In this paper we argue that knowledge in health care is a multidimensional dynamic construct, in contrast to the prevailing idea of knowledge being an objective state. Polanyi demonstrated that knowledge is personal, that knowledge is discovered, and that knowledge has explicit and tacit dimensions. Complex adaptive systems science views knowledge simultaneously as a thing and a flow, constructed as well as in constant flux. The Cynefin framework is one model to help our understanding of knowledge as a personal construct (...) achieved through sense making. Specific knowledge aspects temporarily reside in either one of four domains – the known, knowable, complex or chaotic, but new knowledge can only be created by challenging the known by moving it in and looping it through the other domains. Medical knowledge is simultaneously explicit and implicit with certain aspects already well known and easily transferable, and others that are not yet fully known and must still be learned. At the same time certain knowledge aspects are predominantly concerned with content, whereas others deal with context. Though in clinical care we may operate predominately in one knowledge domain, we also will operate some of the time in the others. Medical knowledge is inherently uncertain, and we require a context-driven flexible approach to knowledge discovery and application, in clinical practice as well as in health service planning. (shrink)

Background Metaphors are central to the human understanding of complex issues; through the immediate associations they evoke and frame problems and suggest solutions. Our suggestion of Music in the Park as a metaphor for health systems reform brings to the forefront the environmentally diverse but bounded spaces of health services that offer a variety of attractors within their confines, while pushing into the background organizational and economic concerns.Reflections Parks, like health services, are embedded in their local landscape, serving their communities, (...) but most importantly parks are public spaces, publically funded, ideally offering universal access and equity and to be shared by all who want to go there.Music, like health, is tangible, technical and scientific, yet ultimately experiential and based on meaning. While it encompasses a wide range of styles and approaches, music making requires as its most important skill active listening which brings with it to be ‘in the moment’, to take personal risks and to draw energy and inspiration from the participants. Hence ‘audiences’ are equally active participants because music only has meaning if it internally resonates with the listener and only can exist in what is a co-constructed experience.Conclusions Music in the Park is a metaphor for primary health care systems based on shared values of experts and unique local communities. Health professionals are players in this arena, who develop and practise the full range of their skills in response to individual and community needs and preferences. Their leadership works through inspiration and empowerment, making patients ‘co-producers’ of their own health and ‘co-shapers’ of their health services. (shrink)

We are never illness or disease, but, rather, always their sum in the world of day-to-day experience. Disease and illness are not closed systems, but mutually constitutive and continuously interacting worlds. In the patient’s case it is always experience as well. Pain, sickness and death help make that particular experienced identity unavoidable, and at some level ultimately inaccessible to medicine’s changing understanding of disease and tools for managing it. Health—rather than cost containment, specific conditions, or technologies—should be the central focus (...) for health care and health-care reform. A compelling reason to focus on health comes from the observation that the prevalence of disease over the .. (shrink)

Bering's target article proposes that the tendency to believe in an afterlife emerged (in evolutionary history) in response to selective pressures unique to human societies. However, the empirical evidence presented fails to account for the broader social context that impinges upon researcher–participant interactions, and so fails to displace the more parsimonious explanation that it is childhood credulity that underlies the acquisition of afterlife beliefs through cultural exposure.

Ethical dilemmas involving tax issues were identified by members of the American Institute of Certified Public Accountants as posing the most difficult ethical problem for them (Finn et al., Journal of Business Ethics 7(8), pp. 607–609, 1988). The KPMG tax shelter fraud case proves that the tax profession has not gone untainted in the age of numerous accounting and corporate scandals, such as the Enron débâcle (Sikka and Hampton, Accounting Forum 29(3), 325–343, 2005). High-profile scandals serve to highlight the problems (...) caused by differences in ethical judgement among accountants and tax practitioners and the issue of ethics has been brought publicly to the forefront of the profession. Nevertheless, the nature and dimension of ethical issues in tax practice have been largely unexplored (Erard, Journal of Public Economics 52(2), 163–197, 1993; Marshall et al., Journal of Business Ethics 17(12), 1265–1279, 1998; Frecknall Hughes, Unpublished PhD Thesis, The University of Leeds, 2002). This research aims to contribute to the debate on ethics in tax practice by reporting interview data on tax practitioners’ perceptions of ethics in the jurisdictions of Ireland and the United Kingdom and exploring the link or equation of ethics with risk management. (shrink)

The perception of behavior as a moral or conventional concern can be influenced by contextual variables, including status and power differences. We propose that social processes and in particular social role enactment through the exercise of power will psychologically motivate moralization. Punishing or rewarding others creates a moral dilemma that can be resolved by externalizing causation to incontrovertible moral rules. Legitimate power related to structure and position can carry moral weight but may not influence the power holder’s perceptions of rules (...) and general norms of behavior. Social identity theory suggests moralization could be promoted by a concern for shared, defining values. However, the tendency to moralize another’s behavior can be injurious to shared identity. We explored white-collar employees’ perceptions of several categories of noxious or deviant workplace behaviors and regressed these perceptions on the tendency to use legitimate, referent, or reward and punish power; social identity; and the interaction of social identity and power, in particular legitimate power. Only the tendency to influence others through punishment or reward predicted moralization. Alternative causal explanations for the findings were addressed through the absence of any relationships between punishment and reward power and perceptions of deviant behaviors as wrong, upsetting, or requiring punishment. We discuss these results in the context of self and social processes, the social construction of morals and power, and the impact of managers’ behavior on group or organizational ethics. (shrink)

IntroductionHearing loss in adults has a pervasive impact on health and well-being. Its effects on everyday listening and communication can directly influence participation across multiple spheres of life. These impacts, however, remain poorly assessed within clinical settings. Whilst various tests and questionnaires that measure listening and communication abilities are available, there is a lack of consensus about which measures assess the factors that are most relevant to optimising auditory rehabilitation. This study aimed to map current measures used in published studies (...) to evaluate listening skills needed for oral communication in adults with hearing loss.MethodsA scoping review was conducted using systematic searches in Medline, EMBASE, Web of Science and Google Scholar to retrieve peer-reviewed articles that used one or more linguistic-based measure necessary to oral communication in adults with hearing loss. The range of measures identified and their frequency where charted in relation to auditory hierarchies, linguistic domains, health status domains, and associated neuropsychological and cognitive domains.Results9121 articles were identified and 2579 articles that reported on 6714 discrete measures were included for further analysis. The predominant linguistic-based measure reported was word or sentence identification in quiet. In contrast, discourse-based measures were used in 2.7% of the articles included. Of the included studies, 36.6% used a self-reported instrument purporting to measures of listening for communication. Consistent with previous studies, a large number of self-reported measures were identified, but 60.4% of these measures were used in only one study and 80.7% were cited five times or fewer.DiscussionCurrent measures used in published studies to assess listening abilities relevant to oral communication target a narrow set of domains. Concepts of communicative interaction have limited representation in current measurement. The lack of measurement consensus and heterogeneity amongst the assessments limit comparisons across studies. Furthermore, extracted measures rarely consider the broader linguistic, cognitive and interactive elements of communication. Consequently, existing measures may have limited clinical application if assessing the listening-related skills required for communication in daily life, as experienced by adults with hearing loss. (shrink)

BACKGROUND AND RATIONALE: Evidence based medicine is the present backbone of rational and objective, modern medical problem solving and is a meeting ground for quantitative and qualitative researchers alike as it culminates into applying the fruits of clinical research to the individual patient. A systematic enquiry into the evolving paradigms in EBM is a need of the hour. AIMS AND METHODS: A qualitative enquiry examining the impact of different methodologies in EBM and their role in generating meaning interpretable at individual (...) levels. RESULTS: Present day outcome based research deals less with patients as individuals than as populations. Evidence based medicine struggles to apply the fruits of population based research to individuals who are often not as predictable as linear quantitative research would like them to be. The present EBM literature neglects a lot of events it doesn't believe to be statistically significant and perhaps here is an area that needs to be improved on - it assumes that because associations are demonstrated between interventions and outcomes in RCTs/meta-analysis, these associations are linear and causal in the real world. While they may be demonstrated repeatedly in highly controlled environments, in the real 'uncontrolled' world of clinical practice with real people, their validity breaks down. CONCLUSIONS: One needs to make the EBM standard model patient-individual (a projection of collective patient event data) resemble the real human individual patient so that optimal EBM individual data that matches our query can be easily and quickly spotted from the dense jungle of information that has grown over the years. This hints at rethinking our entire research methodology and modifying it to suit the needs of the individual patient. (shrink)

Ormerod and Chronicle reported that optimal solutions to traveling salesperson problems were judged to be aesthetically more pleasing than poorer solutions and that solutions with more convex hull nodes were rated as better figures. To test these conclusions, solution regularity and the number of potential intersections were held constant, whereas solution optimality, the number of internal nodes, and the number of nearest neighbors in each solution were varied factorially. The results did not support the view that the convex hull is (...) an important determinant of figural attractiveness. Also, in contrast to the findings of Ormerod and Chronicle, there were consistent individual differences. Participants appeared to be divided as to whether the most attractive figure enclosed a given area within a perimeter of minimum or maximum length. It is concluded that future research in this area cannot afford to focus exclusively on group performance measures. (shrink)

This long-awaited book replaces Hughes and Cresswell's two classic studies of modal logic: _An Introduction to Modal Logic_ and _A Companion to Modal Logic_. _A New Introduction to Modal Logic_ is an entirely new work, completely re-written by the authors. They have incorporated all the new developments that have taken place since 1968 in both modal propositional logic and modal predicate logic, without sacrificing tha clarity of exposition and approachability that were essential features of their earlier works. The book (...) takes readers from the most basic systems of modal propositional logic right up to systems of modal predicate with identity. It covers both technical developments such as completeness and incompleteness, and finite and infinite models, and their philosophical applications, especially in the area of modal predicate logic. (shrink)

Critics have argued that behaviorism must necessarily be inadequate to account for complex human behavior whereas cognitive psychology is adequate to account for such behavior. Recently, Fodor has focused this criticism on certain situations in which humans choose among a set of alternatives. We argue that this criticism applies to forms of behaviorism that are reductionistic but not to non-reductionistic behaviorisms like that of Skinner. Non-reductionistic behaviorism can be used to interpret human choice situations of varying degrees of complexity. Such (...) interpretations run into difficulty in accounting for certain aspects of verbal behavior, but so do cognitive theories. Although nothing, in principle, prohibits either type of theory from accounting for complex human behavior, neither current behavioral theory nor current cognitive theory is developed enough at the present time to do so. (shrink)

Port-wine birthmarks (PWBs) are caused by somatic, mosaic mutations in the G protein guanine nucleotide binding protein alpha subunit q (GNAQ) and are characterized by the formation of dilated, dysfunctional blood vessels in the dermis, eyes, and/or brain. Cutaneous PWBs can be treated by current dermatologic therapy, like laser intervention, to lighten the lesions and diminish nodules that occur in the lesion. Involvement of the eyes and/or brain can result in serious complications and this variation is termed Sturge-Weber syndrome (SWS). (...) Some of the biggest hurdles preventing development of new therapeutics are unanswered questions regarding disease biology and lack of models for drug screening. In this review, we discuss the current understanding of GNAQ signaling, the standard of care for patients, overlap with other GNAQ-associated or phenotypically similar diseases, as well as deficiencies in current in vivo and in vitro vascular malformation models. (shrink)

Irrelevant emotional stimuli often capture attention, disrupting ongoing cognitive processes. In two experiments, we examined whether availability of rewards can prevent...

The theory of personal identity should illuminate and be illuminated by the theory of personality, of which it is a part. I believe that Locke's theory succeeds in this more than that of any other great philosopher, and the modifications which it may need are not fundamental ones. The problems raised by Butler and Flew can be made to disappear.

Successful interactions between people are dependent on rapid recognition of social cues. We investigated whether head direction – a powerful social signal – is processed in the absence of conscious awareness. We used continuous flash interocular suppression to render stimuli invisible and compared the reaction time for face detection when faces were turned towards the viewer and turned slightly away. We found that faces turned towards the viewer break through suppression faster than faces that are turned away, regardless of eye (...) direction. Our results suggest that detection of a face with attention directed at the viewer occurs even in the absence of awareness of that face. While previous work has demonstrated that stimuli that signal threat are processed without awareness, our data suggest that the social relevance of a face, defined more broadly, is evaluated in the absence of awareness. (shrink)