Journal articles on the topic 'Auto-determination Theory'

This paper investigates a real-world distribution problem arising in the vehicle production industry, particularly in a logistics company, in which cars and vans must be loaded on auto-carriers and then delivered to dealerships. A solution to the problem involves the loading and optimal routing, without violating the capacity and time window constraints for each auto-carrier. A two-phase heuristic algorithm was implemented to solve the problem. In the first phase the heuristic builds a route with an optimal insertion procedure, and in the second phase the determination of a feasible loading. The experimental results show that the purposed algorithm can be used to tackle the transportation problem in terms of minimizing total traveling distance, loading/unloading operations and transportation costs, facilitating a decision-making process for the logistics company.

According to Self-determination Theory (SDT), there are only three psychological needs - competence, autonomy and relatedness - truly fundamental and essential for human being’s health and well-being, which can be satisfied by individuals while engaging in a wide variety of behaviors that may differ among individuals and be differentially manifest in different cultures. However, a number of questions have been raised about SDT’s contention that there are only those three basic psychological needs. The present study discusses the possibility that the security need should be considered as a basic need and its relation to the accepted three basic psychological needs. Using the Cultural Theory framework the degree of satisfaction of the basic needs, depending on the type of culture, is also presented.Keywords: Security needs, basic psychological needs, risks, self-determination, Cultural Theory.Las necesidades de seguridad: algunas consideraciones sobre su integración en la Teoría de la Auto-determinación (TAD)Resumen: De acuerdo con la Teoría de la Autodeterminación (SDT, por sus siglas en inglés) solamente existen tres necesidades psicológicas – competencia, autonomía y asociación – verdaderamente fundamentales y esenciales para la salud y el bienestar de los seres humanos, las cuales pueden ser satisfechas por los individuos en una gran variedad de comportamientos que pueden diferir entre los individuos y manifestarse de distinta manera en diferentes culturas. Sin embargo, han surgido una serie de cuestionamientos sobre la afirmación de la Teoría de la Autodeterminación de que sólo existen esas tres necesidades básicas. El presente estudio discute la posibilidad de que la necesidad de seguridad debe ser considerada como una necesidad básica y su relación con las tres necesidades psicológicas aceptadas.Palabras clave: Necesidades de seguridad, necesidades psicológicas básicas, riesgos, autodeterminación, Teoría Cultural.

In the last few years, water utilities have recognized the importance of evaluating the safety of water distribution networks from the potential risks of contamination, arising from failures or from intentional (targeted) or random attacks. Research literature has been recently focused on the optimal design of efficient detection systems, generally expressed as the problem of the optimal placement of monitoring sensors. In this paper, we introduce a methodology for calculating an index of vulnerability that represents the tendency of an injected contaminant to spread over the network. Epanet quality simulations are performed in order to determine the distribution function of the number of potentially contaminated nodes. The results show how such distribution is overall fitted by a stretched exponential law. The comparison with an auto-similar, tree-like network (described by a power-law) allows the determination of the Vulnerability Index, which quantifies how “far” the behavior of a given system deviates from pure scale-freeness. It is analytically calculated by a two-fold approximation of the stretched exponential and provides an alternative way of evaluating robustness against random water contamination. Different networks can then be directly compared, in order to assess and prioritize control measures and interventions.

AbstractResearch suggests that students put more effort into language learning when they feel that it is a voluntary and self-relevant activity or they enjoy the process of mastering that language (i.e., they have a more self-determined orientation). This orientation is fostered when learners feel autonomous, competent, and related to others in their learning environment. We followed 162 university students of French across one semester to examine these causal claims longitudinally. Latent growth curve modeling showed that feelings of autonomy, competence, and relatedness and self-determined motivation increased across the semester while engagement declined. Parallel processes growth curve modeling showed that declines in engagement across the semester were attenuated to the extent that self-determined motivation increased. Auto-regressive cross-lagged analysis showed that, contrary to expectation, more engagement as the semester started predicted greater self-determination mid-semester (instead of vice versa), but these relations became reciprocal from mid-semester on. These findings are consistent with a dynamic model of motivation that emphasizes the reciprocal interplay between motivational constructs over the duration of a language course. The implications of these findings for motivation theory and instructional practices are discussed.

This paper is using the fundamental forecasting model, which is a monetarist theory of exchange rate determination, for the current forecasting. This theory is tested empirically by using data, spot and forward rates and a variety of macro-variables from seven different countries with respect the U.S., as our domestic country. A GARCH-M model is used to forecast the volatility of the spot exchange rate. The paper is also using a Vector Auto-regression (VAR) framework to forecast simultaneously spot (s_t) and forward (f_t) exchange rates by utilizing exogenous macro-variables, time trends, and policy instruments. Further, at the end an impulse response function and a Hodrick-Prescott filter are used to present visually the behavior of the spot exchange rate. The countries used in the empirical work are, U.S. with respect the Euro-zone, Mexico, Canada, U.K., Switzerland, Japan, and Australia. The results show that these methods are giving very good forecasting for these seven exchange rates by minimizing the standard error of the regression (SER) and the root mean squared error (RMSE). Of course, uncertainty exists always in the forecasting of any economic variables, due to unanticipated public policies (monetary, fiscal, and trade) and other “innovations” in our financial markets, plus the new philosophies (i.e., liberalism, lack of ethics, perversions, DEI, AI, wars, BRICS, etc.), official measurements, and value system in our markets, societies, and way of living.

The COVID-19 pandemic resulted in unprecedented exposure to Potentially Morally Injurious Events (PMIEs) for nurses, in which they were both moral transgressors and moral victims, with deleterious consequences on their psycho-social health and functioning. Our experimental design compared memories of PMIEs with memories of severe moral transgressions (SMTs), in which participants were only moral transgressors. Drawing from Self-Determination Theory and research on moral auto-biographical episodic memories, we assessed a conceptual model describing the impact of recalling a single PMIE or SMT event on nurses’ burnout, work satisfaction and adaptive performance. Our convenience sample comprised 614 Romanian nurses, and data was analyzed with path analysis, general linear modelling, and t-tests. Findings showed that memories of PMIEs, compared to SMTs, were more autonomy thwarting, being associated with more controlled work motivation, less moral learning, higher burnout, less work satisfaction, and adaptive performance. Burnout, moral learning, and work satisfaction were significant mediators of the relationships between PMIE and SMT recall and, respectively, adaptive performance. Our results highlight the urgency for organizational practices of moral repair for nurses after the pandemic, along with interventions meant to increase their autonomy and self-determined work motivation.

In his writings on architecture Derrida defines it as "the last fortress of metaphysics" and supports the necessity of a deconstruction of architecture involving its theory as well as its practice. The essay intends to unfold the meaning of these propositions referring them to Derrida's determination of the Western concept and tradition of the political as "onto-topopolitics" (Spectres de Marx, 1993). In the Western culture the political has always been bound to the issue of the gathering within space, of the closing of frontiers as the condition of its living unity. The place and territory are not simple material elements that add to the political, but they are essential to the constitution of the dream of the living unity of the political, the metaphysical illusion of a full and pure auto-sufficiency keeping alterity and alteration out of what we take as our own individual, social, cultural and political identity. According to Derrida, the deconstruction of architecture has to demystify such illusion and to open the space of a different practice of architecture. A space where the possibility of the relationship to the other discloses itself as the irreducible condition of each form of identity

The welding process is characterized by its high energy density, making it imperative to optimize the energy consumption of welding robots without compromising the quality and efficiency of the welding process for their sustainable development. The above evaluation objectives in a particular welding situation are mostly influenced by the welding process parameters. Although numerical analysis and simulation methods have demonstrated their viability in optimizing process parameters, there are still limitations in terms of modeling accuracy and efficiency. This paper presented a framework for optimizing process parameters of welding robots in industry settings, where data augmentation was applied to expand sample size, auto machine learning theory was incorporated to quantify reflections from process parameters to evaluation objectives, and the enhanced non-dominated sorting algorithm was employed to identify an optimal solution by balancing these objectives. Additionally, an experiment using Q235 as welding plates was designed and conducted on a welding platform, and the findings indicated that the prediction accuracy on different objectives obtained by the enlarged dataset through ensembled models all exceeded 95%. It is proven that the proposed methods enabled the efficient and optimal determination of parameter instructions for welding scenarios and exhibited superior performance compared with other optimization methods in terms of model correctness, modeling efficiency, and method applicability.

The article deals with the dynamics of the semantic complex of dominant units in poetic text. Units of poetic text are divided into constant and dominant ones. Constant units realize the function of the context formation. They have one clear meaning. Dominant units realize the function of semantization. They are poly-interpretative. The methodology of the work is based on the theory of intertextuality which is viewed from the position of structural, interpretative and lingua-cultural approaches. The brief typology and characteristics of intertextual relations are given: auto- (self-quotations, self-allusions), in- (quotations, allusions), para- (structural and compositional units of a text such as a title, an epigraph, etc.) and arch-textuality (genre imitation; referring to well-known artistic images or cultural phenomena). The paper presents the model of analysis of dominant units in poetic text. The analysis is carried out in five steps: fragmentation, contextual analysis, search and determination of intertextual relations between the analyzed unit and units of address texts, contextual analysis of address texts, synthesis of the obtained contextual meanings. The practical material under study is the poem Elegy by the Canadian poet L. Cohen. The unit of analysis is the personal pronoun he in the given poetic text. The paper establishes intertextual relations between Elegy and texts from Greek mythology, the Holy Bible, Christian culture, and other works by L. Cohen. The conducted analysis shows that intertextual relations between the studied units initiate exchange and superimposition of their context meanings. As a result, the studied unit can have several meanings (some of which are not present in dictionaries but unique for the given author) within the same context. In this way, the dynamics of the semantic complex of the studied units and poetic text is realized.

The recent publication of André Bazin's Écrits complets (2018), an enormous two-volume edition of 3000 pages which increases ten-fold Bazin's available corpus, provides opportunities for renewed reflection on, and possibly for substantial revisions of, this key figure in film theory. On the basis of several essays, I propose a drastic rereading of Bazin's most explicitly philosophical notion of “ontology.” This all too familiar notion, long settled into a rather dust-laden couple (“Bazin and ontology”) nonetheless retains its fascination. Rather than attempting to provide a systematic reworking of this couple along well established lines, particularly those defined by realism and indexicality, this article proposes to shift the notion of ontology in Bazin from its determination as actual existence toward a more radical concept of ontology based on the notion of mimesis, particularly as articulated, in a Heideggerian mode, by Philippe Lacoue-Labarthe. This more properly ontological concept, also paradoxically and radically improper, is shown to be at work already in Bazin's texts, and it allows us to see that far from simplistically naturalizing photographic technology, Bazin does the contrary: he technicizes nature. If Bazin says that the photograph is a flower or a snowflake, he also implies that, like photographs, these are likewise a kind of technical artifact, an auto-mimetic reproduction of nature. Bazin likewise refers to film as a kind of skin falling away from the body of History, an accumulating pellicule in which nature and history disturbingly merge. This shifted perspective on Bazin's thinking is extended further in reference to Georges Didi-Huberman on the highly mimetic creatures known as phasmids, insects that mimic their environement. I extend this into the dynamic notion of eternal return, an implicit dimension of Bazin's thinking, clarified here in reference to Giorgio Agamben and the “immemorial image” which, like Bazin's “Death Every Afternoon,” presents an eminently repeatable deathly image, an animated corpse-world that can be likened to hell.

En este artículo se quiere trazar una teoría política de la insurrección en el pensamiento de Max Stirner, en tanto alternativa ética y política a la revolución. Se mostrará cómo, según el pensador alemán, la revolución es en última instancia una estrategia fallida de emancipación en tanto en cuanto no libera al individuo de las formas de subjetividad que lo mantienen dependiente del poder. Más en general, se enseñará como el orden liberal post-revolucionario, detrás del lenguaje secular de los derechos, las libertades y la igualdad, engendra técnicas más sutiles de gobernabilidad del individuo. La insurrección, en cambio, puede ser vista como un rechazo de las identidades y de los roles que disciplinan al individuo. Al respecto, se prestará una atención especial al concepto stirneriano de Eigenheit (propiedad de sí), como estrategia ética de auto-determinación y liberación de las formas rígidas de la subjetividad. En última instancia, se querrá mostrar cómo todo el proyecto político de la insurrección stirneriana se basa en un anarquismo ontológico que rechaza la lógica teleocrática del racionalismo moderno y pone en entredicho la misma noción de realización. The aim of this article to outline a political theory of insurrection in Max Stirner’s thought as an ethical and political alternative to revolution. I will show that revolution is ultimately a failed strategy of emancipation as it does not free the individual from the forms of subjectivity that keep her dependent on power. Insurrection, on the other hand, can be seen as a rejection of the identities and roles that discipline the individual. In this regard, special attention will be paid to the Stirnerian concept of Eigenheit as an ethical strategy of self-determination and liberation from rigid forms of subjectivity. Ultimately, I will show how the whole political project of the Stirnerian insurrection is based on an ontological anarchism that rejects the teleocratic logic of modern rationalism and calls into question the very notion of realization.

The subject of the article is the processes of synthesis of a mathematical model of control objects functioning in computer information-control systems of critical purpose for the needs of high-speed railway transport. The main emphasis is on modeling the movement of a passenger train in the high-speed system of Ukrzaliznytsia. The aim is to study the process of regulating the speed of railway vehicles under conditions of uncertainty in the primary information of microprocessor information-control systems of railway transport. Tasks: determination of the criterion of the safety of railway vehicle auto control; obtain a mathematical model of train movement under conditions of uncertainty; check the adequacy of the model. The method used is the mathematical apparatus of discrete models. The following results have been obtained. The mathematical model of train movement developed in this work includes not only information on train position, reference point, direction, and speed of the vehicle but also a variable control indicator to reflect the process of railway traffic adequately. The study shows that, based on the synthesized model, it is possible to use the so-called fuzzy distance between adjacent trains. This approach improves the accuracy of determining the critical distance between trains, the time required to eliminate the risk of collision, the start time of braking, and braking time considering the angle of inclination of the track, as well as the distance of the braking distance. The necessity to determine the control indicator, its value for many points of time, while there is a reduction in speed for the safe movement of trains. Based on the proposed mathematical model, a computer simulation of the process was performed to determine the required time reserve for the train driver to respond to changes in the speed of the previous train, as well as speed ranges that require immediate emergency action. Conclusions. The scientific novelty of the obtained results is the development of a mathematical model of the behavior of mobile units in computer systems for critical use for the needs of railway transport in the presence of failures in the primary information from sensors that record motion parameters. The behavior of the control system at different values of train speed and changes in the value of the interval of the accompanying journey is studied. The theory of traction calculations in computer control systems for mobile units has been further developed. The obtained scientific results will be used in the development of an application program for many critical computer systems for railway.

According to the benefit sharing problem among the market competitive vehicledealers, vehicle manufacturers and auto parts suppliers consisting of three-echelon automotive supply chain, by using decentralized and centralized decision-making ways, we set up a mathematical model, which meet the coordinated conditions and achieve a win-win model for enterpricses within the supply chain.After analyzing the pricing of three-echelon vehiclesupply chain with the applicationof game theory, get the balanced result and profit at all levels in the condition of complete information. According to the interests of the entire supply chain based on the principle of contribution distribution, designed the parameters to make the entier supply chain achieving the maximize profit. We also proposed the way of determining revenue sharing system of three-echelon vehiclesupply chain. Finally, the reasonableness of the sharing factor determining method is proved by numerical examples.

The reliability of automotive internal combustion engines is a function of the reliability of their mechanisms and systems. For many years, domestic and foreign engineers have tested many auto-tractor internal combustion engines and it has been proven that if mathematical models reliably describe physical phenomena, cycles or processes that take place in engines, then the theory of small deviations for theoretical research is much better than any experiment on control characteristics and many second parameters The theory of small deviations for fuel equipment of autotractor diesel engines is considered in the article. The method of transition from the ordinary differential equations describing the quality of diesel fuel spraying to the equations in small deviations. Equation of kinematics and hydrodynamics of precision pairs of fuel equipment in small deviations. Consumption characteristics of fuel in the process of injection in small deviations. Methods of similarity, dimension theory, mathematical statistics, and probability theory, which are used in determining the resource and predicting the operation of tractor engines. It is shown that the most practically accepted method for determining the residual life of autotractor engines is the method of mathematical statistics and probability theory. The role of mathematical modeling in determining the residual life of fuel equipment of autotractor diesel engines is established. It is also noted that it is advisable to use the small deviation method to accurately describe the processes in the fuel equipment of autotractor diesel engines. The mathematical model is based on the known physical laws that describe the interdependencies of the two groups of parameters, control and operational, both within and between groups. The transition of the classical differential equations describing the processes of fuel supply and injection, taking into account fuel leaks in precision pairs, into equations with small deviations of parameters, is shown. The relationship between injection, fuel supply and fuel leakage is analyzed and the most influential parameters found. Impact coefficients are found and their dependencies are plotted on their corresponding parameters. Using the obtained dependencies, the influence of the technical condition of precision pairs on the effective performance of the engine is characterized. Dependences of change of injection characteristics on small deviations of parameters characterizing the technical condition of precision pairs of fuel equipment are also established.

AbstractWe present systematic ab-initio study on the phonon mode potential as a source of anharmonicity in the crystal. As an example, the transverse optical (TO) mode potential in PbTe has been fitted to density-functional-theory calculated energies of phonons excited with different amplitudes of mode displacements. The corresponding equation of motion has been analytically and numerically solved in 1D and 2D space, respectively. The solution is used for constructing the ensemble of 10,000 systems with potential and kinetic energies selected according to the thermal equilibrium distributions. The velocity auto-correlation function derived from the computed trajectories is then used to calculate the profile of the phonon spectrum for the TO an LA modes at three temperatures of 100, 300, and 600 K. This technique allows for determination of the contribution of non-quadratic potential of the phonon mode to the anharmonicity in the crystal and its effect on the phonon spectrum.

“Art as Information: Re-reading Quicksand” is a micro-study of an African American cultural narrative through artmaking. My subject is the autobiographical and fictional novel, Quicksand by Nella Larsen (1928). Larsen’s life and creative storytelling provide paths for how we may attend to cultural heritage knowledge gaps about Black womanhood by engaging with the informing processes of art. This especially highlights artwork concerning self-definition and self-determination while navigating life within a racialized, classed, and gendered body. I re-present Quicksand as an autobiographical artifact and living artwork to explore how we may produce an ever-emerging archives on Black womanhood from rereading cultural auto/bio/fiction. This critical and cyclical exploration involves making artworks that reiterate and interpret knowledges that emerge from reading Larsen’s narrative—modeling a framework of how Art as Information (AAI) may be engaged to reexamine personal narratives.
 This dissertation also reintroduces AAI as a subfield of Information Sciences that engages artmaking as an information technology. It involves the study of arts’ roles within knowledge production: how we craft, document, process, and circulate information through making art. I intertwine Information Sciences with art pedagogy and auto/bio/fiction studies. I also lean on cultural-attentive lenses, such as Black Feminist Material Culture and Culturally Situated Reader Response Theory, to examine how we may tend to cultural knowledges that are historically silenced and disfigured—exploring the liberatory aspects of artmaking to intercept and dismantle exploitative depictions (i.e., visual violences) historically committed against marginalized groups under the guise of neutral documentation and curiosity.

L’articolo precisa i significati filosofici di biopolitica, distinguendo la biopolitica come “potere arbitrario sulla vita biologica” (o politica sulla vita) e la biopolitica come “buon governo al servizio della persona umana” (o politica per la vita). Il primo significato si inserisce in una teoria etica non cognitivista e soggettivista, che ritiene il diritto e il potere quali prodotto della volontà autoreferenziale; il secondo significato rimanda ad una teoria che riconosce valori oggettivi nella natura umana quale fonte del diritto e della politica. La politica come potere arbitrario ritiene la vita un mero oggetto biologico, disponibile e manipolabile, senza limiti etici fondabili a priori: è la teoria che separa l’essere umano dalla persona, attribuendo solo alle persone in grado di autodeterminarsi i diritti. La politica come buon governo prende in considerazione la vita umana come espressione della vita personale (dall’inizio alla fine), riconoscendone il valore quale orizzonte di senso: è la teoria che identifica essere umano e persona, ritenendo che ogni essere umano e tutti gli esseri umani abbiano diritti. ---------- The article specifies philosophical significance of biopolitics, making a difference between biopolitics as “arbitrary power on biological life” (or politics on life) and biopolitics as “good government in the service of human person” (or politics for life). The first significance refers to the ethical theory of non-cognitivism and subjectivism, that considers law and power as a product of will which refers to itself; the second significance sends back to a theory which recognises the objective values of human nature, as the origin of law and politics. The politics as arbitrary power considers life as a biological object, available and at disposal, without any a priori justification of ethical limits: it is the theory which separates human beings and persons, attributing rights only to persons capable of auto-determination. The politics as good government considers human life as an expression of personal life (form the beginning till the end), recognising its value as an horizon of sense: it is the theory that identifies human being and person, considering each human being and all human beings as subjects of rights.

Abstract. The practice of sports by veteran athletes is a reality with an expansion perspective. The objective was to determine predictive variables of healthy lifestyles and satisfaction with life in veteran athletes, according to the Self-determination Theory (SDT). A structural equation model and a mediation model has developed. The number of participants were 680 Portuguese veteran athletes, aged between 30 and 90 years old (M=43.78 DT=8.61). The Basic Psychological Needs Exercise Scale, the Behavioral Regulation in Sport Questionnaire, the Healthy Lifestyles Questionnaire and the Life Satisfaction Scale were used. This model has shown the following adjustments indices: χ2 = 729.116, p < .001, χ2/df = 4.41, CFI = .92; IFI = .92; TLI = .91; GFI = .91; RMSEA = .068; SRMR = .064. As a conclusion, in veteran athletes, the perception of satisfaction of the basic psychological needs for autonomy, leads to autonomously motivated behaviours, promoting better eating and resting habits, as well as high satisfaction with life, and a lower consumption of tobacco. Autonomous motivation has not proved to be a significant mediating variable between the basic psychological need for autonomy, lifestyles and satisfaction with life.
 Resumen. La práctica de deportes por deportistas veteranos es una realidad evidente y con perspectivas de expansión. El objetivo de este estudio fue determinar las variables predictivas para estilos de vida saludables y satisfacción con la vida en deportistas veteranos, desde la Teoría de la Autodeterminación. Se desarolló un modelo de ecuación estructural y un modelo de mediación. Participaron 680 deportistas veteranos portugueses, entre los 30 y 90 años (M=43.78 DT=8.61). Se utilizó la Escala de Necesidades Psicologicas Básicas, el Cuestionario de Regulación Comportamental en el Deporte, el Cuestionário de Estilos de Vida Saludables y la Escala de Satisfacción con la Vida. El modelo demostró los siguientes índices: χ2 = 729.116, p < .001, χ2/df = 4.41, CFI = .92; IFI = .92; TLI = .91; GFI = .91; RMSEA = .068; SRMR = .064. Como conclusiones, em los deportistas veteranos, la percepción de satisfacción de la necesidad psicológica básica de autonomía conduce a comportamientos motivados de manera autónoma, promoviendo estos, mejores hábitos de alimentación y descanso, alta satisfacción con la vida y menos consumo de tabaco. La motivación autónoma no demostró ser una variable mediadora significativa entre la necesidad psicológica básica de autonomía y estilos de vida y satisfacción con la vida.

Abstract Objective. This work was conducted to determine the effectiveness of a nursing intervention, based on the motivational interview, to diminish preoperative anxiety in patients programmed for knee replacement surgery.Methods. Preventive type controlled and randomized clinical trial, on a sample of 56 patients programmed for knee replacement surgery in a clinic in Girardot (Colombia). Random assignment was made: an intervention group (n=28) and a control group (n=28). The six-question Amsterdam Preoperative Anxiety and Information Scale was applied before and after the intervention. The scale has a total score ranging from 5 to 30; the higher the score, the greater the preoperative anxiety. The nursing intervention was conducted in three sessions of motivational interview each lasting 40 min, during the six weeks prior to the surgical procedure; the control group received conventional management of education in the health institution.Results. The mean score of preoperative anxiety was equal in the pre-intervention evaluation in both groups (19.76 in the experimental versus 22.02 in the control =22.02; p<0.226), while during the post-intervention, the anxiety score was lower in the intervention group compared with the control group (15.56 and 20.30, respectively; p<0.013).Conclusion. Nursing intervention based on the motivational interview was effective in diminishing preoperative anxiety in patients programmed for knee replacement surgery.Descriptors: anxiety; arthroplasty, replacement, knee; control groups; motivational interview; orthopedics; perioperative nursing.How to cite this article: Cómo citar este artículo: Medina-Garzón M. Medina-Garzón M. Effectiveness of a Nursing Intervention to Diminish Preoperative Anxiety in Patients Programmed for Knee Replacement Surgery: Preventive Controlled and Randomized Clinical Trial. Invest. Educ. 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