Quality improvement (QI) is fundamental to maintaining high standards of health care. Significant debate exists concerning the necessity for an ethical approval system for those QI projects that push the boundaries, appearing more similar to research than QI. The authors discuss this issue identifying the core ethical issues in family medicine (FM), drawing upon the fundamental principles of medical ethics, including principles of autonomy, utility, justice and non-maleficence. Recent debate concerning the application of QI ethics boards is discussed with relevance (...) to primary care and issues such as general practitioner (GP) intentions, the impact of QI on patients and the use of confidential patient data and the impact of dissemination. The authors conclude that a system of QI ethical approval leaves many issues unresolved and potentially creates several barriers to implementing QI. To ensure ethical QI work is generated within FM it is essential for GPs to learn about and engage in more ethical reflection so that they can better judge and resolve these issues. (shrink)

In this paper, we reconstruct Kant’s notion of the practically conditioned, introduced in the Dialectic of Pure Practical Reason, by drawing on Kant’s general account of the faculty of reason presented in the Transcendental Dialectic of the Critique of Pure Reason. We argue that practical reason’s activity of seeking the practically unconditioned for a given condition generates two different conceptions of the practically unconditioned and identify these as virtue and (the ideal of) happiness. We then account for how and why (...) reason proceeds to combine these two distinct ideas into the composite idea of the highest good. Last, we draw on our discussion to determine more precisely what Kant intends by the ‘supremacy’ of virtue within reason’s idea of the highest good. (shrink)

Sen’s Liberal paradox describes a conflict between weak Pareto, minimal liberalism, and either transitivity or a best element over a domain of individual preferences. This paper examines variants of that paradox with varying amounts of unconditional preferences. We define a notion of unconditional preferences under which, in the absence of Pareto, there can be no cycles. We then define a stronger condition, that makes an individual’s preferences for her own private attributes independent of all other attributes. Under this assumption, there (...) can be no cycles with or without Pareto. We also show there exists a social decision function satisfying those conditions. We then determine the probability of a cycle assuming a much weaker independence condition that does not restrict the domain. This probability converges to one as the number of non-private attributes within the social states increases. Finally, we use simulations to determine the probability that liberalism and Pareto conflict with best elements, maximal elements, and transitivity separately. (shrink)

Background Central to the involvement of children in health research is the notion of risk. In this paper we present one of the factors, a matter of trust, that shaped Canadian parents' and children's perceptions and assessments of risk in child health research. Participants and methods Part of a larger qualitative research study, 82 parents took part an in-depth qualitative interview, with 51 parents having children who had participated in health research and 31 having children with no research history. 51 (...) children ranging from 6 to 19 years of age were also interviewed, with 28 having a history of participation in child health research and 23 having no history. Children also took part in 3 focus groups interviews. Themes emerged through a grounded theory analysis of coded interview transcripts. Findings The presence or absence of trust was not only perceived by parents and children as a contributing factor to involving children in health research, but also shaped their perceptions and assessments of risk. Three interrelated subthemes identified were: (1) relationships of trust; (2) placing trust in symbols of authority; and (3) the continuum of trust. Conclusions Our study reinforces that trust is an important factor when parents assess risk in child health research and shows that children use the language of trust in relation to risk. More discussion regarding trust in training researchers is warranted given the trust in researchers and institutions evident in this study. We also recommend further study of the continuum of trust in child health research. (shrink)

This article provides a brief background of key issues in physician burnout, a significant problem in the healthcare industry. The extent and severity of burnout are not well understood, and those seeking help are often stigmatized. A number of different approaches to alleviating burnout have been suggested, but the problem lacks any single or simple solution.We posit that an ethics committee may be well positioned to help address this issue because of its unique position within an institution. An ethics committee (...) serves the entire hospital staff regardless of department. As such it may be able to identify common elements in the development of burnout, and can serve as a conduit to administration in identifying these. An ethics committee can obtain information about the extent of burnout by conducting surveys to assess the extent and severity of burnout in an institution, and serve as a central resource to help address and alleviate it.Finally, an ethics committee may be able to act as an intermediary between practitioners and the administration, in advising the administration of the extent of the problem and offer suggestions for alleviating it. (shrink)

This study presents the first neuroimaging investigation of female psychopathy in an incarcerated population. Prior studies have found that male psychopathy is associated with reduced limbic and paralimbic activation when processing emotional stimuli and making moral judgments. The goal of this study was to investigate whether these findings extend to female psychopathy. During fMRI scanning, 157 incarcerated and 46 non-incarcerated female participants viewed unpleasant pictures, half which depicted moral transgressions, and neutral pictures. Participants rated each picture on moral transgression severity. (...) Psychopathy was assessed using the Psychopathy Checklist-Revised (PCL-R) in all incarcerated participants. Non-incarcerated participants were included as a control group to derive brain regions of interest associated with viewing unpleasant vs. neutral pictures (emotion contrast), and unpleasant pictures depicting moral transgressions vs. unpleasant pictures without moral transgressions (moral contrast). Regression analyses in the incarcerated group examined the association between PCL-R scores and brain activation in the emotion and moral contrasts. Results of the emotion contrast revealed a negative correlation between PCL-R scores and activation in the right amygdala and rostral anterior cingulate. Results of the moral contrast revealed a negative correlation between PCL-R scores and activation in the right temporo-parietal junction. These results indicate that female psychopathy, like male psychopathy, is characterized by reduced limbic activation during emotion processing. In contrast, reduced temporo-parietal activation to moral transgressions has been less observed in male psychopathy. These results extend prior findings in male psychopathy to female psychopathy, and reveal aberrant neural responses to morally-salient stimuli that may be unique to female psychopathy. (shrink)

Florida International University, USA edwardj{at}fiu.edu ' + u + '@ ' + d + ' '/ /- -> Several authors have analyzed the optimal k -majority rule based on a variety of criteria. Buchanan and Tullock argued that, in constitutional settings, the criterion should be that all changes meet the Pareto criterion; otherwise the status quo should be preferred. They then asserted that unanimity rule would be the preferred voting rule in this setting. In parliamentary settings, they claimed that a (...) near majority rule would be preferred because it minimizes the sum of decision costs and external costs. This article investigates both claims in an N -voter, two-alternative setting. We show the conditions under which unanimity rule is less likely to select BT preferred alternatives than other k -majority rules and prove that the difference in performance can be negligible when N is large and certain weak conditions are met. Furthermore, if we define external costs as the expected number of losers from a BT-inferior vote, then external costs become negligible for a range of supermajority rules. This implies that unanimity rule and a range of supermajority rules should be equally preferred when decision costs are added. Finally, we show that the external cost function can actually increase for certain populations. Many of the broader conclusions should also hold for multiple alternatives. Key Words: constitutional design • Pareto criterion • external costs • social contract. (shrink)

This article explores the reasons some pregnant women enter maternity homes with the plan to place their babies for adoption. The authors discuss changes in maternity homes over the twentieth century and report on findings from a survey of currently licensed homes in Texas. Next, the authors discuss the findings from fieldwork and in-depth interviews with residents of two maternity homes. They identify three major reasons why birth mothers enter maternity homes: the desire to escape abusive or stressful family lives, (...) the desire to avoid the stigma of placing a child for adoption, and the desire to provide their children, and in some cases themselves, with a stable and loving family life. The authors contend that entering a maternity home with the intention of placing their babies for adoption represents an effort on the part of birth mothers to reconfigure their own, often impoverished family lives. (shrink)

We study the effects of homeschool background and time use on academic performance among students at Patrick Henry College, a private religious institution with a 63-credit core classical liberal arts curriculum. Using ordinary least squares regression analysis, we examine four research questions: Does time use influence academic performance? Do homeschooled students perform differently than traditionally schooled students? Does parental education moderate the impact of homeschooling on academic performance? Does homeschooling moderate the impact of ACT scores on academic performance?

It was proposed that the data from Monte Carlo statistical investigations be subjected to analysis of variance methods rather than the conventional techniques of tabling, graphing, and inspecting the data. Two examples in which analysis of variance methods were applied to published Monte Carlo studies were presented. It was suggested that balanced factorial designs should be used whenever possible in Monte Carlo studies so that analysis of variance methods would be directly applicable. Finally, three advantages of analysis of variance methods (...) over conventional techniques were described and analysis of variance methods were contrasted with a possible alternative analytical method, multiple regression analysis. (shrink)

Alea, Bluck, Mroz and Edwards examine how the communication of autobiographical stories via face‐to‐face vs. instant message (IM) influences the extent to which social bonds form between strangers. The results of their study show that the in‐person communication of strangers’ autobiographical memories leads to greater engagement and higher empathy rates in the listener of those stories. That is, sharing autobiographical memories face‐to‐face (compared to IM) is positively correlated with positive feelings and closeness in the listener of those stories.

As the usual regulatory framework did not fit well during the last Ebola outbreak, innovative thinking still needed. In the absence of an outbreak, randomised controlled trials of clinical efficacy in humans cannot be done, while during an outbreak such trials will continue to face significant practical, philosophical, and ethical challenges. This article argues that researchers should also test the safety and effectiveness of novel vaccines in wild apes by employing a pluralistic approach to evidence. There are three reasons to (...) test vaccines in wild populations of apes: i) protect apes; ii) reduce Ebola transmission from wild animals to humans; and iii) accelerate vaccine development and licensing for humans. Data obtained from studies of vaccines among wild apes and chimpanzees may even be considered sufficient for licensing new vaccines for humans. This strategy will serve to benefit both wild apes and humans. (shrink)

Loop regions in proteins have traditionally been described as ‘random coil’, although they are known to adopt well‐defined conformations in most globular proteins. In this contribution we summarize the results of detailed analysis of the structures and sequences of these loop regions in proteins of known three‐dimensional structure. We also describe how these results can be used as an aid to protein design, modification and modelling.

In recent years, three ancient manuscripts relating to the _Yi jin_g (_I Ching_), or _Classic of Changes_, have been discovered. The earliest--the Shanghai Museum Zhou Yi--dates to about 300 B.C.E. and shows evidence of the text's original circulation. The _Guicang_, or _Returning to Be Stored_, reflects another ancient Chinese divination tradition based on hexagrams similar to those of the _Yi jing_. In 1993, two manuscripts were found in a third-century B.C.E. tomb at Wangjiatai that contain almost exact parallels to the (...) _Guicang_'s early quotations, supplying new information on the performance of early Chinese divination. Finally, the Fuyang_ Zhou Y_i was excavated from the tomb of Xia Hou Zao, lord of Ruyin, who died in 165 B.C.E. Each line of this classic is followed by one or more generic prognostications similar to phrases found in the_ Yi jing_, indicating exciting new ways the text was produced and used in the interpretation of divinations. _Unearthing the Changes_ details the discovery and significance of the Shanghai Museum _Zhou Yi_, the Wangjiatai _Guicang_, and the Fuyang _Zhou Yi_, including full translations of the texts and additional evidence constructing a new narrative of the _Yi jing_'s writing and transmission in the first millennium B.C.E. An introduction situates the role of archaeology in the modern attempt to understand the Classic of Changes. By showing how the text emerged out of a popular tradition of divination, these newly unearthed manuscripts reveal an important religious dimension to its evolution. (shrink)

'I know what you're thinking' is a fascinating exploration into the neuroscientific evidence on 'mind reading'.

In many learning or inference tasks human behavior approximates that of a Bayesian ideal observer, suggesting that, at some level, cognition can be described as Bayesian inference. However, a number of findings have highlighted an intriguing mismatch between human behavior and standard assumptions about optimality: People often appear to make decisions based on just one or a few samples from the appropriate posterior probability distribution, rather than using the full distribution. Although sampling-based approximations are a common way to implement Bayesian (...) inference, the very limited numbers of samples often used by humans seem insufficient to approximate the required probability distributions very accurately. Here, we consider this discrepancy in the broader framework of statistical decision theory, and ask: If people are making decisions based on samples—but as samples are costly—how many samples should people use to optimize their total expected or worst-case reward over a large number of decisions? We find that under reasonable assumptions about the time costs of sampling, making many quick but locally suboptimal decisions based on very few samples may be the globally optimal strategy over long periods. These results help to reconcile a large body of work showing sampling-based or probability matching behavior with the hypothesis that human cognition can be understood in Bayesian terms, and they suggest promising future directions for studies of resource-constrained cognition. (shrink)

Papers addressing the role which human motivation plays in a wide range of specialties including clinical psychology, internal medicine, sports psychology, ...

In sentences like Every teacher laughed we think of every teacher as a unary (=type (1)) quantifier - it expresses a property of one place predicate denotations. In variable binding terms, unary quantifiers bind one variable. Two applications of unary quantifiers, as in the interpretation of No student likes every teacher, determine a binary (= type (2)) quantifier; they express properties of two place predicate denotations. In variable binding terms they bind two variables. We call a binary quantifier Fregean (or (...) reducible) if it can in principle be expressed by the iterated application of unary quantifiers. In this paper we present two mathematical properties which distinguish non-Fregean quantifiers from Fregean ones. Our results extend those of van Benthem (1989) and Keenan (1987a). We use them to show that English presents a large variety of non-Fregean quantifi ers. Some are new here, others are familiar (though the proofs that they are non-Fregean are not). The main point of our empirical work is to inform us regarding the types of quantification natural language presents - in particular (van Benthem, 1989) that it goes beyond the usual (Fregean) analysis which treats it as mere iterated application of unary quantifiers. Secondarily, our results challenge linguistic approaches to "Logical Form" which constrain variable binding operators to "locally" bind just one occurrence of a variable, e.g., the Bijection Principle (BP) of Koopman and Sportiche (1983). The BP (correctly) blocks analyses like For which x, x's mother kissed x? for Who did his mother kiss? since For which x would locally bind two occurrences of x. But some of our irreducible binary quantifiers are naturally represented by operators which do locally bind two variables. This paper is organized as follows: Section 1 provides an explicit formulation of our questions of concern. Section 2 classifies the English constructions which we show to be non-Fregean. Section 3 presents the mathematical properties which test for non-Fregean quantification and applies these tests to the constructions in Section 2. Proofs of the mathema tical properties are given in the Appendix. (shrink)

Business ethics is once again a hot topic as examples of improper business practices that violate commonly accepted ethical norms are brought to our attention. With the increasing number of scandals business schools find themselves on the defensive in explaining what they are doing to help respond to the call to teach ‘‘more’’ business ethics. This paper focuses on two issues germane to business ethics teaching efforts: the ‘‘targeted output’’ goals of teaching business ethics and when in the curriculum business (...) ethics should be taught. (shrink)

Recent work in natural language semantics leads to some new observations on generalized quantifiers. In § 1 we show that English quantifiers of type $ $ are booleanly generated by their generalized universal and generalized existential members. These two classes also constitute the sortally reducible members of this type. Section 2 presents our main result--the Generalized Prefix Theorem (GPT). This theorem characterizes the conditions under which formulas of the form Q1x 1⋯ Qnx nRx 1⋯ xn and q1x 1⋯ qnx nRx (...) 1⋯ xn are logically equivalent for arbitrary generalized quantifiers Qi, qi. GPT generalizes, perhaps in an unexpectedly strong form, the Linear Prefix Theorem (appropriately modified) of Keisler & Walkoe (1973). (shrink)