Background: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians’ attitudes and practices regarding error discussions with colleagues.Methods: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables.Results: Responses were received from 338 participants . In all, 73% of (...) respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision , wanting colleagues to learn from the mistake and wanting to receive support . Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm , minor harm or major harm . Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion .Conclusions: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners. (shrink)

Some argue the common practice of inferring multiple processes or systems from a dissociation is flawed. One proposed solution is state-trace analysis, which involves plotting, across two or more conditions of interest, performance measured by either two dependent variables, or two conditions of the same dependent measure. The resulting analysis is considered to provide evidence that either a single process underlies performance or there is evidence for more than one process. This article reports simulations using the simple recurrent network in (...) which changes to the learning rate produced state-trace plots with multiple functions. We also report simulations using a single-layer error-correcting network that generate plots with a single function. We argue that the presence of different functions on a state-trace plot does not necessarily support a dual-system account, at least as typically defined ; it can also indicate variation in a single parameter within theories generally considered to be single-system accounts. (shrink)

Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself. This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better (...) understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain. Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter. This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers. (shrink)

Early versions of satellite and radiosonde datasets suggested that the tropical surface had warmed more than the troposphere, while climate models consistently showed tropospheric amplification of surface warming in response to human-caused increases in greenhouse gases. We revisit such comparisons here using new observational estimates of surface and tropospheric temperature changes. We find that there is no longer a serious discrepancy between modeled and observed trends in the tropics. Our results contradict a recent claim that all simulated temperature trends in (...) the tropical troposphere are inconsistent with observations. This claim was based on the use of older radiosonde and satellite datasets and on two methodological errors: the neglect of observational trend uncertainties introduced by interannual climate variability and application of an inappropriate statistical “consistency test”.This emerging reconciliation of models and observations has two primary explanations. First, because of changes in the treatment of buoy and satellite information, new surface temperature datasets yield slightly reduced tropical warming relative to earlier versions. Second, recently developed satellite and radiosonde datasets now show larger warming of the tropical lower troposphere. In the case of a new satellite dataset from remote sensing systems, enhancedRSS warming is due to an improved procedure of adjusting for inter-satellite biases. When the RSS-derived tropospheric temperature trend is compared with four different observed estimates of surface temperature change, the surface warming is invariably amplified in the tropical troposphere, consistent with model results. Even if we use data from a second satellite dataset with smaller tropospheric warming than in remote sensing systems RSS, observed tropical lapse rates are not significantly different from those in all model simulations.Our results contradict a recent claim that all simulated temperature trends in the tropical troposphere and in tropical lapse rates are inconsistent with observations. This claim was based on the use of older radiosonde and satellite datasets and on two methodological errors: the neglect of observational trend uncertainties introduced by interannual climate variability and application of an inappropriate statistical “consistency test”. (shrink)

Ethics is the emphasis of our first-year Introduction to Clinical Medicine-1 course. Introduction to Clinical Medicine-1 uses problem-based learning to involve groups of seven to nine students and two facilitators in realistic clinical cases. The cases emphasize ethics, but also include human behaviour, basic science, clinical medicine, and prevention learning issues. Three cases use written vignettes, while the other three cases feature standardized patients. Groups meet twice for each case. In session one, students read the case introduction, obtain data from (...) the written case or standardized patient, identify the case's ethical problems, formulate learning issues, discuss ways to resolve the moral conflicts, and assign research responsibilities. In session two, students discuss their assigned learning issues and specify and justify clinical actions to address the case's ethical dilemmas. Following three cases, groups write an essay discussing what they learned and describing how they would approach and resolve the case's learning issues. (shrink)

Hegel attempts both to give evil its metaphysical due and to give it intelligibility within a processive idealistic system. To accomplish these ends, he consistently employs the contrast between the natural and the free act of the subject and the contrast between the particular and the universal. He places these contrasts within the situation of an original and presupposed unity of spirit that itself is the ground of the mediation required for thinking freedom, for evil, and for ultimate reconciliation. He (...) argues for evil’s ultimate intelligibility in terms of its necessity as a consequent moment in the development of spirit from its ground; he resolves problems of evil’s penultimate irrationality in terms of its unstable contradictory elements in spirit’s history which is not yet fully concrete, a simultaneity of “ought to be” and “ought not to be” in the sense that the instability must be surpassed but not that it should never have been. The aims of this paper will be to summarize and evaluate Hegel’s efforts to give evil both significance and intelligibility within his system and to estimate if a system of progressive idealism contributes a philosophically new dimension to the problem of evil in a universe. (shrink)

Hegel’s basic position so far on the various meanings of evil as necessary and thereby intelligible directly in the development of spirit might be summed up as follows. Evil is always a necessary moment of instability which gives impetus in the movement from various meanings of particularity to various meanings of universality; from the more abstract expression of potential unity and truth to the more actualized notion and unity.

Eos or the Wider Aspects of Cosmogony J H Jeans Originally published in 1928 "A fascinating summary of his tremendous conclusions…" Times Literary Supplement "No book in the series surpasses Eos in brilliance and profundity…" Is this universe permanent or transitory? If transitory, is it near its end or just beginning? Is life common or rare? Where does life stand in relation t the stupendous mass of inert matter? These and other issues are lucidly dealt with in this book. 80pp, (...) 6 b&w plates Hermes, or the Future of Chemistry T W Jones Originally published in 1928. "A complete and readable survey of chemical developments, making special reference to bio-chemistry, synthetic fuels, and catalysis." Manchester Guardian "Tells us…with brilliant clarity, what chemistry and its achievements are likely to be in the future." Morning Post Chemistry as the means of human emancipation is the subject of this book. Today chemistry is one off the master factors of our existence; tomorrow, the author argues, it will dominate every phase of life, winning for man the goal of all endeavour: economic freedom, and may also effect a startling change in man himself. 82pp. Sybilla or the Future of Prophecy C A Mace Originally published in 1927 "An entertaining and instructive pamphlet." Morning Post An examination of the possibilities of scientific forecasting. 90pp Archimedes or the Future of Physics L L Whyte Originally published in 1928. "This book will be an inspiration. The writer is a clear and fearless thinker." Discovery When this volume was written, physics, biology and psychology were, in the author’s view, converging towards a scientific synthesis of unprecedented importance whose influence on thought and social custom would be profound. This book interprets those events. 88pp. (shrink)