Unethical conduct has reached crisis proportions in business :A1–A10, 2011) and on today’s college campuses :58–65, 2007). Despite the evidence that suggests that more than half of business students admit to dishonest practices, only about 5 % of business school deans surveyed believe that dishonesty is a problem at their schools :299–308, 2010). In addition, the AACSB which establishes standards for accredited business schools has resisted the urging of deans and business experts to require business schools to teach an ethics (...) class, and fewer than one-third of businesses schools now teach a business ethics course at the graduate or undergraduate levels. In this paper we briefly introduce the status of business ethics education and report the results of a survey of business students, deans of the top business schools, and business ethics subject matter experts about ten ethical outcomes. We then offer five specific recommendations to encourage business ethics faculty and decision makers to improve the teaching of business ethics. (shrink)

In a series of ten preregistered experiments (N=2043), we investigate the effect of outcome valence on judgments of probability, negligence, and culpability – a phenomenon sometimes labelled moral (and legal) luck. We found that harmful outcomes, when contrasted with neutral outcomes, lead to increased perceived probability of harm ex post, and consequently to increased attribution of negligence and culpability. Rather than simply postulating a hindsight bias (as is common), we employ a variety of empirical means to demonstrate that (...) the outcome-driven asymmetry across perceived probabilities constitutes a systematic cognitive distortion. We then explore three distinct strategies to alleviate the hindsight bias and its downstream effects on mens rea and culpability ascriptions. Not all are successful, but at least some prove promising. They should, we argue, be taken into consideration in criminal jurisprudence, where distortions due to the hindsight bias are likely considerable and deeply disconcerting. (shrink)

Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome (...) evaluation instrument. The aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers’ experiences and perceived importance of outcomes of Moral Case Deliberation. (shrink)

How do people respond to others' accidental behaviors? Reward and punishment for accidents might be depend on the actor's intentions, or instead on the unintended outcomes she brings about. Yet, existing paradigms in experimental economics do not include the possibility of accidental monetary allocations. We explore the balance of outcomes and intentions in a two-player economic game where monetary allocations are made with a "trembling hand": that is, intentions and outcomes are sometimes mismatched. Player 1 allocates $10 (...) between herself and Player 2 by rolling one of three dice. One die has a high probability of a selfish outcome, another has a high probability of a fair outcome, and the third has a high probability of a generous outcome. Based on Player 1's choice of die, Player 2 can infer her intentions. However, any of the three die can yield any of the three possible outcomes. Player 2 is given the opportunity to respond to Player 1's allocation by adding to or subtracting from Player 1's payoff. We find that Player 2's responses are influenced substantially by the accidental outcome of Player 1's roll of the die. Comparison to control conditions suggests that in contexts where the allocation is at least partially under the control of Player 1, Player 2 will punish Player 1 accountable for unintentional negative outcomes. In addition, Player 2's responses are influenced by Player 1's intention. However, Player 2 tends to modulate his responses substantially more for selfish intentions than for generous intentions. This novel economic game provides new insight into the psychological mechanisms underlying social preferences for fairness and retribution. (shrink)

Background: Clinical ethics support services have been advocated in recent decades. In clinical practice, clinical ethics support services are often requested for difficult decisions near the end of life. However, their contribution to improving healthcare has been questioned and demands for evaluation have been put forward. Research indicates that there are considerable challenges associated with defining adequate outcomes for clinical ethics support services. In this systematic review, we report findings of qualitative studies and surveys, which have been conducted to (...) evaluate clinical ethics support services near the end of life. Methods: Electronic databases and other sources were queried from 1970 to May 2018. Two authors screened studies independently. Methodological quality of studies was assessed. For each arm of the review, an individual synthesis was performed. Prospero ID: CRD42016036241. Ethical Considerations: Ethical approval is not needed as it is a systematic review of published literature. Results: In all, 2088 hits on surveys and 2786 on qualitative studies were found. After screening, nine surveys and four qualitative studies were included. Survey studies report overall positive findings using a very wide and heterogeneous range of outcomes. Negative results were reported only occasionally. However, methodological quality and conceptual justification of used outcomes was often weak and limits generalizability of results. Conclusion: Evidence points to positive outcomes of clinical ethics support services. However, methodological quality needs to be improved. Further qualitative or mixed-method research on evaluating clinical ethics support services may contribute to the development of evaluating outcomes of clinical ethics support services by means of broaden the range of appropriate (process-oriented) outcomes of (different types of) clinical ethics support services. (shrink)

In Nigeria, as in other developing countries, access to training in research ethics is limited, due to weak social, economic, and health infrastructure. The project described in this article was designed to develop the capacity of academic staff of the College of Medicine, University of Ibadan, Nigeria to conduct ethically acceptable research involving human participants.

In a series of ten preregistered experiments (N=2043), we investigate the effect of outcome valence on judgments of probability, negligence, and culpability – a phenomenon sometimes labelled moral (and legal) luck. We found that harmful outcomes, when contrasted with neutral outcomes, lead to increased perceived probability of harm ex post, and consequently to increased attribution of negligence and culpability. Rather than simply postulating a hindsight bias (as is common), we employ a variety of empirical means to demonstrate that (...) the outcome-driven asymmetry across perceived probabilities constitutes a systematic cognitive distortion. We then explore three distinct strategies to alleviate the hindsight bias and its downstream effects on mens rea and culpability ascriptions. Not all are successful, but at least some prove promising. They should, we argue, be taken into consideration in criminal jurisprudence, where distortions due to the hindsight bias are likely considerable and deeply disconcerting. (shrink)

Background There has been little attention paid to research on the outcomes of clinical ethics support or critical reflection on what constitutes a good CES outcome. Understanding how CES users perceive the importance of CES outcomes can contribute to a better understanding, use of and normative reflection on CES outcomes. Objective To describe the perceptions of Dutch healthcare professionals on important outcomes of moral case deliberation, prior to MCD participation, and to compare results between respondents. Methods (...) This mixed-methods study used both the Euro-MCD instrument and semi-structured interviews. Healthcare professionals who were about to implement MCD were recruited from nursing homes, hospitals, psychiatry and mentally disabled care institutions. Results 331 healthcare professionals completed the Euro-MCD instrument, 13 healthcare professionals were interviewed. The outcomes perceived as most important were ‘more open communication’, ‘better mutual understanding’, ‘concrete actions’, ‘see the situation from different perspectives’, ‘consensus on how to manage the situation’ and ‘find more courses of action’. Interviewees also perceived improving quality of care, professionalism and the organization as important. Women, nurses, managers and professionals in mentally disabled care rated outcomes more highly than other respondents. Conclusions Dutch healthcare professionals perceived the MCD outcomes related to collaboration as most important. The empirical findings can contribute to shared ownership of MCD and a more specific use of MCD in different contexts. They can inform international comparative research on different CES types and contribute to normative discussions concerning CES outcomes. Future studies should reflect upon important MCD outcomes after having experienced MCD. (shrink)

BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation. Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA (...) North European field survey among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.ResultsAll outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.ConclusionsThe findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such as moral reflexivity and moral attitude outcomes, should still be included. In the future, a combination of empirical findings and normative reflection will contribute to the revision of the instrument. (shrink)

The outcome set of a belief change operator is the set of outcomes that can be obtained with it. Axiomatic characterizations are reported for the outcome sets of the standard AGM contraction operators and eight types of base-generated contraction. These results throw new light on the properties of some of these operators.

The prevalence and complexity of local sustainable development challenges require coordinated action from multiple actors in the business, public, and civil society sectors. Large multi-stakeholder partnerships that build capacity by developing and leveraging the diverse perspectives and resources of partner organizations are becoming an increasingly popular approach to addressing such challenges. Multi-stakeholder partnerships are designed to address and prioritize a social problem, so it can be challenging to define the value proposition to each specific partner. Using a resource-based view, this (...) study examines partner outcomes from the perspective of the strategic interest of the partner as distinct from the strategic goal of the partnership. Based on 47 interviews with representatives of partner organizations in four Canadian case studies of community sustainability plan implementation, this article details 10 resources partners can gain from engaging in a multi-stakeholder partnership. (shrink)

Impaired neurodevelopmental outcome, in particular cognitive impairment, after neonatal hypoxic-ischemic encephalopathy is a major concern for parents, clinicians, and society. This study aims to investigate the potential benefits of using advanced quantitative electroencephalography analysis for early prediction of cognitive outcomes, assessed here at 2 years of age. EEG data were recorded within the first week after birth from a cohort of twenty infants with neonatal hypoxic-ischemic encephalopathy. A proposed regression framework was based on two different sets of features, namely (...) graph-theoretical features derived from the weighted phase-lag index and entropies metrics represented by sample entropy, permutation entropy, and spectral entropy. Both sets of features were calculated within the noise-assisted multivariate empirical mode decomposition domain. Correlation analysis showed a significant association in the delta band between the proposed features, graph attributes and entropy features from the neonatal EEG data and the cognitive development at age two years. These features were used to train and test the tree ensemble regression models. The highest prediction performance was reached to 14.27 root mean square error, 12.07 mean absolute error, and 0.45 R-squared using the entropy features with a boosted tree regression model. Thus, the results demonstrate that the proposed qEEG features show the state of brain function at an early stage; hence, they could serve as predictive biomarkers of later cognitive impairment, which could facilitate identifying those who might benefit from early targeted intervention. (shrink)

The decision-theoretic account of probability in the Everett or many-worlds interpretation, advanced by David Deutsch and David Wallace, is shown to be circular. Talk of probability in Everett presumes the existence of a preferred basis to identify measurement outcomes for the probabilities to range over. But the existence of a preferred basis can only be established by the process of decoherence, which is itself probabilistic.

In a typical comparative clinical trial the randomization scheme is fixed at the beginning of the study, and maintained throughout the course of the trial. A number of researchers have championed a randomized trial design referred to as ‘outcome-adaptive randomization.’ In this type of trial, the likelihood of a patient being enrolled to a particular arm of the study increases or decreases as preliminary information becomes available suggesting that treatment may be superior or inferior. While the design merits of outcome-adaptive (...) trials have been debated, little attention has been paid to significant ethical concerns that arise in the conduct of such studies. These include loss of equipoise, lack of processes for adequate informed consent, and inequalities inherent in the research design which could lead to perceptions of injustice that may have negative implications for patients and the research enterprise. This article examines the ethical difficulties inherent in outcome-adaptive trials. (shrink)

In the introduction to a recent anthology of contemporary issues in philosophy of psychiatry, editors Jeffrey Poland and Şerife Tekin declare this to be a moment of crisis within the field. They suggest that the state of psychiatry today reflects Thomas Kuhn's conception of a period of extraordinary science, which occurs when anomalies begin to build up, confidence in the dominant paradigm is shook, competing theories arise, and philosophical questions come to the fore. Although perhaps not all would agree that (...) the field is in crisis, there is certainly an abundance of pessimism. Within the realm of research, a mood of explanatory pessimism has been growing, characterized by a... (shrink)

During recent years we have seen and assisted at a significantly increased number of twin births. The main reason for this increase in the frequency of twin births is the increasing number of so called “induced pregnancies”, whether through hormonal stimulation or artificial insemination techniques.It is well known1 that twins have high mortality and morbidity rates during the perinatal and the following period. The characteristics of conception and pregnancy can determine the development of several pathologies, including prematurity and intrauterine growth (...) retardation, …. (shrink)

With both the cost and quality of health care under scrutiny, many in the health care industry have turned to outcomes research and practice guidelines for answers. But many physicians have resisted, claiming their clinical judgment is a better guide. Both camps may be right.

The term ‘intelligence’ as used in this paper refers to items of knowledge collected for the sake of assessing and maintaining national security. The intelligence community (IC) of the United States (US) is a community of organizations that collaborate in collecting and processing intelligence for the US. The IC relies on human-machine-based analytic strategies that 1) access and integrate vast amounts of information from disparate sources, 2) continuously process this information, so that, 3) a maximally comprehensive understanding of world actors (...) and their behaviors can be developed and updated. Herein we describe an approach to utilizing outcomes-based learning (OBL) to support these efforts that is based on an ontology of the cognitive processes performed by intelligence analysts. Of particular importance to the Cognitive Process Ontology is the class Representation that is Warranted. Such a representation is descriptive in nature and deserving of trust in its veridicality. The latter is because a Representation that is Warranted is always produced by a process that was vetted (or successfully designed) to reliably produce veridical representations. As such, Representations that are Warranted are what in other contexts we might refer to as ‘items of knowledge’. (shrink)

The decision-theoretic account of probability in the Everett or many-worlds interpretation, advanced by David Deutsch and David Wallace, is shown to be circular. Talk of probability in Everett presumes the existence of a preferred basis to identify measurement outcomes for the probabilities to range over. But the existence of a preferred basis can only be established by the process of decoherence, which is itself probabilistic.

To improve the value of pharmaceutical spending, some manufacturers and payers have introduced outcomes-based contracts, where rebates are tied to specified outcomes. We reviewed the literature and interviewed key experts to assess these contracts' potential to slow pharmaceutical spending. We found that while outcomes-based contracts are increasingly common in the US, they are still limited by multiple factors — including the lack of meaningful outcomes data. Moreover, there is no evidence to date that they slow pharmaceutical (...) spending or increase access. Experts favored having CMS test and rigorously evaluate this model to achieve a better understanding of the implications. (shrink)

The paper extends the framework of outcomes in branching space-time (Kowalski and Placek [1999]) by assigning probabilities to outcomes of events, where these probabilities are interpreted either epistemically or as weighted possibilities. In resulting models I define the notion of common cause of correlated outcomes of a single event, and investigate which setups allow for the introduction of common causes. It turns out that a deterministic common cause can always be introduced, but (surprisingly) only special setups permit (...) the introduction of truly stochastic common causes. I analyse next the Bell-Aspect experiment and derive the Bell-CH inequalities. I observe that we postulate there not a common cause for outcomes of a single event but rather a common common cause that accounts for outcomes of many events, where 'events' mean 'measurements with (different) directions of polarization'. Since the inequalities are violated, I claim that no causal story can be told about the Bell correlations, where causality is subliminal and restricted by screening-off condition. Similarly, given certain intuitive principles, no deterministic story can be told about these correlations. (shrink)

We reconsider the nonlocal aspects of quantum mechanics with special reference to the EPR argument. We first confine our considerations to the correlations between the outcomes of measurements on spatially distant constituents, without worrying about the measurement problem. We pay particular attention to the relativistic aspects of the problem. Our first conclusion is that, when developed along the lines we follow, the EPR inference that quantum correlations and locality together imply incompleteness, is appropriate. We then investigate whether the other (...) common conclusion from the EPR argument, i.e. that standard quantum theory implies a spooky action at a distance, is correct. We emphasize the crucial role played by the locality assumption and we discuss the use of counterfactuals in the ‘relativistic’ reformulation of the EPR argument. We show that the above conclusion is false if understood as saying that standard quantum theory exhibits, at least with reference to possessed elements of physical reality, some sort of parameter dependence. Thus, in a sense, the coexistence of quantum mechanics with relativity is even more peaceful than commonly thought. We then go through a similar analysis by taking explicitly into account the measurement process. We point out the difficulties which one meets when confronting reduction mechanisms with relativistic requirements. This leads us to recognize the necessity of reconsidering the criteria for attributing objective properties to individual physical systems. Our final conclusion is that, in principle, it is perfectly possible to build up theories leading to the objectification of macroscopic properties which do not imply any spooky action at a distance. (shrink)

The Iowa Gambling Task (IGT) is widely used to study decision‐making within healthy and psychiatric populations. However, the complexity of the IGT makes it difficult to attribute variation in performance to specific cognitive processes. Several cognitive models have been proposed for the IGT in an effort to address this problem, but currently no single model shows optimal performance for both short‐ and long‐term prediction accuracy and parameter recovery. Here, we propose the Outcome‐Representation Learning (ORL) model, a novel model that provides (...) the best compromise between competing models. We test the performance of the ORL model on 393 subjects' data collected across multiple research sites, and we show that the ORL reveals distinct patterns of decision‐making in substance‐using populations. Our work highlights the importance of using multiple model comparison metrics to make valid inference with cognitive models and sheds light on learning mechanisms that play a role in underweighting of rare events. (shrink)

The paper intends to provide an algebraic framework in which subluminal causation can be analysed. The framework merges Belnap's 'outcomes in branching time' with his 'branching space-time' (BST). it is shown that an important structure in BST, called 'family of outcomes of an event', is a boolean algebra. We define next non-stochastic common cause and analyse GHZ-Bell theorems. We prove that there is no common cause that accounts for results of GHZ-Bell experiment but construct common causes for two (...) other quantum mechanical setups. Finally, we investigate why some setups allow for common causes whereas other setups do not. (shrink)

Learning outcomes currently play an increasingly important role in higher education. This paper identifies a number of key issues that need to be taken into account in identifying and making use of them. It includes a review of the background from which learning outcomes have emerged. It also highlights the behaviourist approach underlying their use in teaching and assessment and identifies key issues that need to be taken into account in adopting such an approach.

Learning outcomes currently play an increasingly important role in higher education. This paper identifies a number of key issues that need to be taken into account in identifying and making use of them. It includes a review of the background from which learning outcomes have emerged. It also highlights the behaviourist approach underlying their use in teaching and assessment and identifies key issues that need to be taken into account in adopting such an approach.

I argue that no outcome is good, bad, or evaluatively neutral for anyone. My argument concerns non-comparative personal evaluative properties alone; it does not support (say) the conclusion that no outcome is better for anyone than any other outcome. First I argue that there is a sequence of outcomes with the following properties, and that the existence of such a sequence supports the conclusion that no outcome is good for anyone: (i) the first member of the sequence is good (...) for you if any outcome is good for you, (ii) any two adjacent members of the sequence are on a par for you, and (iii) the last member of the sequence is not good for you. I then defend similar arguments that no outcome is bad or evaluatively neutral for anyone. Thus, I conclude that no outcome is good, bad, or evaluatively neutral for anyone. (shrink)

Democratic theorists often distinguish between two views of democratic procedures. ‘Outcomes theorists’ emphasize the instrumental nature of these procedures and argue that they are only valuable because they tend to produce good outcomes. In contrast, ‘proceduralists’ emphasize the intrinsic value of democratic procedures, for instance, on the grounds that they are fair. In this paper. I argue that we should reject pure versions of these two theories in favor of an understanding of the democratic ideal that recognizes a (...) commitment to both intrinsically valuable democratic procedures and democratic outcomes. In instances in which there is a conflict between these two commitments, I suggest they must be balanced. This balancing approach offers a justification of judicial review on the grounds that it potentially limits outcomes that undermine democracy. But judicial review is not justifiable in any instance in which a bad democratic outcome results from democratic procedures. When the loss that would result from overturning a democratic procedure is greater than the gain to democracy that would result from ensuring against an undemocratic outcome; judicial review is not justifiable. Loss or gain to democracy is defined by the negative or positive impact of each action on the core democratic values of equality and autonomy, aspects of the democratic ideal. Even when judicial review is justified, the fact that it overturns intrinsically valuable procedures suggests that such review is never ideal from the standpoint of democracy. (shrink)

In the traditional fix-it model of medical decision making, the identified problem is typically characterized by a diagnosis that indicates a deviation from normalcy. When a medical problem is multifaceted and the available interventions are only partially effective, a broader vision of the health care endeavor is needed. What matters to the patient, and what should matter to the practitioner, is the patient's future possibilities. More specifically, what is important is the character of the alternative futures that the patient could (...) have and choosing among them so as to achieve the best future possible, with the ranking of outcomes determined by the patient's preferences. This paper describes the fix-it model, presents and defends the outcomes-based model, and demonstrates that the latter is useful in developing normative conceptions of informed consent and decision making and in establishing a basis for societal involvement in the decision making process. Finally, several shortcomings of the model will be acknowledged. (shrink)

BackgroundIn paediatric oncology, healthcare professionals face moral challenges. Clinical ethics support services, such as moral case deliberation, aim to assist them in dealing with these challenges. Yet, healthcare professionals can have different expectations and goals related to clinical ethics support services.MethodsIn this study, the perceptions held by healthcare professionals regarding the importance of possible outcomes of MCDs, prior to implementation of MCDs, were investigated. A multisite, cross-sectional, quantitative study was performed at all six Paediatric Oncology Centres in Sweden. Healthcare (...) professionals answered the Euro-MCD instrument with 26 potential MCD outcomes using a scale from Not important to Very important. Descriptive and comparative statistical analyses were carried out.ResultsAll outcomes were rated high, i.e., between 3.12 and 3.78. More open communication, developing skills to analyse ethically difficult situations, better mutual understanding, and deciding on concrete actions were rated as most important. Understanding of ethical theories and critical examination of policies were rated less important. Most often nursing assistants rated higher and physicians lower than the other professions did. Women and participants without previous experience of MCDs perceived outcomes as more important. There were differences between centres as one centre had significantly higher, and one centre had significantly lower ratings compared to the others.ConclusionIt is clear that healthcare professionals want MCDs to improve teamwork and skills in order to analyse and manage ethically difficult situations. When comparing to previous research about important MCD outcomes, there were similarities in what healthcare professionals consider to be important when handling moral challenges regardless of country and potential differences in healthcare settings and systems, such as paediatric vs. adult care. (shrink)

Beliefs like the Gambler's Fallacy and the Hot Hand have interested cognitive scientists, economists, and philosophers for centuries. We propose that these judgment patterns arise from the observer's mental models of the sequence-generating mechanism, moderated by the strength of belief in an a priori base rate. In six behavioral experiments, participants observed one of three mechanisms generating sequences of eight binary events: a random mechanical device, an intentional goal-directed actor, and a financial market. We systematically manipulated participants’ beliefs about the (...) base rate probabilities at which different outcomes were generated by each mechanism. Participants judged 18 sequences of outcomes produced by a mechanism with either an unknown base rate, a specified distribution of three equiprobable base rates, or a precise, fixed base rate. Six target sequences ended in streaks of between two and seven identical outcomes. The most common predictions for subsequent events were best described as pragmatic belief updating, expressed as an increasingly strong expectation that a streak of identical signals would repeat as the length of that streak increased. The exception to this pattern was for sequences generated by a random mechanical device with a fixed base rate of.50. Under this specific condition, participants exhibited a bias toward reversal of streaks, and this bias was larger when participants were asked to make a dichotomous choice versus a numerical probability rating. We review alternate accounts for the anomalous judgments of sequences and conclude with our favored interpretation that is based on Rabin's version of Tversky & Kahneman's Law of Small Numbers. (shrink)

This study examined the role of key causal analysis strategies in forecasting and ethical decision-making. Undergraduate participants took on the role of the key actor in several ethical problems and were asked to identify and analyze the causes, forecast potential outcomes, and make a decision about each problem. Time pressure and analytic mindset were manipulated while participants worked through these problems. The results indicated that forecast quality was associated with decision ethicality, and the identification of the critical causes of (...) the problem was associated with both higher quality forecasts and higher ethicality of decisions. Neither time pressure nor analytic mindset impacted forecasts or ethicality of decisions. Theoretical and practical implications of these findings are discussed. (shrink)

Intrauterine insemination is one of many treatments provided to infertility patients. Many factors such as, but not limited to, quality of semen, the age of a woman, and reproductive hormone levels contribute to infertility. Therefore, the aim of our study is to establish a statistical probability concerning the prediction of which groups of patients have a very good or poor prognosis for pregnancy after IUI insemination. For that purpose, we compare the results of two analyses: Cluster Analysis and Kohonen Neural (...) Networks. The k-means algorithm from the clustering methods was the best to use for selecting patients with a good prognosis but the Kohonen Neural Networks was better for selecting groups of patients with the lowest chances for pregnancy. (shrink)

Practical conflicts include conflicts in agents who judge, from the perspective of their own values, desires, beliefs, and the like, that one prospective course of action is superior to another but are tempted by what they judge to be the inferior course of action. A man who wants a late-night snack, even though he judges it best, from the identified perspective, to abide by his recent New Year's resolution against eating such snacks until he has lost ten pounds, is the (...) locus of a practical conflict. So is a woman who judges it best (in the same way) to run a mile this morning but is tempted to spend the entire morning working in her office instead. The topic of this essay is practical outcomes of conflicts of this kind. My concern, more specifically, is with outcomes of two general kinds: akratic (from the classical Greek term akrasia: want of self-control) and enkratic (from enkrateia: self-control) actions. (shrink)

Outcome-adaptive randomization has been proposed as a corrective to certain ethical difficulties inherent in the traditional randomized clinical trial using fixed-ratio randomization. In particular, it has been suggested that OAR redresses the balance between individual and collective ethics in favour of the former. In this paper, I examine issues of welfare and autonomy arising in relation to OAR. A central issue in discussions of welfare in OAR is equipoise, and the moral status of OAR is crucially influenced by the way (...) in which this concept is construed. If OAR is based on a model of equipoise that demands strict indifference between competing interventions throughout the trial, such equipoise is disturbed by accruing data favouring one treatment over another; OAR seeks to redress this by weighting randomization to the seemingly superior treatment. However, this is a partial response, as patients continue to be allocated to the inferior therapy. Moreover, it rests upon considerations of aggregate harms and benefits, and does not therefore uphold individual ethics. Issues of fairness also arise, as early and late enrollees are randomized on a different basis. Fixed-ratio randomization represents a fuller and more consistent response to a loss of equipoise, as so construed. With regard to consent, the complexity of OAR poses challenges to adequate disclosure and comprehension. Additionally, OAR does not offer a remedy to the therapeutic misconception—participants’ tendency to attribute treatment allocation in an RCT to individual clinical judgments, rather than to scientific considerations—and, if anything, accentuates rather than alleviates this misconception. In relation to these issues, OAR fails to offer ethical advantages over fixed-ratio randomization. More broadly, the ethical basis of OAR can be seen to lie more in collective than in individual ethics, and overall it fares worse in this territory than fixed-ratio randomization. (shrink)

Data from medical research are typically summarized with various types of outcome measures. We present three arguments in favor of absolute over relative outcome measures. The first argument is from cognitive bias: relative measures promote the reference class fallacy and the overestimation of treatment effectiveness. The second argument is decision-theoretic: absolute measures are superior to relative measures for making a decision between interventions. The third argument is causal: interpreted as measures of causal strength, absolute measures satisfy a set of desirable (...) properties, but relative measures do not. Absolute outcome measures outperform relative measures on all counts. (shrink)