A Charter on Medical Professionalism (CMA) has just recently been developed internationally, and the Canadian Medical Association is calling for public dialogue on medical professionalism now that reforms in the Canadian system of health care are imminent. We posit that good practices are at issue; we outline the essence of these in general and also specifically in the knowing, teaching and intervening components of practice. We also see challenges not to, but in, medical professionalism – first and foremost in the (...) profession's definition of good practices and the payer's confinement of insurance coverage to these. (shrink)

Increasingly, clinical research is evaluated on the quality of its statistical analysis. Traditionally, statistical analyses in clinical research have been carried out from a ‘frequentist’ perspective. The presence of an alternative paradigm – the Bayesian paradigm – has been relatively unknown in clinical research until recently. There is currently a growing interest in the use of Bayesian statistics in health care research. This is due both to a growing realization of the limitations of frequentist methods and to the ability of (...) Bayesian methods explicitly to incorporate prior expert knowledge and belief into the analyses. This is in contrast to frequentist methods, where prior experience and beliefs tend to be incorporated into the analyses in an ad hoc fashion. This paper outlines the frequentist and Bayesian paradigms. Acute myocardial infarction mortality data are then analysed from both a Bayesian and a frequentist perspective. In some analyses, the two methods are seen to produce comparable results; in others, they produce different results. It is noted that in this example, there are clinically relevant questions that are more easily addressed from a Bayesian perspective. Finally, areas in clinical research where Bayesian ideas are increasingly common are highlighted. (shrink)

Adaptive training adjusts a training task with the goal of improving learning outcomes. Adaptive training has been shown to improve human performance in attention, working memory capacity, and motor control tasks. Additionally, correlations have been observed between neural EEG spectral features and the performance of some cognitive tasks. This relationship suggests some EEG features may be useful in adaptive training regimens. Here, we anticipated that adding a neural measure into a behavioral-based adaptive training system would improve human performance on a (...) subsequent transfer task. We designed, developed, and conducted a between-subjects study of 44 participants comparing three training regimens: Single Item Fixed Difficulty, Behaviorally Adaptive Training, and Combined Adaptive Training using both behavioral and EEG measures. Results showed a statistically significant transfer task performance advantage of the CAT-based system relative to SIFD and BAT systems of 6 and 9 percentage points, respectively. Our research shows a promising pathway for designing closed-loop BCI systems based on both users' behavioral performance and neural signals for augmenting human performance. (shrink)

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

In his recent work, ‘Sport, Aesthetic Experience, and Art as the Ideal Embodied Metaphor’, Tim L. Elcombe explores links between sport and art from a pragmatically informed conception of aesthetic experience. However, Elcombe's work does not highlight the role of the imagination in the interpretation of the aesthetic something Michael Polanyi claims to be the ‘cornerstone of aesthetic theory’. With the backdrop of an increased interest in the aesthetics, phenomenology, and epistemology of sport, this discussion essay seeks to defend the (...) usefulness and value of definitional demarcation debates between sport and art, to use Polanyi’s distinctions among technical, scientific and artistic problems to support the claim that sport is not art, and to offer an account of how sport contributes in its own way to human flourishing and why it is no less valuable experientially than art. (shrink)

SummaryThe dichotomy between ‘scientific’ and ‘practical’ approaches to guideline development is false and divisive. Instead we should concentrate on developing mechanisms to develop and implement valid guidelines to improve patient care. The development of valid guidelines requires considerable expertise and is time consuming and expensive. It is most efficiently done at a regional or national level. The implementation of valid guidelines requires local action including the identification and modification of valid guidelines and a coordinated evidence-based implementation strategy (Grimshaw & Eccles (...) 1998). (shrink)

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in (...) biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diagnostic Criteria, Psychological Tests, and Ratings Scales: Extending the HistoryPeter Zachar, PhD (bio)Le moigne narrates a history of the development of psychiatric ratings scales as hybrids between psychological tests and diagnostic categories. In his telling, psychological tests seek to quantify population-based traits on which every person has a position and which tend to be conceptualized as being stable. Personality traits are often conceptualized as dispositions. Diagnostic categories represent not (...) trait-like properties of populations but episodic states consisting of clusters of symptoms experienced by individuals with disorders. Ratings, scales, he notes, are hybrids between the two. They are used to quantify psychiatric symptom clusters so that change over time can be measured. Le Moigne argues that these distinctions were initially suggested during the development of measures that could assess outcomes in psychopharmacological treatment studies.With respect to depression, Le Moigne writes that in the 1970s and 1980s something akin to depressive personality was reconceptualized as a temperament. A key move, somewhat reflective of Kraepelin’s notion of a depressive temperament, was to view a dysthymic temperament as both a predisposing factor and an attenuated form of depression. Thus, an episodic state commandeered the predisposing–dispositional role that was assigned to stable personality traits.This conceptual shift allowed test-like ratings scales to be seen as useful for quantifying not just stable traits, but salient features of episodic states that are potentially subject to change in response to interventions. To put it another way, in the development of a psychological test, one goal is to have high test-retest reliability (i.e., stability of measurement). With rating scales used to measure change, one wants the scores to not be as stable; ideally the scores on the later assessments will be lower. According to Le Moigne, when dysthymia was subsequently placed on axis I of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III (as a syndrome) and segregated from personality disorders which were placed on axis II, personality traits were evicted from the conceptualization of depressive disorders.One perennial feature of psychiatry and psychology is that even if an older idea is superseded [End Page 253] in the view of some thinkers, it can still attract adherents. Indeed, interest in understanding a relationship between personality and attenuated states did not fully disappear. For example, based on research in genetics, the schizophrenia spectrum concept included not only schizophrenia, but also milder conditions such that were conceptualized as personality disorders; that is, schizotypal personality disorder and paranoid personality disorder (Kety, Rosenthal, Wender, & Schulsinger, 1971).During the development of the DSM-IV, some people wanted to add depressive personality disorder to the manual (Phillips, Hirschfeld, Shea, & Gunderson, 1995). It seems to have become a territorial dispute between mood disorder specialists and personality disorder specialists The mood disorders specialists challenged the personality disorder specialists to differentiate depressive personality disorder from early onset, chronic dysthymia. They were able to do so by using criteria such as critical, blaming, and derogatory toward self. After the mood disorders work group proposed incorporating some of those criteria into a revised criteria set for dysthymia, the two sets overlapped. The result was the old criteria for dysthymia were printed in DSM-IV and criteria for depressive personality disorder and the revised criteria for dysthymia were both placed in the appendix.In the DSM-5, Axis II was eliminated and personality disorders were placed alongside all the syndromic symptom clusters at the same level. Even so, interest in attenuated presentations as personality-related lingered still. During the development of the DSM-5 there was some thought to using diagnostic spectra as a meta-structure for organizing the manual (Andrews et al., 2009). One idea was to move some personality disorders into a best fitting spectrum, akin to attenuated forms. This did occur with schizotypal personality disorder which is both in the DSM-5 chapter on schizophrenia and in the chapter on personality disorder. In the schizophrenia chapter it is positioned as the earliest emerging disorder on the spectrum. There was also some interest in grouping avoidant personality disorder with the anxiety disorders, but the evidence supporting such a change was not available.These issues may... (shrink)

John Urry was an extraordinary, generous and compelling force. As is evident in the hundreds of tributes and testimonials to his memory gathered already, his work influenced so many people through his talks at conferences, his published words in the pages of journals and his many books, and in conversations across viva examination tables, PhD juries and supervisory meetings. This essay remembers John’s contribution to the study of mobility and spatial theory more generally.

This article presents the first author's experiences as an Australian doctoral student undertaking a PhD by publication in the arena of the social sciences. She published nine articles in refereed journals and a peer-reviewed book chapter during the course of her PhD. We situate this experience in the context of current discussion about doctoral publication practices, in order to inform both postgraduate students and academics in general. The article discusses recent thinking about PhD by publication and identifies the factors that (...) students should consider prior to adopting this approach, in terms of university requirements, supervisors' attitudes, the research subject matter, intellectual property, capacity and working style, and issues of co-authorship. It then outlines our perceptions of the advantages and disadvantages of undertaking a PhD by publication. We suggest that, in general, the advantages outweigh the disadvantages. We conclude by reflecting on how the first author's experiences relate to current discussions about fostering publications by doctoral students. (shrink)

This article considers the relationship between business ethics and philosophy, specifically in relation to the field and persons working in it. The starting point is a grammatical one: business ethics by the rules of grammar belongs to ethics. In terms of academic disciplines, it belongs to applied ethics, which belongs to ethics, which belongs to practical philosophy, which belongs to philosophy. However, in the field of business ethics today one will seldom meet colleagues from philosophy; instead, they will come from (...) business, applying business studies perspectives, approaches, and increasingly quantitative methods. This article provides empirical evidence that today the three top journals with “business ethics” in their titles are mostly run by business scholars with PhDs in business. The article compares the three journals today with their inaugural issues and finds that at their inception all three were run by a majority of philosophers. The article discusses six possible explanations for this shift and provides suggestions for how to bring business ethics back to philosophers. (shrink)

This paper represents an attempt to better understand the educational expectations of Japanese university students. Eighty students were asked to indicate whether or not they felt there was some relationship between 24 English words. The results were then added and entered into a table where the number at each intersection of words represented the total number of students that felt there relationship between those two words. This table was then analyzed using Multidimensional Scaling to produce a two dimension plot representing (...) the relationship between these 24 words. Since the distance between the words the plot represents the level of similarity, a study of the result gives some insight into the educational expectations of these students. A description of the data collection and analysis, as well as, one possible interpretation of the results is included. (shrink)

After meeting in Zurich, Nikos Kazantzakis and Elli Lambridi undertook a number of Nietzsche pilgrimages in Switzerland together in 1918, beginning with a trip to Silvaplana. At the time, Kazantzakis had written a thesis on Nietzsche and had translated The Birth of Tragedy and Thus Spoke Zarathustra into Greek, while Elli Lambridi was enrolled in a PhD in philosophy at the University of Zurich writing on Aristotle. They continually debated the nature of the philosopher-type in relation to Nietzsche and Dionysianism, (...) and this philosophical engagement is the central topic of this paper. Lambridi envisaged a Dionysian philosopher fully engaged in an ethical and natural life within a community of others and also envisaged a derived politics of affirmative communal responsibility. Kazantzakis considered that the philosopher should take a much more Apolline, spiritually focused and solitary path, continually ascending toward heroic self-redemption. As well as examining their recorded exchanges, this paper also addresses the fictional resumption of their relationship in The New People, a novel which Lambridi wrote some time after Kazantzakis’ death. In the novel, they resume their discussion of the philosopher-type in 2118, in an eternal recurrence event. In the end, the male character, Petros, learns that the grounding event of a Dionysian Nietzscheanism is an instinctive promise of responsibility for the future of others. (shrink)

The British National Lottery has now been running for almost three years and it arouses social and ethical misgivings in several quarters, whether in its contribution to the British gambling scene or in the size and distribution of its prizes or in its contributions to the good causes which it was introduced to benefit. Bringing wide experience and an expert eye to analyse and comment on the lottery, Dr Moore, DSc PhD FIA, is Emeritus Professor of Decision Sciences at London (...) Business School, Sussex Place, Regent’s Park, London NW1 4SA. (shrink)

Commodore Perry’s expedition to Japan in 1853–1854 was more than just a diplomatic mission: it also had scientific objectives and for the officers and crews it was in addition an opportunity to do some shopping. Among the goods bought in Japan were various books, some of which were donated to the American Oriental Society. In 1855 the Lippincott Company of Philadelphia published a facsimile of a Japanese illustrated book, which had first been published in 1740, with accompanying transcription and partial (...) translation. This was the work of Joseph Wilson MD, a naval surgeon who served on one of the ships that took part in the Perry Expedition. In this article I consider why this facsimile was published, how Wilson managed to learn sufficient Japanese to undertake the translation, and what its reception was. Why did it sell so few copies, why did the reviewers focus on botany, and why did it not stimulate an interest in the academic study of Japan? Why, for that matter, were no articles on Japan published in JAOS between 1855 and 1910? This article explores the hesitant start to American japanology by examining the fate of the first Japanese book printed anywhere in the world outside Japan. (shrink)

The British National Lottery has now been running for almost three years and it arouses social and ethical misgivings in several quarters, whether in its contribution to the British gambling scene or in the size and distribution of its prizes or in its contributions to the good causes which it was introduced to benefit. Bringing wide experience and an expert eye to analyse and comment on the lottery, Dr Moore, DSc PhD FIA, is Emeritus Professor of Decision Sciences at London (...) Business School, Sussex Place, Regent’s Park, London NW1 4SA. (shrink)

Identity construction — the process of creating and building a new future self — is an integral part of a person’s professional career development. However, at present we have little understanding of the psychological mechanisms that underpin this process. Likewise, we have little understanding of the barriers that obstruct it, and which thus may contribute to inequality in career outcomes. Using a social identity lens, and particularly the Social Identity Model of Identity Change (SIMIC), we explore the process of academic (...) identity construction among doctoral students. Through thematic analysis of semi-structured interviews with 22 PhD candidates, we observe that the identity construction process relies on a person’s perception of a navigable pathway between their current self and their future self. Importantly, participants who were able to access multiple identity resources were more likely to perceive a navigable pathway to a future professional self (e.g., as an academic), unless they perceived these identities to be incompatible with those held by leading members of the profession (e.g., their supervisors). This research suggests that the identities that people are able to access as they progress in their careers may play an important role in their ongoing professional identity construction and career success. (shrink)

This article considers the two major biographies of sexologist Magnus Hirschfeld, MD (1868—1935), an early campaigner for ‘gay rights’ avant la lettre. Like him, his first biographer Charlotte Wolff (1897—1986) was a Jewish doctor who lived and worked in Weimar Republic Berlin and fled Germany when the Nazi regime came to power. When researching Hirschfeld’s biography (published in English in 1986) Wolff met a librarian and gay activist, Manfred Herzer, who would eventually be a cofounder of the Gay Museum in (...) Berlin and publish (in German, in 1992) the other major Hirschfeld biography currently available. Using, inter alia, the correspondence between Wolff and Herzer, the article aims to explore and interrogate the boundaries and possibilities of ‘biography’ as a form of ‘doing history’. (shrink)

The thesis that follows proffers a solution to the mind-matter problem, the problem as to how mind and matter relate. The proposed solution herein is a variant of panpsychism – the theory that all (pan) has minds (psyche) – that we name pansentient monism. By defining the suffix 'psyche' of panpsychism, i.e. by analysing what 'mind' is (Chapter 1), we thereby initiate the effacement of the distinction between mind and matter, and thus advance a monism. We thereafter critically examine the (...) prevalent view, antithetical to a pansentient monism, that mind is not identical to matter but emergent therefrom (Chapter 2). This anti-emergentist critique acts also as a fortification of the Genetic Argument for panpsychism: if mind is not emergent (nor distinct) from matter, mind must always have existed with matter. But what is 'matter'? Chapter 3 investigates what we understand by 'matter', or 'the physical', and exposes it as a highly deficient concept and percept that in concreto points to its identity with that denoted by 'mind'. This also acts as a fortification of the Abstraction Argument for panpsychism, employing a new taxonomy of physicalism and a new taxonomy of the varieties of abstraction. Thus do we reach a monism that is a parsimonious psycho-physical identity theory. But here we face what can be called The Identity Problem for Panpsychism: if our panpsychism is a psycho-physical identity theory, how can it respond to the powerful objections that beset the identity theory of the twentieth century? In Chapter 4 it will be argued that, like emergentism, this psycho-neural identity theory presupposed a deficient concept of 'matter', down to which mind was reduced away, let alone identified. But to identify down phenomena to what is actually an abstraction is to commit failure of explanation. When the theory is amended accordingly, we move from a psycho-neural identity theory to a genuine psycho-physical identity theory that as such can overcome the aforementioned identity problem. Furthermore, as Chapter 5 clarifies, our pansentient monism has, in addition to parsimony, the explanatory power to resolve the problem of mental causation that afflicts both the reductive physicalism of psycho-neural identity theory and the non-reductive physicalism of emergentism, by genuinely identifying physical and mental causation. Jaegwon Kim considers the place of consciousness in a physical world and the nature of mental causation to be the two key components of the mind-matter problem. Through the critical analysis of our prosaic understanding of mind and matter in this thesis, which incorporates the thought of both classical and contemporary thinkers through a novel fusion, it is hoped that both components are addressed and redressed. That is to say that I present this pansentient monism as a plausible, parsimonious, explanatory, and thus, I think, powerful position towards this ever-perplexing mind-matter mystery. -/- [This thesis was passed in January 2019 with viva examination from Galen Strawson and Joel Krueger. (shrink)

Viola Cordova was the first Native American woman to receive a PhD in philosophy. Even as she became an expert on canonical works of traditional Western philosophy, she devoted herself to defining a Native American philosophy. Although she passed away before she could complete her life’s work, some of her colleagues have organized her pioneering contributions into this provocative book. In three parts, Cordova sets out a complete Native American philosophy. First she explains her own understanding of the nature of (...) reality itself—the origins of the world, the relation of matter and spirit, the nature of time, and the roles of culture and language in understanding all of these. She then turns to our role as residents of the Earth, arguing that we become human as we deepen our relation to our people and to our places, and as we understand the responsibilities that grow from those relationships. In the final section, she calls for a new reverence in a world where there is no distinction between the sacred and the mundane. Cordova clearly contrasts Native American beliefs with the traditions of the Enlightenment and Christianized Europeans. By doing so, she leads her readers into a deeper understanding of both traditions and encourages us to question any view that claims a singular truth. From these essays—which are lucid, insightful, frequently funny, and occasionally angry—we receive a powerful new vision of how we can live with respect, reciprocity, and joy. (shrink)

Research integrity climate is an important factor that influences an individual’s behavior. A strong research integrity culture can lead to better research practices and responsible conduct of research. Therefore, investigations on organizational climate can be a valuable tool to identify the strengths and weaknesses of each group and develop targeted initiatives. This study aims to assess the perceptions on integrity climate in three universities in Hungary. A cross-sectional study was conducted with PhD students, postdocs, and professors from three Hungarian universities. (...) The survey included demographic questions, such as gender, age, scientific field, academic rank, and the Survey of Organizational Research Climate. A total of 432 participants completed the survey. Our results show that postdocs and assistant professors perceived integrity climate more negatively than PhD students and full professors in every survey scale. Contrarily, PhD students perceive more positively than the other groups. Disciplinary differences show that researchers in the Biomedical sciences perceive regulatory bodies to be fairer when evaluating their projects than those in the Natural sciences. Natural sciences also perceive more negatively how the department values integrity when compared to Humanities. Humanities perceive more positively Advisor/Advisee Relations than Biomedical Sciences. Our results suggest that institutions should pay more attention to early career researchers, especially insecure and temporary positions like postdocs and assistant professors. They should provide RCR resources, socialize them in RCR, and set more reasonable expectations. Moreover, department leaders should develop initiatives to foster better integrity climates. (shrink)

The recently uncovered role of Fukutin‐related protein (FKRP) in fibronectin glycosylation has challenged our understanding of the basis of disease pathogenesis in the muscular dystrophies. FKRP is a Golgi‐resident glycosyltransferase implicated in a broad spectrum of muscular dystrophy (MD) pathologies that are not fully attributable to the well‐described α‐Dystroglycan hypoglycosylation. By revealing a new role for FKRP in the glycosylation of fibronectin, a modification critical for the development of the muscle basement membrane (MBM) and its associated muscle linkages, new possibilities (...) for understanding clinical phenotype arise. This modification involves an interaction between FKRP and myosin‐10, a protein involved in the Golgi organization and function. These observations suggest a FKRP nexus exists that controls two critical aspects to muscle fibre integrity, both fibre stability at the MBM and its elastic properties. This review explores the new potential disease axis in the context of our current knowledge of muscular dystrophies. (shrink)

On March 14-15, 2006, at the US National Institute of Standards and Technology (NIST) in Gaithersburg, MD there took place the first Upper Ontology Summit (UOS). This was a convening of custodians of several prominent upper ontologies, key technology participants, and interested other parties, with the purpose of finding a means to relate the different ontologies to each other. The result is reflected in a joint communiqué, directed to the larger ontology community and the general public, and expressing a joint (...) intent to build bridges among the existing upper ontologies in ways designed to increase and rationalize their utilization and to enhance their semantic interoperability. (shrink)

Background Medical Assistance in Dying in Canada came into effect in 2016 with the passing of Bill C-14. As patient interest and requests for MAID continue to evolve in Canada, it is important to understand the attitudes of future providers and the factors that may influence their participation. Attitudes towards physician hastened death in general and the specific provision of MAID are unknown among Canadian residents. This study examined residents’ attitudes towards PHD and MAID, and identified factors that may influence (...) their decision to participate in PHD and provide MAID. Methods A cross-sectional survey was adapted from prior established surveys on MAID to reflect the Canadian setting. All Canadian family medicine programs were invited to participate. The survey was distributed between December 2016 and April 2017. Analysis of the results included descriptive statistics to characterize the survey participants and multivariable logistic regressions to identify factors that may influence residents’ attitudes towards PHD and MAID. Results Overall, 247 residents from 6 family medicine training programs in Canada participated. While residents were most willing to participate in treatment withdrawal, active participation in PHD and MAID by prescription of a lethal drug and lethal injection were less acceptable. Logistic regressions identified religion as a consistent and significant factor impacting residents’ willingness to participate in PHD and MAID. Residents who were not strictly practicing a religion were more likely to be willing to participate in PHD and MAID. Increased clinical exposure to death and dying crudely correlated with increased willingness to participate in PHD and MAID, but when examined in multivariable models, only a few activities had a statistically significant association. Other significant factors included the residents’ sex and location of training. Conclusions Residents are hesitant to provide MAID themselves, with religious faith being a major factor impacting their decision. (shrink)

Public health ethics is neither taught widely in medical schools or schools of public health in the US or around the world. It is not surprising that health care professionals are particularly challenged when faced with ethical questions which extend beyond safeguarding the interests of their individual patients to matters that affect overall public good. The perceived threat of terror after September 11 2007, the anthrax attacks and the Katrina debacle are recent circumstances which may result in coercion. These have (...) piqued the interest of medical professionals and the general public on public health ethics. The Ethics of Coercion in Mass Casualty Medicine written by Griffin Trotter MD, PhD attempts to fill a timely void in this area by examining the ethics of coercion in times of public health disasters. (shrink)