Health care organizations are increasingly asked to show accountability about their performance. This paper proposes that accountability can best be achieved through evaluative methods that are based on evidence regarding the relationship between processes of care and expected outcomes. Root cause analysis (RCA) is used as an illustration of how a generic method of inquiring can be transformed into an ongoing monitoring, evaluation, user education and accountability strategy. The role of performance indicators, as well as patient and community expectations, is (...) discussed. (shrink)

The question of how we apply knowledge from biomedical science to medical and public health practice has been the subject of heated debates about generalizability and related concepts, such as applicability and inductive inference. In this essay, I interpret the term from the perspective of two causal models: determinism and indeterminism. I suggest that theories of generalizability can be formulated on the basis of both models and take the form of testable but unverifiable hypotheses, an attribute that is common to (...) all scientific theories. Nonetheless, there is one noteworthy difference between the two models: determinism allows one to rationalize a decision to treat a certain kind of patient but only indirectly a decision to treat any particular patient, whereas indeterminism accommodates both types of decisions. (shrink)

Rationale, aims and objectives Given the increasing prevalence of cataract and demand for cataract extraction surgery, patients must often wait to undergo this procedure. We validated a previously developed priority scoring system in terms of clinical variables, pre-intervention health status, appropriateness of surgery and gain in visual acuity (VA) and health-related quality of life (HRQoL).Methods Explicit prioritization criteria for cataract extraction created by a variation of the Research and Development (RAND) and University of California Los Angeles appropriateness methodology were retrospectively (...) applied to a prospective cohort of 5257 patients on waiting lists to undergo cataract by phacoemulsification at 17 hospitals in Spain. Demographic data, clinical data and data related to surgical technique were collected by trained ophthalmologists. Patients were evaluated by their ophthalmologist before the intervention and 6 weeks afterward. They also completed, by mail, the Visual Function Index (VF-14) before the intervention and 3 months afterward.Results High-priority patients experienced greater improvement in VA and HRQoL than those classified as intermediate or low-priority (P < 0.0001), even after adjusting by VA and the VF-14 score at baseline. The time to intervention was the same for high-priority patients as it was for intermediate and low-priority patients.Conclusions The priority score we developed identified patients most likely to experience the greatest improvements from cataract extraction. Use of this tool could provide a fairer and more rational way to prioritize patients for cataract extraction. (shrink)

John Lavery's The First Wounded, London Hospital, August 1914 records a memorable event in the First World War. This painting and the archives of the Royal London Hospital provide a fascinating insight into the nursing and medical care of these early war casualties.

There is a popular hypothesis that performance on implicit and explicit memory tasks reflects 2 distinct memory systems. Explicit memory is said to store those experiences that can be consciously recollected, and implicit memory is said to store experiences and affect subsequent behavior but to be unavailable to conscious awareness. Although this division based on awareness is a useful taxonomy for memory tasks, the authors review the evidence that the unconscious character of implicit memory does not necessitate that it be (...) treated as a separate system of human memory. They also argue that some implicit and explicit memory tasks share the same memory representations and that the important distinction is whether the task (implicit or explicit) requires the formation of a new association. The authors review and critique dissociations from the behavioral, amnesia, and neuroimaging literatures that have been advanced in support of separate explicit and implicit memory systems by highlighting contradictory evidence and by illustrating how the data can be accounted for using a simple computational memory model that assumes the same memory representation for those disparate tasks. (shrink)

Nous nous inscrivons dans une culture, nous sommes les heritiers de multiples traditions. Le romantisme qui a su remettre la tradition a l'honneur, aussi bien que les Lumieres avec leur mefiance - allant jusqu'au refus - vis-a-vis de toute tradition, sont pour nous de telles traditions. Nous devons nous rapporter a nos traditions en Aufklarer, les soumettre a l'examen critique, mais nous devons savoir egalement que l'elucidation de la tradition ne peut se resoudre dans la pure maitrise de la critique, (...) qu'elle est reflexion a partir d'une appartenance. (shrink)

IntroductionBisphenol A is highly debated and studied in relation to a variety of health outcomes. This large variation in the literature makes BPA a topic that is prone to selective use of literature, in order to underpin one’s own findings and opinion. Over time, selective use of literature, by means of citations, can lead to a skewed knowledge development and a biased scientific consensus. In this study, we assess which factors drive citation and whether this results in the overrepresentation of (...) harmful health effects of BPA.MethodsA citation network analysis was performed to test various determinants of citation. A systematic search identified all relevant publications on the human health effect of BPA. Data were extracted on potential determinants of selective citation, such as study outcome, study design, sample size, journal impact factor, authority of the author, self-citation, and funding source. We applied random effect logistic regression to assess whether these determinants influence the likelihood of citation.ResultsOne hundred sixty-nine publications on BPA were identified, with 12,432 potential citation pathways of which 808 citations occurred. The network consisted of 63 cross-sectional studies, 34 cohort studies, 29 case-control studies, 35 narrative reviews, and 8 systematic reviews. Positive studies have a 1.5 times greater chance of being cited compared to negative studies. Additionally, the authority of the author and self-citation are consistently found to be positively associated with the likelihood of being cited. Overall, the network seems to be highly influenced by two highly cited publications, whereas 60 out of 169 publications received no citations.ConclusionIn the literature on BPA, citation is mostly driven by positive study outcome and author-related factors, such as high authority within the network. Interpreting the impact of these factors and the big influence of a few highly cited publications, it can be questioned to which extent the knowledge development in human literature on BPA is actually evidence-based. (shrink)

BACKGROUND: Serotonin transporter promoter genotype appears to increase risk for depression in the context of stressful life events. However, the effects of this genotype on measures of stress sensitivity are poorly understood. Therefore, this study examined whether 5-HTTLPR genotype was associated with negative information processing biases in early childhood. METHOD: Thirty-nine unselected seven-year-old children completed a negative mood induction procedure and a Self-Referent Encoding Task designed to measure positive and negative schematic processing. Children were also genotyped for the 5-HTTLPR gene. (...) RESULTS: Children who were homozygous for the short allele of the 5-HTTLPR gene showed greater negative schematic processing following a negative mood prime than those with other genotypes. 5-HTTLPR genotype was not significantly associated with positive schematic processing. LIMITATIONS: The sample size for this study was small. We did not analyze more recently reported variants of the 5-HTTLPR long alleles. CONCLUSIONS: 5-HTTLPR genotype is associated with negative information processing styles following a negative mood prime in a non-clinical sample of young children. Such cognitive styles are thought to be activated in response to stressful life events, leading to depressive symptoms; thus, cognitive styles may index the "stress-sensitivity" conferred by this genotype. (shrink)

Bhattacharyya, K. The Advaita concept of subjectivity.--Deutsch, E. Reflections on some aspects of the theory of rasa.--Nakamura, H. The dawn of modern thought in the East.--Organ, T. Causality, Indian and Greek.--Chatterjee, M. On types of classification.--Lacombe, O. Transcendental imagination.--Bahm, A. J. Standards for comparative philosophy.--Herring, H. Appearance, its significance and meaning in the history of philosophy.--Chang Chung-yuan. Pre-rational harmony in Heidegger's essential thinking and Chʼan thought.--Staal, J. F. Making sense of the Buddhist tetralemma.--Enomiya-Lassalle, H. M. The mysticism of Carl Albrecht (...) and Zen.--Parrinder, G. The nature of mysticism.--Cairns, G. E. Axiological contributions of East and West to the spiritual development of mankind.--Mayeda, S. Śaṇkara's view of ethics.--Mercier, A. On peace.--Barlingay, S. S. A discussion of some aspects of Gaudapāda's philosophy. (shrink)

We offer a formal account of the English past tenses. We see the perfect as having reference time at speech time and the preterite as having reference time at event time. We formalize four constraints on reference time, which we bundle together under the term ‘perspective’. Once these constraints are satisfied at the different reference times of the perfect and preterite, the contrasting functions of these tenses are explained. Thus we can account formally for the ‘definiteness effect’ and the ‘lifetime (...) effect’ of the perfect, for the fact that the perfect seems to ‘explain’ something about the present, and that the perfect cannot presuppose a past time point. We explain why perfect and preterite can sometimes be interchangeable, and we offer a solution to the ’present perfect puzzle’. We explain the unacceptability of notorious examples of the perfect such as * Gutenberg has discovered the art of printing . We give greater definition to the familiar notions of ‘current relevance’ and ‘extended now’. (shrink)

This article presents a preliminary study of an unusual Nuzi-type text. A transliteration, translation, and commentary are offered. It transpires that the text is an internal bureaucratic memorandum from ancient Kurruḫanni (very likely Tell al-Faḫḫar) dealing with barley belonging(?) / owed(?) to certain men.

Zoologist A. J. Cain began historical research on Linnaeus in 1956 in connection with his dissatisfaction over the standard taxonomic hierarchy and the rules of binomial nomenclature. His famous 1958 paper 'Logic and Memory in Linnaeus's System of Taxonomy' argues that Linnaeus was following Aristotle's method of logical division without appreciating that it properly applies only to 'analysed entities' such as geometric figures whose essential nature is already fully known. The essence of living things being unanalysed, there is no basis (...) on which to choose the right characters to define a genus nor on which to differentiate species. Yet Cain 's understanding of Aristotle, which depended on a 1916 text by H. W. B. Joseph, was fatally flawed. In the 1990s Cain devoted himself to further historical study and softened his verdict on Linnaeus, praising his empiricism. The idea that Linnaeus was applying an ancient and inappropriate method cries out for fresh study and revision. (shrink)

Recently, a class of $\mathcal{P}\mathcal{T}$ -invariant scalar quantum field theories described by the non-Hermitian Lagrangian $\mathcal{L}$ = $ \frac{1}{2} $ (∂ϕ) 2 +gϕ 2 (iϕ)ε was studied. It was found that there are two regions of ε. For ε<0 the $\mathcal{P}\mathcal{T}$ -invariance of the Lagrangian is spontaneously broken, and as a consequence, all but the lowest-lying energy levels are complex. For ε≥0 the $\mathcal{P}\mathcal{T}$ -invariance of the Lagrangian is unbroken, and the entire energy spectrum is real and positive. The subtle (...) transition at ε=0 is not well understood. In this paper we initiate an investigation of this transition by carrying out a detailed numerical study of the effective potential V eff (ϕc) in zero-dimensional spacetime. Although this numerical work reveals some differences between the ε<0 and the ε>0 regimes, we cannot yet see convincing evidence of the transition at ε=0 in the structure of the effective potential for $\mathcal{P}\mathcal{T}$ -symmetric quantum field theories. (shrink)

In the early nineties of the previous century, leaf languages were introduced as a means for the uniform characterization of many complexity classes, mainly in the range between P and PSPACE . It was shown that the separability of two complexity classes can be reduced to a combinatorial property of the corresponding defining leaf languages. In the present paper, it is shown that every separation obtained in this way holds for every generic oracle in the sense of Blum and Impagliazzo. (...) We obtain several consequences of this result, regarding, e. g., universal oracles, simultaneous separations and type-2 complexity. (shrink)

Let us call an integer part of an ordered field any subring such that every element of the field lies at distance less than 1 from a unique element of the ring. We show that every real closed field has an integer part.

OBJECTIVES: To determine the relationship between ethical reasoning and gender and occupation among a group of male and female nurses and doctors. DESIGN: Partialist and impartialist forms of ethical reasoning were defined and singled out as being central to the difference between what is known as the "care" moral orientation (Gilligan) and the "justice" orientation (Kohlberg). A structured questionnaire based on four hypothetical moral dilemmas involving combinations of (health care) professional, non-professional, life-threatening and non-life-threatening situations, was piloted and then mailed (...) to a randomly selected sample of doctors and nurses. SETTING: 400 doctors from Victoria, and 200 doctors and 400 nurses from New South Wales. RESULTS: 178 doctors and 122 nurses returned completed questionnaires. 115 doctors were male, 61 female; 50 nurses were male and 72 were female. It was hypothesised that there would be an association between feminine subjects and partialist reasoning and masculine subjects and impartialist reasoning. It was also hypothesised that nurses would adopt a partialist approach to reasoning and doctors an impartialist approach. No relationship between any of these variables was observed. (shrink)

This paper argues that in modern biotechnology, naturalness as an argument contributed to a stalemate in public debate about innovative technologies. Naturalness in this is often placed opposite to human disruption. It also often serves as a label that shapes moral acceptance or rejection of agricultural innovative technologies. The cause of this lies in the use of nature as a closed, static reference to naturalness, while in fact ‘‘nature’’ is an open and dynamic concept with many different meanings. We propose (...) an approach for a dynamic framework that permits an integrative use of naturalness in debate, by connecting three sorts of meaning that return regularly in the arguments brought forward in debate; cultural, technological, and ecological. We present these as aspects of nature that are always present in the argument of naturalness. The approach proposes a dynamic relation between these aspects, formed by gradients of naturalness, which in turn are related to ethical concerns. In this way we come to an overview that makes it possible to give individual arguments a relative place and that does justice to the temporality of the concept of nature and the underlying ethical concerns stakeholders have in respect to innovation in agriculture. (shrink)

Les décisions politiques sur les risques environnementaux complexes font fréquemment intervenir des éléments scientifiques contestés. Il n’y a généralement pas de « faits » qui conduisent à une politique correcte unique. Les éléments de preuve qui sont intégrés dans les avis scientifiques destinés à une décision politique nécessitent une évaluation de leur qualité. En 2003, l’Agence néerlandaise d’évaluation environnementale a adopté une méthode standardisée, désignée sous le nom de « guide », dans le cadre de laquelle les principaux aspects de (...) la production et de l’utilisation des connaissances sont présentés grâce à une liste de contrôle visant à l’évaluation et à la communication des incertitudes. Dans cet article, nous présentons des résultats de l’application de ce guide à la controverse sur les risques des particules en suspension. La délibération active sur l’incertitude dans un contexte d’expertise entraîne un processus d’apprentissage commun entre les experts et les décideurs politiques, ce qui conduit à une meilleure prise de conscience du phénomène d’incertitude et de ses implications politiques.Policy decisions on complex environmental risks often involve disputed science. Typically, there are no “ facts” to support a single unequivocally correct policy. The evidence provided in scientific studies for policy-making decisions requires high-quality assessment. In 2003, the Netherlands Environmental Assessment Agency adopted a standardized method, referred to as “guidelines”, whereby key quality aspects of knowledge production and use are presented in the form of a checklist for uncertainty assessments and communication. In this article, we present the outcomes of applying the guidelines in controversies on the risks of ambient particulate matter. In the policy–advisory context, active deliberation on uncertainty produces a common learning process for advisors and policy makers, which leads to a deeper understanding and increased awareness of the phenomenon of uncertainty and its policy implications. (shrink)

To describe phenomena that occur at different time scales, computational models of the brain must incorporate different levels of abstraction. At time scales of approximately 1/3 of a second, orienting movements of the body play a crucial role in cognition and form a useful computational level embodiment level,” the constraints of the physical system determine the nature of cognitive operations. The key synergy is that at time scales of about 1/3 of a second, the natural sequentiality of body movements can (...) be matched to the natural computational economies of sequential decision systems through a system of implicit reference called deictic in which pointing movements are used to bind objects in the world to cognitive programs. This target article focuses on how deictic bindings make it possible to perform natural tasks. Deictic computation provides a mechanism for representing the essential features that link external sensory data with internal cognitive programs and motor actions. One of the central features of cognition, working memory, can be related to moment-by-moment dispositions of body features such as eye movements and hand movements. (shrink)

An analysis is presented of the significance and consequent limitations on the applicability of the von Neumann measurement postulate in quantum mechanics. Directly observable quantities, such as the expectation value of the velocity operator, are distinguished from mathematical constructs, such as the expectation value of the canonical momentum, which are not directly observable. A simple criterion to distinguish between the two types of operators is derived. The non-observability of the electromagnetic four-potentials is shown to imply the non-measurability of the canonical (...) momentum. The concept of a mechanical gauge is introduced and discussed. Classically the Lagrangian is nonunique within a total time derivative. This may be interpreted as the freedom of choosing a “mechanical” (M) gauge function. In quantum mechanics it is often implicitly assumed that the M-gauge vanishes. However, the requirement that directly observable quantities be independent of the arbitrary mechanical gauge is shown to lead to results analogous to those derived from the requirement of electromagnetic gauge independence of observables. The significance of the above to the observability of transition amplitudes between field-free energy eigenstates in the presence (and absence) of electromagnetic fields is discussed. E- and M-gauge independent transition amplitudes between field-free energy eigenstates in the absence of electromagnetic fields are defined. It is shown that, in general, such measurable amplitudes cannot be defined in the presence of externally applied time-dependent fields. Transition amplitudes in the presence of time-independent fields are discussed. The path dependence of previous derivations of E-gauge independent Hamiltonians and/or transition amplitudes in the presence of electromagnetic fields are related to the inherent M-gauge dependence of these quantities in the presence of such fields. (shrink)

Historian James H. Jones published the first edition of Bad Blood, the definitive history of the Tuskegee Syphilis Experiment, in 1981. Its clear-eyed examination of that research and its implications remains a bioethics classic, and the 30-year anniversary of its publication served as the impetus for the reexamination of research ethics that this symposium presents. Recent revelations about the United States Public Health Service study that infected mental patients and prisoners in Guatemala with syphilis in the late 1940s in order (...) to determine the efficacy of treatment represent only one of the many attestations to the persistence of ongoing, critical, and underaddressed issues in research ethics that Bad Blood first explored. Those issues include, but are not limited to: the complex and contested matters of the value of a given research question, the validity of the clinical trial designed to address it, and the priorities of science. (shrink)

How does microbiota research impact our understanding of biological individuality? We summarize the interdisciplinary summer school on "Microbiota, Symbiosis and Individuality: Conceptual and Philosophical Issues" (July 2019), which was supported by a European Research Council starting grant project "Immunity, DEvelopment, and the Microbiota" (IDEM). The summer school centered around interdisciplinary group work on four facets of microbiota research: holobionts, individuality, causation, and human health. The conceptual discussion of cutting-edge empirical research provided new insights into microbiota and highlights the value of (...) incorporating into meetings experts from other disciplines, such as philosophy and history of science. (shrink)

This paper builds on London and Hart’s critique that Prahalad’s best-selling book prompted a unilateral effort to find a fortune at the bottom of the pyramid. Prahalad’s instrumental, firm-centered construction suggests, perhaps unintentionally, a buccaneering style of business enterprise devoted to capturing markets rather than enabling new socially entrepreneurial ventures for those otherwise trapped in conditions of extreme poverty. London and Hart reframe Prahalad’s insight into direct global business enterprise toward “creating a fortune with the base of the pyramid” rather (...) than at the BoP. This shift in language requires a recalibration of strategic focus, we argue, and will necessitate implementation of “moral imagination” to formulate new mental models that can frame the possibility of local entrepreneurs working collaboratively and discursively with development partners drawn from civil society, corporate, and government sectors. Successful partnerships will arise from interactive processes of emergent, co-creative learning within a shared problem domain or “community of practice”. We call attention to three related pluralist framings of situated learning within such communities of practice: decentered stakeholder networks; global action networks; and a focus on “faces and places” as a cognitive lens to humanize and locally situate diverse inhabitants within base of the pyramid partnership projects. (shrink)

Human moral judgement may have evolved to maximize the individual's welfare given parochial culturally constructed moral systems. If so, then moral condemnation should be more severe when transgressions are recent and local, and should be sensitive to the pronouncements of authority figures (who are often arbiters of moral norms), as the fitness pay-offs of moral disapproval will primarily derive from the ramifications of condemning actions that occur within the immediate social arena. Correspondingly, moral transgressions should be viewed as less objectionable (...) if they occur in other places or times, or if local authorities deem them acceptable. These predictions contrast markedly with those derived from prevailing non-evolutionary perspectives on moral judgement. Both classes of theories predict purportedly species-typical patterns, yet to our knowledge, no study to date has investigated moral judgement across a diverse set of societies, including a range of small-scale communities that differ substantially from large highly urbanized nations. We tested these predictions in five small-scale societies and two large-scale societies, finding substantial evidence of moral parochialism and contextual contingency in adults' moral judgements. Results reveal an overarching pattern in which moral condemnation reflects a concern with immediate local considerations, a pattern consistent with a variety of evolutionary accounts of moral judgement. (shrink)

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

The introduction of novel diagnostic techniques in clinical domains such as genomics and radiology has led to a rich ethical debate on how to handle unsolicited findings that result from these innovations. Yet while unsolicited findings arise in both genomics and radiology, most of the relevant literature to date has tended to focus on only one of these domains. In this article, we synthesize and critically assess similarities and differences between “scanning the body” and “sequencing the genome” from an ethical (...) perspective. After briefly describing the novel diagnostic contexts leading to unsolicited findings, we synthesize and reflect on six core ethical issues that relate to both specialties: terminology; benefits and risks; autonomy; disclosure of unsolicited findings to children; uncertainty; and filters and routine screening. We identify ethical rationales that pertain to both fields and may contribute to more ethically sound policies. Considerations of preserving public trust and ensuring that people perceive healthcare policies as fair also support the need for a combined debate. (shrink)

Cyclin-dependent kinase 5 has been implicated in Alzheimer's disease pathogenesis. Here, we demonstrate that overexpression of p25, an activator of cdk5, led to increased levels of BACE1 mRNA and protein in vitro and in vivo. A p25/cdk5 responsive region containing multiple sites for signal transducer and activator of transcription was identified in the BACE1 promoter. STAT3 interacts with the BACE1 promoter, and p25-overexpressing mice had elevated levels of pSTAT3 and BACE1, whereas cdk5-deficient mice had reduced levels. Furthermore, mice with a (...) targeted mutation in the STAT3 cdk5 responsive site had lower levels of BACE1. Increased BACE levels in p25 overexpressing mice correlated with enhanced amyloidogenic processing that could be reversed by a cdk5 inhibitor. These data demonstrate a pathway by which p25/cdk5 increases the amyloidogenic processing of APP through STAT3-mediated transcriptional control of BACE1 that could have implications for AD pathogenesis. (shrink)

In this historical contribution, we assess Duns Scotus’s analysis of atonement (Commentary on the Sentences bk. III). We also include a partial exploration of his analysis of penance (Sentences bk. IV), because certain topics which we tend to discuss within atonement-theory, for example the analysis of the virtue of punishment, pertained to the subject of penance for Scotus. In recent scholarship, Andrew Rosato has argued that Scotus adapted the Anselmian non-penal view of Christ’s substitutionary satisfaction to the penal understanding of (...) satisfaction operative in penance. In this contribution, however, we argue that Scotus’s understanding remained non-penal: his view of the atonement depends on meritorious supererogatory acts of love. Additionally, we harvest some valuable Scotistic insights for atonement-theory, some of them applicable to penal theories as well. (shrink)

With this issue we initiate the policy of expanding the scope of Tulane Studies in Philosophy to include, in addition to the work of members of the department, contributions from philosophers who have earned advanced degrees from Tulane and who are now teaching in other colleges and universities. The Editor THE LOGIC OF OUR LANGUAGE ROBERT L. ARRINGTON Wittgenstein wrote in the Tractatus that "logic is not a body of doctrine, but a mirror-image of the world. " 1 In line (...) with his suggestion that a proposition is a 'picture', Wittgenstein argued that propositions 'show' the logical structure of the real. He was insistent, however, that "the apparent logical form of a proposition need not be its real one. " 2 As a result of this we can misunderstand the structure of fact. Philosophical problems arise just when "the logic of our language is mis understood. " 3 It is common knowledge that much of this view of logic was rejected by Wittgenstein himself in the Philosophical Investi gations. There we are told that language has no ideal or sublime 4 logic which mirrors the structure of the extra-linguistic world. Consequently, inferences from the structure of language to the structure of that extra-linguistic world are invalid. Reality can be 'cut up' in any of a number of ways by language. Wittgenstein adopted a view of philosophy which would render that discipline a non-explanatory, non-critical study of the multiple ways in which language can be used. (shrink)

The majority of commentators agree that the time to focus on embodiment has arrived and that the disembodied approach that was taken from the birth of artificial intelligence is unlikely to provide a satisfactory account of the special features of human intelligence. In our Response, we begin by addressing the general comments and criticisms directed at the emerging enterprise of deictic and embodied cognition. In subsequent sections we examine the topics that constitute the core of the commentaries: embodiment mechanisms, dorsal (...) and ventral visual processing, eye movements, and learning. (shrink)

In the recent past, several papers have pointed to the possibility that tumour removal generates a permissive environment in which tumour growth is potentiated. This phenomenon has been coined “perioperative tumour growth” and whilst it represents a departure in terms of our attitude to the surgical process, this concept was first hinted at by Paget1Sir James Paget (1814–1899) was a surgeon and physiologist who is widely held (along with Rudolph Virchow) to be the father of the science of pathology. Paget (...) described Paget's disease of the nipple as well as Paget's disease of bone. himself. Despite this, the time interval immediately before and after cancer surgery (i.e. the perioperative period) remains an underutilised interval during which chemotherapeutic regimens are rarely implemented. Herein, we present a summarised review of the literature that supports the concept that tumour removal may potentiate the growth of residual neoplastic disease. We also outline current knowledge regarding underlying mechanisms and in this manner highlight potential therapeutic entry points. Finally, we emphasise the urgent need for trials of agents that could protect patients against the harmful host–tumour interactions that may occur during the perioperative period. BioEssays 28: 433–437, 2006. © 2006 Wiley Periodicals, Inc. (shrink)

Albinism in Tanzania causes fierce health-related stigma. Little research has focused on the impact of stigma reduction strategies aiming to reduce albinism related stigma. Therefore, this research assessed the impact of two short video interventions among high school students in Tanzania on their attitude towards people with albinism: a contact intervention (n = 95) and an education intervention (n = 97). A mixed method design was used. Directly before and after the interventions impact was measured among all participants through the (...) Albinism Social Distance Scale for Adolescents (ASDS-A), knowledge items, and entertainment items. After these measurements focus group discussions were conducted, 16 in total (n = 80). Both interventions caused a significant increase in the levels of correct knowledge about albinism. The education intervention entailed a significant positive change in attitude measured through the ASDS-A, whereas the contact intervention did not have a significant effect. In terms of entertainment value, the respondents were more enthusiastic about the contact intervention. The study suggests that education interventions on their own can be a successful tool in decreasing albinism related stigma. Additionally, qualitative findings show many positive outcomes for the contact intervention. Therefore, we would recommend using a combination of these two interventions, which has also proved successful in the past. However, more research on the effect of a combination of the two strategies is recommended. (shrink)

In this contribution we investigate the conceptual coherence of penal substitution and its moral validity. After assessing two opposing modern contributions, we turn to Reformed and medieval scholasticism. This scholastic manoeuvre sheds additional light on the analytic questions at issue. Following Owen and Scotus in their use of a relational analysis of guilt and its punishment, we argue that penal substitution is conceptually and morally coherent, albeit not univocally vis-à-vis ordinary punishment. Absent from the case of substitution is personal deservedness; (...) herein we follow Murphy. However, this leaves open the conceptual possibility of representative deservedness. (shrink)

The natural input memory (NIM) model is a new model for recognition memory that operates on natural visual input. A biologically informed perceptual preprocessing method takes local samples (eye fixations) from a natural image and translates these into a feature‐vector representation. During recognition, the model compares incoming preprocessed natural input to stored representations. By complementing the recognition memory process with a perceptual front end, the NIM model is able to make predictions about memorability based directly on individual natural stimuli. We (...) demonstrate that the NIM model is able to simulate experimentally obtained similarity ratings and recognition memory for individual stimuli (i.e., face images). (shrink)

Rationing healthcare is a difficult task, which includes preventing patients from accessing potentially beneficial treatments. Proponents of implicit rationing argue that politicians cannot resist pressure from strong patient groups for treatments and conclude that physicians should ration without informing patients or the public. The authors subdivide this specific programme of implicit rationing, or “hidden rationing”, into local hidden rationing, unsophisticated global hidden rationing and sophisticated global hidden rationing. They evaluate the appropriateness of these methods of rationing from the perspectives of (...) individual and political autonomy and conclude that local hidden rationing and unsophisticated global hidden rationing clearly violate patients’ individual autonomy, that is, their right to participate in medical decision-making. While sophisticated global hidden rationing avoids this charge, the authors point out that it nonetheless violates the political autonomy of patients, that is, their right to engage in public affairs as citizens. A defence of any of the forms of hidden rationing is therefore considered to be incompatible with a defence of autonomy. (shrink)

The ethics literature has identified moral motivation as a factor in ethical decision-making. Furthermore, moral identity has been identified as a source of moral motivation. In the current study, we examine religiosity as an antecedent to moral identity and examine the mediating role of self-control in this relationship. We find that intrinsic and extrinsic dimensions of religiosity have different direct and indirect effects on the internalization and symbolization dimensions of moral identity. Specifically, intrinsic religiosity plays a role in counterbalancing the (...) negative impact of extrinsic religiosity on the internalization of moral identity. Further, intrinsic religiosity also counterbalances the negative and indirect impact of extrinsic religiosity on symbolization of moral identity via self-control. Lastly, self-control does not play a mediating role in the impact of religiosity on the internalization dimension of moral identity. We conclude that this study presents important findings that advance our understanding of the antecedents of moral identity, and that these results may have implications for the understanding of ethical decision-making. (shrink)

Background: The Taiwan Nursing Accreditation Council has proposed eight core professional nursing qualities including ethical literacy. Consequently, nursing ethics education is a required course for student nurses. These courses are intended to improve the ethical literacy. Moral sensitivity is the cornerstone of ethical literacy, and learning moral sensitivity is the initial step towards developing ethical literacy. Objectives: To explore the effect of nursing ethics educational interventions based on multiple teaching strategies on student nurses moral sensitivity. Based on the visual, auditory (...) and kinaesthetic model, three strategies were developed for determining the programme components and corresponding learning styles. Research design: This was a quasi-experimental study. Participants: A total of 234 junior-college student nurses participated in this study. All participants were aged 18–19 years. Ethical considerations: The study protocol was approved by the institutional review boards of Kaohsiung Veterans General Hospital. Only the participants who signed an informed consent form took part in the study. The participants were permitted to withdraw from the study at any point if they wished to do so without affecting their academic score. Results: The scores of Modified Moral Sensitivity Questionnaire for Student Nurses were significantly improved after the intervention of integrating multiple teaching strategies ( p =.042). Significant relationships were observed between the satisfaction scores of two teaching strategies and moral sensitivity. The results indicated that using multiple teaching strategies is effective for promoting nursing ethics learning. Conclusion: This strategy was consistent with the student nurses’ preferred learning style and was used to correct their erroneous ethical conceptions, assisting in developing their ethical knowledge. (shrink)

In this paper we describe a method for the specification of computationalmodels of argument using dialogue games. The method, which consists ofsupplying a set of semantic definitions for the performatives making upthe game, together with a state transition diagram, is described in full.Its use is illustrated by some examples of varying complexity, includingtwo complete specifications of particular dialogue games, Mackenzie's DC,and the authors' own TDG. The latter is also illustrated by a fully workedexample illustrating all the features of the game.

Recent studies suggest that vertebrate genetic material ingested by invertebrates (iDNA) can be used to investigate vertebrate ecology. Given the ubiquity of invertebrates that feed on vertebrates across the globe, iDNA might qualify as a very powerful tool for 21st century population and conservation biologists. Here, we identify some invertebrate characteristics that will likely influence iDNA retrieval and elaborate on the potential uses of invertebrate‐derived information. We hypothesize that beyond inventorying local faunal diversity, iDNA should allow for more profound insights (...) into wildlife population density, size, mortality, and infectious agents. Based on the similarities of iDNA with other low‐quality sources of DNA, a general technical framework for iDNA analyses is proposed. As it is likely that no such thing as a single ideal iDNA sampler exists, forthcoming research efforts should aim at cataloguing invertebrate properties relevant to iDNA retrieval so as to guide future usage of the invertebrate tool box. (shrink)