَ " خُذْ هَذَا، فَتَصَدَّقْ بِهِ ". قَالَ أَعَلَى أَفْقَرَ مِنَّا، فَضَحِكَ النَّبِيُّ صلى الله عليه وسلم حَتَّى بَدَتْ نَوَاجِذُهُ قَالَ " أَطْعِمْهُ عِيَالَكَ ".
Narrated Abu Huraira:A man came to the Prophet (ﷺ) and said, "I am ruined!" The Prophet (ﷺ) said, "What is the matter with you?" He said, "I had sexual relation with my wife (while I was fasting) in Ramadan." The Prophet (ﷺ) said, "Have you got enough to manumit a slave?" He said, "No." The Prophet (ﷺ) said, "Can you fast for two successive months?" The man said, "No." The Prophet (ﷺ) said, "Can you feed sixty poor persons?" The man said, "No." Then the Prophet (ﷺ) said to him, "Sit down," and he sat down. Afterwards an 'Irq, i.e., a big basket containing dates was brought to the Prophet (ﷺ) and the Prophet (ﷺ) said to him, "Take this and give it in charity." The man said, "To poorer people than we?" On that, the Prophet (ﷺ) smiled till his premolar teeth became visible, and then told him, "Feed your family with it." (See Hadith No. 157, Vol)
حَدَّثَنَا عَبْدُ اللَّهِ بْنُ مُعَاوِيَةَ الْجُمَحِيُّ الْبَصْرِيُّ، قَالَ حَدَّثَنَا صَالِحٌ الْمُرِّيُّ، عَنْ هِشَامِ بْنِ حَسَّانَ، عَنْ مُحَمَّدِ بْنِ سِيرِينَ، عَنْ أَبِي هُرَيْرَةَ، قَالَ خَرَجَ عَلَيْنَا رَسُولُ اللَّهِ صلى الله عليه وسلم وَنَحْنُ نَتَنَازَعُ فِي الْقَدَرِ فَغَضِبَ حَتَّى احْمَرَّ وَجْهُهُ حَتَّى كَأَنَّمَا فُقِئَ فِي وَجْنَتَيْهِ الرُّمَّانُ فَقَالَ " أَبِهَذَا أُمِرْتُمْ أَمْ بِهَذَا أُرْسِلْتُ إِلَيْكُمْ إِنَّمَا هَلَكَ مَنْ كَانَ قَبْلَكُمْ حِينَ تَنَازَعُوا فِي هَذَا الأَمْرِ عَزَمْتُ عَلَيْكُمْ أَلاَّ تَتَنَازَعُوا فِيهِ " . قَالَ أَبُو عِيسَى وَفِي الْبَابِ عَنْ عُمَرَ وَعَائِشَةَ وَأَنَسٍ . وَهَذَا حَدِيثٌ غَرِيبٌ لاَ نَعْرِفُهُ إِلاَّ مِنْ هَذَا الْوَجْهِ مِنْ حَدِيثِ صَالِحٍ الْمُرِّيِّ . وَصَالِحٌ الْمُرِّيُّ لَهُ غَرَائِبُ يَنْفَرِدُ بِهَا لاَ يُتَابَعُ عَلَيْهَا .
Abu Hurairah narrated:"The Messenger of Allah(s.a.w) came out to us while we were discussing about Al-Qadar. He became angry such that his face became red, as if a pomegranate was bursting through his cheeks. He said: 'Is this what I ordered you to do?' - or: 'Is this what I have been sent to you with? The people before you were only ruined when they differed about this matter. I order you [I order you] to not debate about it.'". (Daif)
حَدَّثَنَا يَحْيَى بْنُ حَبِيبِ بْنِ عَرَبِيٍّ، قَالَ حَدَّثَنَا الْمُعْتَمِرُ بْنُ سُلَيْمَانَ، قَالَ حَدَّثَنَا أَبِي، عَنْ سُلَيْمَانَ الأَعْمَشِ، عَنْ أَبِي صَالِحٍ، عَنْ أَبِي هُرَيْرَةَ، عَنِ النَّبِيِّ صلى الله عليه وسلم قَالَ " احْتَجَّ آدَمُ وَمُوسَى فَقَالَ مُوسَى يَا آدَمُ أَنْتَ الَّذِي خَلَقَكَ اللَّهُ بِيَدِهِ وَنَفَخَ فِيكَ مِنْ رُوحِهِ أَغْوَيْتَ النَّاسَ وَأَخْرَجْتَهُمْ مِنَ الْجَنَّةِ . قَالَ فَقَالَ آدَمُ وَأَنْتَ مُوسَى الَّذِي اصْطَفَاكَ اللَّهُ بِكَلاَمِهِ أَتَلُومُنِي عَلَى عَمَلٍ عَمِلْتُهُ كَتَبَهُ اللَّهُ عَلَىَّ قَبْلَ أَنْ يَخْلُقَ السَّمَوَاتِ وَالأَرْضَ قَالَ فَحَجَّ آدَمُ مُوسَى " . قَالَ أَبُو عِيسَى وَفِي الْبَابِ عَنْ عُمَرَ وَجُنْدَبٍ . وَهَذَا حَدِيثٌ حَسَنٌ صَحِيحٌ غَرِيبٌ مِنْ هَذَا الْوَجْهِ مِنْ حَدِيثِ سُلَيْمَانَ التَّيْمِيِّ عَنِ الأَعْمَشِ . وَقَدْ رَوَى بَعْضُ أَصْحَابِ الأَعْمَشِ عَنِ الأَعْمَشِ عَنْ أَبِي صَالِحٍ عَنْ أَبِي هُرَيْرَةَ عَنِ النَّبِيِّ صلى الله عليه وسلم نَحْوَهُ . وَقَالَ بَعْضُهُمْ عَنِ الأَعْمَشِ عَنْ أَبِي صَالِحٍ عَنْ أَبِي سَعِيدٍ عَنِ النَّبِيِّ صلى الله عليه وسلم . وَقَدْ رُوِيَ هَذَا الْحَدِيثُ مِنْ غَيْرِ وَجْهٍ عَنْ أَبِي هُرَيْرَةَ عَنِ النَّبِيِّ صلى الله عليه وسلم .
Abu Hurairah narrated that the Prophet(S.A.W) said:"Adam and Musa argued, Musa said: "O Adam! You are the one that Allah created with His Hand, and blew into you of His Spirit, and you misled the people and caused them to be expelled from Paradise.' So Adam said: 'You are Musa, the one Allah selected with His Speech! Are you blaming me for something I did which Allah had decreed for me, before creating the heavens and the earth?'" He said: " So Adam confuted Musa
Research library, full list
176 to 200 of 1,215Intertemporal choice--toward an integrative framework.
Intertemporal choices are decisions with consequences that play out over time. These choices range from the prosaic--how much food to eat at a meal--to life-changing decisions about education, marriage, fertility, health behaviors and savings. Intertemporal preferences also affect policy debates about long-run challenges, such as global warming. Historically, it was assumed that delayed rewards were discounted at a constant rate over time. Recent theoretical and empirical advances from economic, psychological and neuroscience perspectives, however, have revealed a more complex account of how individuals make intertemporal decisions. We review and integrate these advances. We emphasize three different, occasionally competing, mechanisms that are implemented in the brain: representation, anticipation and self-control.
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Understanding factors influencing care seeking for sick children in Ebonyi and Kogi States, Nigeria.
Background: Nigeria has one of the highest child mortality rates in the world, with an estimated 750,000 deaths annually among children under age five. The majority of these deaths are due to pneumonia, malaria, or diarrhea. Many parents do not seek sick-child care from trained, biomedical providers, contributing to this high rate of mortality.
Methods: This qualitative study explores factors enabling or preventing parents from seeking care for sick under-five children in Nigeria's Kogi and Ebonyi states, including gender-related roles and social norms. Interviews were conducted with parents of sick under-five children and service providers, and focus group discussions were held with community leaders to assess how care-seeking behavior was influenced by four modes from the Colvin et al. conceptual framework for household decision-making and pathways to care. These include (1) caregivers…
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Neural Dynamics of Shooting Decisions and the Switch from Freeze to Fight.
Real-life shooting decisions typically occur under acute threat and require fast switching between vigilant situational assessment and immediate fight-or-flight actions. Recent studies suggested that freezing facilitates action preparation and decision-making but the neurocognitive mechanisms remain unclear. We applied functional magnetic resonance imaging, posturographic and autonomic measurements while participants performed a shooting task under threat of shock. Two independent studies, in unselected civilians (N = 22) and police recruits (N = 54), revealed that preparation for shooting decisions under threat is associated with postural freezing, bradycardia, midbrain activity (including the periaqueductal gray-PAG) and PAG-amygdala connectivity. Crucially, stronger activity in the midbrain/PAG during this preparatory stage of freezing predicted faster subsequent accurate shooting. Fi…
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Assessment of Executive Function in Patients With Substance Use Disorder: A Comparison of Inventory- and Performance-Based Assessment.
Introduction: Chronic polysubstance abuse (SUD) is associated with neurophysiological and neuroanatomical changes. Neurocognitive impairment tends to affect quality of life, occupational functioning, and the ability to benefit from therapy. Neurocognitive assessment is thus of importance, but costly and not widely available. Therefore, in a busy clinical setting, procedures that include readily available measures targeting core cognitive deficits would be beneficial. This paper investigates the utility of psychometric tests and a questionnaire-based inventory to assess "hot" and "cold" neurocognitive measures of executive functions (EF) in adults with a substance use disorder. Hot decision-making processes are associated with emotional, affective, and visceral responses, while cold executive functions are associated with rational decision-making.
Material and methods: Subjects with polys…
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Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease.
A significant number of elderly patients die during their first 3 months of dialysis. Because dialysis can impair the quality of both life and death, a personalized care plan based on both early prognosis and patient choices is required. We developed a prognostic screening tool to identify older patients in need of specific care based on a multidisciplinary approach. Our study included 24,348 patients aged 75 years and older from the French national renal epidemiology and information network (REIN) registry who began dialysis between 1 January 2005 and 30 September 2012. Our primary outcome was overall mortality during the first 3 months of renal replacement therapy. Multivariate logistic regression was used to construct a scoring system in a random half of the cohort (training set). This score, which included age, gender, specific comorbidities, albumin levels, and mobility, was then ap…
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Prior Advance Care Planning Is Associated with Less Decisional Conflict among Surrogates for Critically Ill Patients.
Rationale: Although numerous studies have documented that family members in intensive care units struggle with end-of-life decisions for incapacitated patients, there is little information about whether prior advance care planning lessens the burden of decision making.
Objectives: We sought to measure decisional conflict in surrogates of critically ill patients and to examine whether prior advance care planning is associated with less decisional conflict.
Methods: We performed a secondary data analysis of a multicenter, prospective cohort study done at five U.S. academic medical centers that included 471 surrogates of 257 patients with acute respiratory distress syndrome. The main outcome was surrogates' burden of decision making as measured using the Decisional Conflict Scale. Surrogates completed a questionnaire item addressing whether they had had any prior advance care planning conve…
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You JJ, Downar J, Fowler RA, Lamontagne F, Ma IW, Jayaraman D, Kryworuchko J, Strachan PH, Ilan R, Nijjar AP, Neary J, Shik J, Brazil K, Patel A, Wiebe K, Albert M, Palepu A, Nouvet E, des Ordons AR, Sharma N, Abdul-Razzak A, Jiang X, Day A, Heyland DK, Canadian Researchers at the End of Life Network (2015)cohort or longitudinalMEDLINE-indexed journal, not yet read by usJAMA internal medicine283 citations Barriers to goals of care discussions with seriously ill hospitalized patients and their families: a multicenter survey of clinicians.
Importance: Seriously ill hospitalized patients have identified communication and decision making about goals of care as high priorities for quality improvement in end-of-life care. Interventions to improve care are more likely to succeed if tailored to existing barriers.
Objective: To determine, from the perspective of hospital-based clinicians, (1) barriers impeding communication and decision making about goals of care with seriously ill hospitalized patients and their families and (2) their own willingness and the acceptability for other clinicians to engage in this process.
Design, setting, and participants: Multicenter survey of medical teaching units of nurses, internal medicine residents, and staff physicians from participating units at 13 university-based hospitals from 5 Canadian provinces.
Main outcomes and measures: Importance of 21 barriers to goals of care discussions rated …
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Advance care planning beyond advance directives: perspectives from patients and surrogates.
Context: Advance care planning (ACP) has focused on documenting life-sustaining treatment preferences in advance directives (ADs). The ADs alone may be insufficient to prepare diverse patients and surrogates for complex medical decisions.
Objectives: To understand what steps best prepare patients and surrogates for decision making.
Methods: We conducted 13 English/Spanish focus groups with participants from a Veterans Affairs and county hospital and the community. Seven groups included patients (n=38), aged ≥65 years, who reported making serious medical decisions. Six separate groups included surrogates (n=31), aged ≥18 years, who made decisions for others. Semistructured focus groups asked what activities best prepared the participants for decision making. Two investigators independently coded data and performed thematic content analysis. Disputes were resolved by consensus.
Results: Th…
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Development and validation of a questionnaire to detect behavior change in multiple advance care planning behaviors.
Introduction: Advance directives have traditionally been considered the gold standard for advance care planning. However, recent evidence suggests that advance care planning involves a series of multiple discrete behaviors for which people are in varying stages of behavior change. The goal of our study was to develop and validate a survey to measure the full advance care planning process.
Methods: The Advance Care Planning Engagement Survey assesses "Process Measures" of factors known from Behavior Change Theory to affect behavior (knowledge, contemplation, self-efficacy, and readiness, using 5-point Likert scales) and "Action Measures" (yes/no) of multiple behaviors related to surrogate decision makers, values and quality of life, flexibility for surrogate decision making, and informed decision making. We administered surveys at baseline and 1 week later to 50 diverse, older adults from…
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Norms of decision making in the ICU: a case study of two academic medical centers at the extremes of end-of-life treatment intensity.
Purpose: To explore norms of decision making regarding life-sustaining treatments (LSTs) at two academic medical centers (AMCs) that contribute to their opposite extremes of end-of-life ICU use.
Methods: We conducted a 4-week mixed methods case study at each AMC in 2008-2009 involving direct observation of patient care during rounds in the main medical ICU, semi-structured interviews with staff, patients, and families, and collection of artifacts (e.g., patient lists, standardized forms). We compared patterns of decision making regarding initiation, continuation, and withdrawal of LST using tests of proportions and grounded theory analysis of field note and interview transcripts.
Results: We observed 80 patients [26 (32.5 %) ≥65 years old] staffed by 4 attendings, and interviewed 23 staff and 3 patients/families at the low-intensity AMC (LI-AMC), and observed 73 patients [26 (35.6 %) ≥65…
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Decision-making impairments in women with binge eating disorder in comparison with obese and normal weight women.
Objective: The purpose of the current study was to examine decision making in female patients with binge eating disorder (BED) in comparison with obese and normal weight women.
Method: In the study, 20 patients with BED, 21 obese women without BED and 34 healthy women participated. Decision making was assessed using the Iowa Gambling Task (IGT). Several questionnaires were administered measuring binge eating severity, sensitivity for punishment and reward, and self-control.
Results: The findings indicated that the BED and obese group performed poorly on the IGT. Participants who have BED and are obese did not improve their choice behaviour over time, whereas participants with normal weight showed a learning effect. An association between IGT performance and binge eating severity was found.
Conclusion: This study demonstrates that patients with BED display decision-making deficits on the …
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Traditional expectations versus US realities: first- and second-generation Asian Indian perspectives on end-of-life care.
Background: Although end-of-life care preferences vary across racial/ethnic groups, little is known about how cultural values affect end-of-life care preferences among South Asian immigrants and their offspring in the US.
Objective: To examine the perspectives of first- and second-generation South Asians living in the US regarding end-of-life care.
Design: Focus group study. Discussions explored participant preferences and experiences with family members facing the end of life.
Participants: Twelve first-generation and 11 second-generation self-identified Asian Indians living in the mid-Atlantic region.
Approach: Content analysis of focus group transcripts.
Results: First-generation participants ranged in age from 41 to 76 years and were evenly split by gender. Second-generation participants ranged in age from 23 to 36 years and included seven women and four men. All participants were hi…
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I don't want to be the one saying 'we should just let him die': intrapersonal tensions experienced by surrogate decision makers in the ICU.
Background: Although numerous studies have addressed external factors associated with difficulty in surrogate decision making, intrapersonal sources of tension are an important element of decision making that have received little attention.
Objective: To characterize key intrapersonal tensions experienced by surrogate decision makers in the intensive care unit (ICU), and explore associated coping strategies.
Design: Qualitative interview study.
Participants: Thirty surrogates from five ICUs at two hospitals in Pittsburgh, Pennsylvania, who were actively involved in making life-sustaining treatment decisions for a critically ill loved one.
Approach: We conducted in-depth, semi-structured interviews with surrogates, focused on intrapersonal tensions, role challenges, and coping strategies. We analyzed transcripts using constant comparative methods.
Key results: Surrogates experience signif…
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Decision-making and outcomes of feeding tube insertion: a five-state study.
Objectives: To examine family member's perceptions of decision-making and outcomes of feeding tubes.
Design: Mortality follow-back survey. Sample weights were used to account for oversampling and survey design. A multivariate model examined the association between feeding tube use and overall quality of care rating regarding the last week of life.
Setting: Nursing homes, hospitals, and assisted living facilities.
Participants: Respondents whose relative had died from dementia in five states with varying feeding tube use.
Measurements: Respondents were asked about discussions, decision-making, and outcomes related to their loved ones' feeding problems.
Results: Of 486 family members surveyed, representing 9,652 relatives dying from dementia, 10.8% reported that the decedent had a feeding tube, 17.6% made a decision not to use a feeding tube, and 71.6% reported that there was no decision a…
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Breast cancer delay: a grounded model of help-seeking behaviour.
The conventional definition and classifications of breast cancer delay are based on arbitrary empirical time cut-offs. In general, studies of cancer delay are based on these traditional definitions of patient and provider delay and are essentially atheoretical. If we aim to better understand delay, a reconsideration of its traditional conceptualisation and study methods is warranted. We propose a multidimensional model of breast cancer delay grounded in data from in-depth interviews with symptomatic patients and nested in the theory of illness behaviour. Our results show that delay prior to the first encounter with health services has to do with more than simply the patient as an individual, and delay posterior to this encounter is not due only to the health care providers. In fact, delay is a result of the interplay between the patient's socio-cultural context, individual characteristic…
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The role of self-reported impulsivity and reward sensitivity versus neurocognitive measures of disinhibition and decision-making in the prediction of relapse in pathological gamblers.
Background: Disinhibition and decision-making skills play an important role in theories on the cause and outcome of addictive behaviors such as substance use disorders and pathological gambling. In recent studies, both disinhibition and disadvantageous decision-making strategies, as measured by neurocognitive tests, have been found to influence the course of substance use disorders. Research on factors affecting relapse in pathological gambling is scarce.
Method: This study investigated the effect of both self-reported impulsivity and reward sensitivity, and neurocognitively assessed disinhibition and decision-making under conflicting contingencies, on relapse in a group of 46 pathological gamblers.
Results: Logistic regression analysis indicated that longer duration of the disorder and neurocognitive indicators of disinhibition (Stop Signal Reaction Time) and decision-making (Card Playi…
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Health literacy not race predicts end-of-life care preferences.
Background: Several studies have reported that African Americans are more likely than whites to prefer aggressive treatments at the end of life.
Objective: Since the medical information presented to subjects is frequently complex, we hypothesized that apparent differences in end-of-life preferences and decision making may be due to disparities in health literacy. A video of a patient with advanced dementia may overcome communication barriers associated with low health literacy.
Design: Before and after oral survey.
Participants: Subjects presenting to their primary care doctors.
Methods: Subjects were asked their preferences for end-of-life care after they heard a verbal description of advanced dementia. Subjects then viewed a 2-minute video of a patient with advanced dementia and were asked again about their preferences. For the analysis, preferences were dichotomized into comfort care …
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Empathy and life support decisions in intensive care units.
Background: Although experts advocate that physicians should express empathy to support family members faced with difficult end-of-life decisions for incapacitated patients, it is unknown whether and how this occurs in practice.
Objectives: To determine whether clinicians express empathy during deliberations with families about limiting life support, to develop a framework to understand these expressions of empathy, and to determine whether there is an association between more empathic statements by clinicians and family satisfaction with communication.
Design: Multi-center, prospective study of audiotaped physician-family conferences in intensive care units of four hospitals in 2000-2002.
Measurements: We audiotaped 51 clinician-family conferences that addressed end-of-life decisions. We coded the transcripts to identify empathic statements and used constant comparative methods to categ…
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Voices of African American, Caucasian, and Hispanic surrogates on the burdens of end-of-life decision making.
Background: End-of-life decisions are frequently made by patients' surrogates. Race and ethnicity may affect such decision making. Few studies have described how different racial/ethnic groups experience end-of-life surrogate decision making.
Objectives: To describe the self-reported experience the self-reported experience of African-American, Caucasian, and Hispanic surrogate decision makers of seriously ill patients and to examine the relationship of race, ethnicity, and culture to that experience.
Design: Purposive sample to include racial/ethnic minorities in a qualitative study using focus group interviews.
Participants: The participants of the study were 44 experienced, mostly female, surrogate decision makers for older veterans.
Approach: Transcripts were qualitatively analyzed to identify major themes, with particular attention to themes that might be unique to each of the three …
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Sprung CL, Woodcock T, Sjokvist P, Ricou B, Bulow HH, Lippert A, Maia P, Cohen S, Baras M, Hovilehto S, Ledoux D, Phelan D, Wennberg E, Schobersberger W (2008)cohort or longitudinalMEDLINE-indexed journal, not yet read by usIntensive care medicine90 citations Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study.
Objective: To evaluate physicians' reasoning, considerations and possible difficulties in end-of-life decision-making for patients in European intensive care units (ICUs).
Design: A prospective observational study.
Setting: Thirty-seven ICUs in 17 European countries.
Patients and participants: A total of 3,086 patients for whom an end-of-life decision was taken between January 1999 and June 2000. The dataset excludes patients who died after attempts at cardiopulmonary resuscitation and brain-dead patients.
Measurements and results: Physicians indicated which of a pre-determined set of reasons for, considerations in, and difficulties with end-of-life decision-making was germane in each case as it arose. Overall, 2,134 (69%) of the decisions were documented in the medical record, with inter-regional differences in documentation practice. Primary reasons given by physicians for the decision…
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Surviving surrogate decision-making: what helps and hampers the experience of making medical decisions for others.
Background: A majority of end-of-life medical decisions are made by surrogate decision-makers who have varying degrees of preparation and comfort with their role. Having a seriously ill family member is stressful for surrogates. Moreover, most clinicians have had little training in working effectively with surrogates.
Objectives: To better understand the challenges of decision-making from the surrogate's perspective.
Design: Semistructured telephone interview study of the experience of surrogate decision-making.
Participants: Fifty designated surrogates with previous decision-making experience.
Approach: We asked surrogates to describe and reflect on their experience of making medical decisions for others. After coding transcripts, we conducted a content analysis to identify and categorize factors that made decision-making more or less difficult for surrogates.
Results: Surrogates identi…
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Toward shared decision making at the end of life in intensive care units: opportunities for improvement.
Background: In North America, families generally wish to be involved in end-of-life decisions when the patient cannot participate, yet little is known about the extent to which shared decision making occurs in intensive care units.
Methods: We audiotaped 51 physician-family conferences about major end-of-life treatment decisions at 4 hospitals from August 1, 2000, to July 31, 2002. We measured shared decision making using a previously validated instrument to assess the following 10 elements: discussing the nature of the decision, describing treatment alternatives, discussing the pros and cons of the choices, discussing uncertainty, assessing family understanding, eliciting patient values and preferences, discussing the family's role in decision making, assessing the need for input from others, exploring the context of the decision, and eliciting the family's opinion about the treatment d…
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Koenigs M, Tranel D (2007)cohort or longitudinalMEDLINE-indexed journal, not yet read by usThe Journal of neuroscience : the official journal of the Society for Neuroscience279 citations Irrational economic decision-making after ventromedial prefrontal damage: evidence from the Ultimatum Game.
Emotion regulation is often critical for adaptive decision making. Here, we investigate whether emotion regulation defects following focal prefrontal brain damage are associated with exceptionally irrational economic decision making in situations of unfair treatment. In the Ultimatum Game, two players are given one opportunity to split a sum of money. One player (the proposer) offers a portion of the money to the second player (the responder) and keeps the rest. The responder can either accept the offer (in which case both players split the money as proposed) or reject the offer (in which case both players get nothing). Relatively low Ultimatum offers are often rejected, and this "irrational" behavior has been attributed to an emotional reaction to unfair treatment. Using the lesion method, we tested the hypothesis that damage to ventromedial prefrontal cortex (VMPC), an area critical fo…
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Understanding cardiopulmonary resuscitation decision making: perspectives of seriously ill hospitalized patients and family members.
Background: To improve communication and decision making related to cardiopulmonary resuscitation (CPR), a greater understanding of the perspectives of hospitalized patients with advanced diseases and their family members are needed.
Methods: In five Canadian hospitals, we administered a face-to-face questionnaire to older inpatients with end-stage cancer and advanced medical diseases and, where possible, to one of their family members, regarding information needs, the deliberation process, and their preferred decisional role.
Findings: A total of 440 of 569 patients (78%) and 160 of 176 available caregivers (91%) agreed to participate. Most patients (61%) had thought about what treatment they wanted if their heart stopped, few patients (11.3%) could describe more than two components of CPR, and only 2.7% of patients thought that the success rate of CPR was < 10%. A minority of patients …
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Attitudes of physicians, nurses and relatives towards end-of-life decisions concerning nursing home patients with dementia.
Objective: For many nursing home patients in the advanced stages of dementia, a decision to start or forgo treatment has to be taken at the end of their life. It is very important for the peace of mind of all involved in such decision-making that there is agreement on which decision is in the best interest of the patient. It is thus important to investigate the attitude of physicians, nurses and relatives towards medical end-of-life decisions concerning patients with dementia, so that the policy in nursing homes can be tuned to stimulate dialogue and understanding between all parties.
Methods: Fifteen statements about artificial nutrition and hydration (ANH), advance directives, hastening death, self-determination and euthanasia, and nursing home policy were presented to physicians, nurses and relatives of nursing home patients suffering from dementia.
Results: In general, physicians, nu…
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