Experimentation in cosmology: Intervening on the whole universe.

There are many arguments against the possibility of experimenting on the whole universe. This system seems to be too big to be manipulated, it exists in only one exemplar and its evolution is a non-repeatable process. In this paper, I claim that we can nonetheless talk about experimentation in cosmology if we use Woodward's non-anthropocentric notion of intervention. However, Woodward and other interventionists argued that an intervention was necessarily an exogenous causal process and thus that no intervention on a closed system such as the universe was possible. I discuss their argument and I determine the conditions under which a consistent notion of endogenous intervention on the universe can be defined. Then, I show that there is at least one cosmic phenomenon satisfying these conditions: the photon decoupling. Finally, I draw some conclusions from this analysis regarding a realist approach of cosmology.

What if Hitler had won WWII and met Kennedy in 1964? Perception and evaluation of counterfactual historical fiction.

Introduction: This study investigates the cognitive processing and perception of counterfactual historical fiction and its effects on readers' receptivity to fascism, superstitious beliefs, and satisfaction with the present state of politics. Counterfactual historical fiction presents alternative realities where history diverges from the official historiography, such as in Robert Harris' novel Fatherland, which depicts a counterfactual world where Hitler won WWII. It was hypothesized that reading this genre incurs additional cognitive costs and is perceived with less realism and more aesthetic appreciation compared to historical fiction. Methods: Seventy-four subjects were divided into two groups and presented with two versions of paragraphs from Fatherland. An experimental group read the original version, describing a counterfactual reality where Hitler is still alive in 1964 (counterfactual historical fiction). A control group read a manipulated version, where events are made plausible by being backdated to 1941 (historical fiction). The study employed a triangulation of methods, utilizing online eye tracking and self-report questionnaires with 7-point Likert scale measurements. Results: The results indicate that counterfactual historical fiction is associated with increased cognitive demands at the first point of divergence, i.e., the first linguistic cue indicating counterfactuality. This genre also induced less perceived realism of history (factuality) and more surprise. Both versions of the text impacted readers by decreasing agreement with fascism, reducing superstitious beliefs, and enhancing their positive evaluation of the current political situation. Discussion: The study reveals the cognitive processing of counterfactual historical fiction, highlighting the need for revising current theoretical assumptions. Additionally, the positive impact on readers' attitudes and beliefs may underscore literature's potential role in fostering critical thinking, pro-social behavior, and satisfaction. Further research is suggested for subsequent empirical validation.

Emotional contextual effects of face perception: a test of the affective realism hypothesis.

Affective feelings naturally infuse individuals' perceptions, serving as valid windows onto the real world. The affective realism hypothesis further explains how these feelings work: as properties of individuals' perceptual experiences, these feelings influence perception. Notably, this hypothesis based on affective feelings with different valences has been substantiated, whereas the existing evidence is not compelling enough. Moreover, whether specific affective feelings can be experienced as properties of target perception remains unclear. Addressing these two issues deepens our understanding of the nature of emotional representation. Hence, we investigated the affective realism hypothesis based on affective feelings with different valences and specific emotions, comparing it with the affective misattribution hypothesis. In Experiment 1, we examined the effects of affective feelings with various valences on targets' perception through the AM (1a) and CFS paradigms (1b). In Experiment 2, we investigated the effects of affective feelings with anger, sadness, and disgust using similar methods. Results from Experiments 1a and 1b consistently indicated significant differences in valence ratings of neutral faces under emotional contexts with varying valences. Experiment 2a revealed significant differences in specific emotion ratings of neutral faces under different specific emotional contexts in the AM paradigm, whereas such differences were not observed in the CFS paradigm in Experiment 2b. We concluded that affective feelings with different valences, rather than specific emotions, can be experienced as inherent properties of target perception, validating the affective realism hypothesis. These findings supported the view that the nature of emotional representation should be described as affective dimensions.

Emotionality in Transboundary Water: A Case Study of Helmand River.

While a substantial body of literature perceives rationality as the only path for negotiations over the use of the transboundary shared watercourse, recent scholarship has unveiled the role of emotion in decision-making processes over the use of the shared water. This research aims to challenge the conventional approach-rationality-by exploring affective dynamics of the riparian nations of the Helmand River (shared between upstream Afghanistan and downstream Iran) and how decisions over the use of the shared Helmand River are ingrained in the emotional dispositions of the riparian nations. Taking an integrated approach combining emotional political ecology and neoclassical realism, this research unravels the intricate emotional dynamics of the riparian nations to the flow of the Helmand River. The staggering increase in water withdrawal-both surface and groundwater resources- coupled with the population growth, and adverse effects of climate changes has stimulated the negative emotional dispositions of the borderland communities- the sufferings of farming communities due to lack of access to water-resulting in water conflict escalation in the Helmand River Basin. Finally, it is asserted that negotiations over the use of Helmand River are considered to be ill-equipped unless emotionality and rationality-a pluralistic approach- are equally weighed or gauged in water allocation and utilization by the co-riparian nations.

What Is a Disease for Doctors? A Realist Thematic Qualitative Analysis of the Interpretation of Clinical Vignettes.

Given the long-standing debate about the nature of the concept of disease, the objective of this study was to understand how doctors categorize a condition as a disease or not, and what the kind of information they use is. A survey with a set of eighteen clinical vignettes was designed, and nineteen physicians and senior students purposefully selected were asked to interpret those situations as diseases or not and to produce an anonymous short written piece of text providing the motivation of their choice. Realist thematic analysis was used to analyse the answers, and four themes emerged: the temporal dimension of a disease, reification of disease, disease as an existential condition, and disease as a motivation to action. The respondents' interpretations were very heterogeneous, supporting the idea that physicians do not share a common prototypical concept of disease. The results suggested that the interpretation of a condition as a disease or not is the final outcome of a process, in which information from objective, subjective, and socially mediated elements is taken into consideration. According to a critical realist and systemic approach, we hypothesize that the context of doctor-patient relationship could influence the interpretation of the same condition as being a disease or not.

Training as imagined? A critical realist analysis of Scotland's internal medicine simulation programme.

BACKGROUND: Evaluating the impact of simulation-based education (SBE) has prioritised demonstrating a causal link to improved patient outcomes. Recent calls herald a move away from looking for causation to understanding 'what else happened'. Inspired by Shorrock's varieties of human work from patient safety literature, this study draws on the concept of work-as-done versus work-as-imagined. Applying this to SBE recognises that some training impacts will be unexpected, and the realities of training will never be quite as imagined. This study takes a critical realist stance to explore the experience and consequences, intended and unintended, of the internal medicine training (IMT) simulation programme in Scotland, to better understand 'training-as-done'. METHODS: Critical realism accepts that there is a reality to uncover but acknowledges that our knowledge of reality is inevitably our construction and cannot be truly objective. The IMT simulation programme involves three courses over a 3-year period: a 3-day boot camp, a skills day and a 2-day registrar-ready course. Following ethical approval, interviews were conducted with trainees who had completed all courses, as well as faculty and stakeholders both immersed in and distant from course delivery. Interviews were audio-recorded, transcribed verbatim and analysed using critical realist analysis, influenced by Shorrock's proxies for work-as-done. RESULTS: Between July and December 2023, 24 interviews were conducted with ten trainees, eight faculty members and six stakeholders. Data described proxies for training-as-done within three broad categories: design, experience and impact. Proxies for training design included training-as-prescribed, training-as-desired and training-as-prioritised which compete to produce training-as-standardised. Experience included training-as-anticipated with pre-simulation anxiety and training-as-unintended with the valued opportunity for social comparison as well as a sense of identity and social cohesion. The impact reached beyond the individual trainee with faculty development and inspiration for other training ventures. CONCLUSION: Our findings highlight unintended consequences of SBE such as social comparison and feeling 'valued as a trainee, valued as a person'. It sheds light on the fear of simulation, reinforcing the importance of psychological safety. A critical realist approach illuminated the 'bigger picture', revealing insights and underlying mechanisms that allow this study to present a new framework for conceptualising training evaluation.

A systematic review of the mechanisms influencing engagement in diabetes prevention programmes for people with pre-diabetes.

AIMS: To identify barriers and enablers that influence engagement in and acceptability of diabetes prevention programmes for people with pre-diabetes. The results will provide insights for developing strategies and recommendations to improve design and delivery of diabetes prevention programmes with enhanced engagement and acceptability for people with pre-diabetes. METHODS: This review used a critical realist approach to examine context and mechanisms of diabetes prevention programmes. Medline, Embase, PsycInfo, Cinahl, Web of Science, Scopus and Pre-Medline were searched for English language studies published between 2000 and 2023. A quality assessment was conducted using Joanna Briggs Institute critical appraisal tools. RESULTS: A total of 90 papers met inclusion criteria. The included studies used a variety of quantitative and qualitative methodologies. Data extracted focused on barriers and enablers to engagement in and acceptability of diabetes prevention programmes, with seven key mechanisms identified. These included financial, environmental, personal, healthcare, social and cultural, demographic and programme mechanisms. Findings highlighted diverse factors that influenced engagement in preventive programmes and the importance of considering these factors when planning, developing and implementing future diabetes prevention programmes. CONCLUSIONS: Mechanisms identified in this review can inform design and development of diabetes prevention programmes for people with pre-diabetes and provide guidance for healthcare professionals and policymakers. This will facilitate increased participation and engagement in preventive programmes, potentially reducing progression and/or incidence of pre-diabetes to type 2 diabetes and improving health outcomes.

The Case for Heterogeneity in Metacognitive Appraisals of Biased Beliefs.

ACADEMIC ABSTRACT: Prominent theories of belief and metacognition make different predictions about how people evaluate their biased beliefs. These predictions reflect different assumptions about (a) people's conscious belief regulation goals and (b) the mechanisms and constraints underlying belief change. I argue that people exhibit heterogeneity in how they evaluate their biased beliefs. Sometimes people are blind to their biases, sometimes people acknowledge and condone them, and sometimes people resent them. The observation that people adopt a variety of "metacognitive positions" toward their beliefs provides insight into people's belief regulation goals as well as insight into way that belief formation is free and constrained. The way that people relate to their beliefs illuminates why they hold those beliefs. Identifying how someone thinks about their belief is useful for changing their mind. PUBLIC ABSTRACT: The same belief can be alternatively thought of as rational, careful, unfortunate, or an act of faith. These beliefs about one's beliefs are called "metacognitive positions." I review evidence that people hold at least four different metacognitive positions. For each position, I discuss what kinds of cognitive processes generated belief and what role people's values and preferences played in belief formation. We can learn a lot about someone's belief based on how they relate to that belief. Learning how someone relates to their belief is useful for identifying the best ways to try to change their mind.

Impaired inhibitory control when processing real but not cartoon emotional faces in autistic children: Evidence from an event-related potential study.

Impaired socioemotional functioning characterizes autistic children, but does weak inhibition control underlie their socioemotional difficulty? This study addressed this question by examining whether and, if so, how inhibition control is affected by face realism and emotional valence in school-age autistic and neurotypical children. Fifty-two autistic and 52 age-matched neurotypical controls aged 10-12 years completed real and cartoon emotional face Go/Nogo tasks while event-related potentials (ERPs) were recorded. The analyses of inhibition-emotion components (i.e., N2, P3, and LPP) and a face-specific N170 revealed that autistic children elicited greater N2 while inhibiting Nogo trials and greater P3/LPP and late LPP for real but not cartoon emotional faces. Moreover, autistic children exhibited a reduced N170 to real face emotions only. Furthermore, correlation results showed that better behavioral inhibition and emotion recognition in autistic children were associated with a reduced N170. These findings suggest that neural mechanisms of inhibitory control in autistic children are less efficient and more disrupted during real face processing, which may affect their age-appropriate socio-emotional development.

Realistic About Reference Production: Testing the Effects of Domain Size and Saturation.

Experiments on visually grounded, definite reference production often manipulate simple visual scenes in the form of grids filled with objects, for example, to test how speakers are affected by the number of objects that are visible. Regarding the latter, it was found that speech onset times increase along with domain size, at least when speakers refer to nonsalient target objects that do not pop out of the visual domain. This finding suggests that even in the case of many distractors, speakers perform object-by-object scans of the visual scene. The current study investigates whether this systematic processing strategy can be explained by the simplified nature of the scenes that were used, and if different strategies can be identified for photo-realistic visual scenes. In doing so, we conducted a preregistered experiment that manipulated domain size and saturation; replicated the measures of speech onset times; and recorded eye movements to measure speakers' viewing strategies more directly. Using controlled photo-realistic scenes, we find (1) that speech onset times increase linearly as more distractors are present; (2) that larger domains elicit relatively fewer fixation switches back and forth between the target and its distractors, mainly before speech onset; and (3) that speakers fixate the target relatively less often in larger domains, mainly after speech onset. We conclude that careful object-by-object scans remain the dominant strategy in our photo-realistic scenes, to a limited extent combined with low-level saliency mechanisms. A relevant direction for future research would be to employ less controlled photo-realistic stimuli that do allow for interpretation based on context.

Enhancing Resilience in Biometric Research: Generation of 3D Synthetic Face Data Using Advanced 3D Character Creation Techniques from High-Fidelity Video Games and Animation.

Biometric authentication plays a vital role in various everyday applications with increasing demands for reliability and security. However, the use of real biometric data for research raises privacy concerns and data scarcity issues. A promising approach using synthetic biometric data to address the resulting unbalanced representation and bias, as well as the limited availability of diverse datasets for the development and evaluation of biometric systems, has emerged. Methods for a parameterized generation of highly realistic synthetic data are emerging and the necessary quality metrics to prove that synthetic data can compare to real data are open research tasks. The generation of 3D synthetic face data using game engines' capabilities of generating varied realistic virtual characters is explored as a possible alternative for generating synthetic face data while maintaining reproducibility and ground truth, as opposed to other creation methods. While synthetic data offer several benefits, including improved resilience against data privacy concerns, the limitations and challenges associated with their usage are addressed. Our work shows concurrent behavior in comparing semi-synthetic data as a digital representation of a real identity with their real datasets. Despite slight asymmetrical performance in comparison with a larger database of real samples, a promising performance in face data authentication is shown, which lays the foundation for further investigations with digital avatars and the creation and analysis of fully synthetic data. Future directions for improving synthetic biometric data generation and their impact on advancing biometrics research are discussed.

Scoping review of international relations theories in health security: A cue for health diplomacy.

Background: Health security as a domain has gained tremendous importance in the recent past. Emerging and re-emerging diseases globally, coupled with the derailment of the determinants of health mainly the socio-political environment, has made health security a cross-cutting entity in diverse fields including International Relations (IR). With the ongoing global polycrisis, the health-related issues which were previously sidelined as a concept of less strategic importance in the IR field, are now contributing to the shift of the world order. This has instilled an increased participation of IR scholars in the discussions and debates on health security concerns. The field of IR contains numerous theoretical lenses through which scholars analyze such situations, policies, and systems of the world. Methods: In this paper, we use a scoping review method to inspect how IR theories have been applied in analyzing health security concerns. Results: We observed that various diverging IR theories have been used to deliberate on states' actions in tackling the recent pandemic and have also been prescriptive about the changing notions of multilateralism and international governing organizations. Realism, liberalism, and securitization were among the most frequently applied IR theories in the context of health security discussions. Conclusions: This work provides an impetus to enhance the interaction among interdisciplinary teams leading to evolving solutions that can address issues of global importance in the contemporary world.

Caring for/with Modernist Playthings: Fidgeting with Objects in Tennessee Williams's The Glass Menagerie.

Modernist literature of the early to mid-twentieth century on both sides of the Atlantic is replete with examples of a particular kind of relationship with objects, namely, the touching, collecting, and grasping of small, often highly personal, and ostensibly quotidian objects. From John's glass collection in Woolf's "Solid Objects," Peter Walsh's stroking of his pocket-knife in Mrs. Dalloway, Miriam's frenzied absorption with flowers in Lawrence's Sons and Lovers, to Laura's fiddling of her glass menagerie in Tennessee Williams's eponymous play, fidgeting in modernist literature and drama reveals a particular tendency of not just characters' possession of things but also their possession by things. This phenomenon, I argue, allows characters to practice care as they withdraw from oppressive narratives of normalcy and (economic and biological) productivity, challenging their exclusionary and othering configurations. My paper looks at fidgeting in The Glass Menagerie as a part of this larger ideological and haptic orientation in modernist literature. The care invested by Laura in her intimate relationship with these "playthings" allows her to intercept not only male narrativizing forces and articulation of herself but also the rhetoric of productivity that circulates both within the play and in the larger economic backdrop of post-depression America. My paper attempts to foreground these objects of care in our readings of the play and modernist texts in general and, in so doing, highlight their importance as lenses of analysis that render visible alternate forms of agency and resistance. Lastly, it attempts to reframe fidgeting as an act of embodied refusal, evoking the radical potential of refusal within feminist and disability studies.

Capitalist Heterotopia & Lost Social Utopia: Documenting Class, Work, and Migration in Post-Communist East-Central European Fiction.

Some of the most acclaimed novels from post-communist countries deal with communism through an anti-communist ethos. The emerging international canon of post-communist representations of communism and transition to capitalism has always sought to enfoce a convincing anti-communist ideal. Writers have only recently formulated critiques of the post-communist transition through what Boris Buden describes as post-communist cultures without social utopias. Those novels are not rooted in anti-communism but rather criticize the death of utopias following the fall of communism. Drawing on the Romanian case, we try to outline the heterotopias of capitalism in post-communism from the standpoint of novels on migration and work abroad, addressing contemporary understandings of capitalist realism, post-socialist realism, autofiction, and documented realism. Analysing novels by Liliana Nechit, Mihai Buzea, and Adrian Schiop, we reveal the subjective nature of the testimonial literature on migration and contrast it to the need to incorporate workers' agency into this literary process. While the description of Eastern European capitalism through novels about migration has become an indictment of communism and a subtle plea for a 'better' form of capitalism, the novels about internal migration recover a lost social utopia that ended with the 1989 collapse of Romanian communism.

In Our Mind's Eye: Thinkable and Unthinkable, and Classical and Quantum in Fundamental Physics, with Schrödinger's Cat Experiment.

This article reconsiders E. Schrödinger's cat paradox experiment from a new perspective, grounded in the interpretation of quantum mechanics that belongs to the class of interpretations designated as "reality without realism" (RWR) interpretations. These interpretations assume that the reality ultimately responsible for quantum phenomena is beyond conception, an assumption designated as the Heisenberg postulate. Accordingly, in these interpretations, quantum physics is understood in terms of the relationships between what is thinkable and what is unthinkable, with, physical, classical, and quantum, corresponding to thinkable and unthinkable, respectively. The role of classical physics becomes unavoidable in quantum physics, the circumstance designated as the Bohr postulate, which restores to classical physics its position as part of fundamental physics, a position commonly reserved for quantum physics and relativity. This view of quantum physics and relativity is maintained by this article as well but is argued to be sufficient for understanding fundamental physics. Establishing this role of classical physics is a distinctive contribution of the article, which allows it to reconsider Schrödinger's cat experiment, but has a broader significance for understanding fundamental physics. RWR interpretations have not been previously applied to the cat experiment, including by N. Bohr, whose interpretation, in its ultimate form (he changed it a few times), was an RWR interpretation. The interpretation adopted in this article follows Bohr's interpretation, based on the Heisenberg and Bohr postulates, but it adds the Dirac postulate, stating that the concept of a quantum object only applies at the time of observation and not independently.

Disagreement Gets Mistaken for Bad Listening.

It is important for people to feel listened to in professional and personal communications, and yet they can feel unheard even when others have listened well. We propose that this feeling may arise because speakers conflate agreement with listening quality. In 11 studies (N = 3,396 adults), we held constant or manipulated a listener's objective listening behaviors, manipulating only after the conversation whether the listener agreed with the speaker. Across various topics, mediums (e.g., video, chat), and cues of objective listening quality, speakers consistently perceived disagreeing listeners as worse listeners. This effect persisted after controlling for other positive impressions of the listener (e.g., likability). This effect seemed to emerge because speakers believe their views are correct, leading them to infer that a disagreeing listener must not have been listening very well. Indeed, it may be prohibitively difficult for someone to simultaneously convey that they disagree and that they were listening.

The effect of different patient-based learning models on student perceptions of empathy, engagement, knowledge, and learning experience.

BACKGROUND: Problem-based learning is used widely in pharmacy and medical programmes, incorporating realistic patient scenarios into regular teaching as a way of linking theory to practice. Routine case-based learning lessons ranges from real patient involvement, scripted patient scenarios, digital simulations (avatars) as well as through media such as Zoom. The existing literature has explored the extensive benefits of using patients in clinical education, but fewer studies have directly compared the efficacy of each model as learning tools. AIM: To compare student perceptions of patient-based learning models to elicit student empathy, increase engagement, improve knowledge, and enrich learning experience. METHODS: A questionnaire was distributed to second-year pharmacy students in Swansea University to gather their perceptions on the nine different patient-based learning models in their routine teaching (SUMS RESC 2023-0011). Students were asked to rank their experience of the models explicitly against each other, based on the four pillars of (1) eliciting student empathy, (2) increasing engagement, (3) improving knowledge and (4) enriching the learning experience. Students were also asked to rate the significance of realism (i.e. knowing the patient demographics/having a visual representation of the patient) to their experience. RESULTS: Altogether, 31 student rankings of the nine learning models were weighted (9 = highest rank; 1 = lowest ranked). The data showed clear preferences for real-patient involvement over fictional cases, especially for eliciting empathy. Interestingly, scripted scenarios were rated highly for both engagement and learning experience only when avatars were involved, which suggests a role of animated visual representation of the patient in facilitating these outcomes. CONCLUSION: Whilst it is useful to have multiple patient-based learning models, this study serves as a guide for educators in preparing case-based learning sessions for achieving the desired outcomes of any of the four pillars above.

High-Fidelity, Indigenously Prepared, Low-Cost Moulage as a Valid Simulation Tool to Improve Trauma Education.

Background Simulation-based trauma education facilitates repeated practice in a controlled and safer environment for the learner without any risk to the patient's well-being. Moulage contributes to the perception of reality during training using standardized patients. However, the high cost of commercial moulage items is often prohibitive for regular use. This study aimed to assess the effectiveness of indigenously prepared, low-cost moulage as a valid simulation tool to improve trauma education, explore possible replacements of commercial moulage products, and determine their merits and demerits. Methodology Readily available economic items were used to make low-cost moulage on the simulated patients to replicate trauma victims. A cross-sectional design used a pre-validated Modified Moulage Authenticity Rating Scale to collect data from 61 participants of Advanced Trauma Life Support and Advanced Trauma Care for Nurses courses to analyze the effectiveness and fidelity of moulage. Results In total, 54 (89%) participants scored the low-cost moulage to provide high fidelity effectively. The majority of respondents graded the authenticity of moulage as good. Overall, 46 (75%) participants felt moulage injuries were quite realistic. All agreed that the moulage-based simulation offered a good teaching-learning alternative to assess and manage trauma victims. Further, 45 (73%) participants felt they were in an actual clinical situation, and 58 (95%) stated it could help them in their clinical practice. Conclusions Indigenously prepared, low-cost moulage is a feasible and cost-effective means to enhance fidelity in simulation-based trauma education. It can also be a possible replacement for commercial moulage. Further research is needed to rigorously evaluate the effectiveness of indigenously prepared, cost-effective moulage in trauma education to enhance patient care outcomes. This technique can also be easily translated into other simulation-based medical education domains.

Understanding the Institutional Logics of China's Community-Based Intervention for Older People.

Community-based policies have gained global popularity, signaling a paradigm shift from individual responsibility for healthy aging to an approach involving community-based intervention. Learning from Western experience, China has also experimented with this form of intervention. It has policy interventions aimed at providing community-based facilities and services that enable older people to age in place. However, the institutional foundations of Chinese communities differ greatly from those in Western countries. Implementing a critical realist case study focusing on a community-based program in Beijing, this study aims to examine the institutional logics that contribute toward a contextually appropriate community-based policy intervention in China. We identified three institutional logics. First, the Confucian moral obligation of benevolence requires authorities to provide social welfare for vulnerable citizens. Second, China's community-based interventions are state-led territorialized provisions prioritizing communities rather than individuals. Third, community-based social policies are subordinate to economic growth objectives. This study contributes to the understanding of contextually appropriate community-based policy interventions in China.

Influence of materiality in professional geriatric care: Conceptual, methodological and empirical insights.

Most people become more reliant on care and support as they age. The constitution of ageing people in the context of nursing support thus represents a material aspect in the daily life of these people and must be taken into account in the science of gerontology. However, theories of (geriatric) care have previously been predominantly human-centric. In light of the material turn, the goal of this paper is to highlight the potential to be found in using agential realism to critically examine geriatric care. It will begin by detailing previous perspectives on geriatric care and any use of material aspects to be found in it. It will then present a conceptual-methodical approach that allows for an examination of the act of caring, taking material aspects into account. The application of this approach to empirical material drawn from an example of acute care in Germany will, in conclusion, illustrate significant elements that, in light of agential realism, must also be taken into account when investigating what it means to provide good geriatric care.