methods that have shown promise for improving extreme risk analysis, particularly for assessing the risks of invasive pests and pathogens associated with international trade. We describe the legally inspired regulatory regime for banks, where these methods have been brought to bear on extreme ‘operational risks’. We argue that an ‘advocacy model’ similar to that used in the Basel II compliance regime for bank operational risks and to a lesser extent in biosecurity import risk analyses is ideal for permitting the diversity (...) of relevant evidence about invasive species to be presented and soundly evaluated. We recommend that the process be enhanced in ways that enable invasion ecology to make more explicit use of the methods found successful.. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

There is limited guidance on how to assess the ethical acceptability of research risks that extend beyond research participants to third parties (or “research bystanders”). Community or stakeholder engagement has been proposed as one way to address potential harms to community members, including bystanders. Despite widespread agreement on the importance of community engagement in biomedical research, this umbrella term includes many different goals and approaches, agreement on which is ethically required or recommended for a particular context. We analyse the case (...) of a potential Zika virus human challenge trial to assess whether and how community engagement can help promote the ethical acceptability of research posing risks to bystanders. We conclude that, in addition to having intrinsic value, community engagement can improve the identification of bystander risks, effective approaches to minimizing them, and transparency about bystander risks for host communities. (shrink)

This study aimed to investigate whether a range of tasks that have been generally classed as requiring insight form an empirically separable group of tasks distinct from tasks generally classed as non-insight. In this study, 24 insight tasks, 10 non-insight tasks, and tests of individual differences in cognitive abilities and working memory were administered to 60 participants. Cluster analysis of the problem-solving tasks indicated that the presumed insight problems did tend to cluster with other presumed insight problems, and similarly the (...) presumed non-insight problems tended to cluster with other presumed non-insight tasks. Performance on presumed insight problems was particularly linked to measures of ideational flexibility with a different pattern of results for the non-insight tasks. Spatial insight problems were linked to spatial flexibility and verbal insight tasks were linked to vocabulary scores. The results are discussed in relation to recent developments of dual process theories of thinking. (shrink)

Recent controversy surrounding the Surfactant Positive Airway Pressure and Pulse Oximetry Trial and the Office for Human Resource Protection’s judgment that its informed consent procedures were inadequate has unmasked considerable confusion about OHRP’s definition of research risks. The controversy concerns application of that definition to trials comparing multiple treatments within the existing standard of care. Some have argued that it is impossible for such trials to pose research risks on the grounds that all risks associated with a standard-of-care treatment should (...) instead be considered risks of treatment. However, analysis of OHRP’s definition demonstrates that some risks in such trials can be research risks. (shrink)

The currently leading cognitive theory of consciousness, Global Workspace Theory,1,2 postulates that the primary functions of consciousness include a global broadcast serving to recruit internal resources with which to deal with the current situation and to modulate several types of learning. In addition, conscious experiences present current conditions and problems to a "self" system, an executive interpreter that is identifiable with brain structures like the frontal lobes and precuneus.1Be it human, animal or artificial, an autonomous agent3 is said to be (...) functionally conscious if its control structure (mind) implements Global Workspace Theory and the LIDA Cognitive Cycle, which includes unconscious memory and control functions needed to integrate the conscious component of the system. We would therefore consider humans, many animals4 and even some virtual or robotic agents5,6 to be functionally conscious. Such entities may approach phenomenal consciousness, as found in human and other biological brains, as additional brain-like features are added.Here we argue that adding mechanisms to produce a stable, coherent perceptual field7 in a LIDA controlled mobile robot might provide a small but significant step toward phenomenal consciousness in machines.>8 We also propose that implementing several of the various notions of self in such a LIDA controlled robot may well prove another step toward phenomenal consciousness in machines. (shrink)

: This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in (...) moral problem solving are discussed. (shrink)

The integrated information theory is a promising theory of consciousness. However, there are several problems with IIT's axioms and postulates. Moreover, IIT entails that some twodimensional grids of identical logic gates have more consciousness than humans. Many have found this prediction to be implausible, and as will be argued here, this prediction also exacerbates the so-called 'hard problem of consciousness'. Recently, it has been argued that if we treat the phenomenological aspects of consciousness as an illusion, we can avoid the (...) hard problem altogether by replacing it with the more tractable illusion problem: the problem of explaining how introspection systematically misrepresents experiences as having phenomenology. IIT is intended to be a theory of the phenomenological aspects of consciousness. However, it is possible to reformulate the axioms and postulates of IIT consistently with illusionism. Here it is argued that the resulting theory -- illusionist integrated information theory -- removes several problems for IIT including the hard problem and the logic gate problem, and also enables meaningful progress for illusionists on solving the illusion problem. (shrink)

In recent years there has been an upsurge of research aimed at removing the mystery from insight and creative problem solving. The present special issue reflects this expanding field. Overall the papers gathered here converge on a nuanced view of insight and creative thinking as arising from multiple processes that can yield surprising solutions through a mixture of “special” Type 1 processes and “routine” Type 2 processes.

This article aims to initiate a discussion on the demarcation of the ethics of care. This discussion is necessary because the ethics of care evolves by making use of insights from varying disciplines. As this involves the risk of contamination of the care ethical discipline, the challenge for care ethical scholars is to ensure to retain a distinct care ethical perspective. This may be supported by an open and critical debate on the criteria and boundaries of the ethics of care. (...) As a contribution, this article proposes a tentative outline of the care ethical discipline. What is characteristic of this outline is the emphasis on relational programming, situation-specific and context-bound judgments, a political–ethical perspective, and empirical groundedness. It is argued that the ethics of care is best developed further by means of an intradisciplinary approach. Two intradisciplinary examples show how within the frame of one discipline, other disciplines are absorbed, both with their body of knowledge and their research methodology. (shrink)

In ‘The nature of moral judgments and the extent of the moral domain’, Fraser criticises findings by Kelly et al. that speak against the moral/conventional distinction, arguing that the experiment was confounded. First, we note that the results of that experiment held up when confounds were removed . Second, and more importantly, we argue that attempts to prove the existence of a M/C distinction are systematically confounded. In contrast to Fraser, we refer to data that support our view. We highlight (...) the implications for the moral/conventional theory. (shrink)