Gilbert et al. have raised important questions about the empirical grounding of neuroethical analyses of the apparent phenomenon of Deep Brain Stimulation ‘causing’ personality changes. In this paper, we consider how to make neuroethical claims appropriately calibrated to existing evidence, and the role that philosophical neuroethics has to play in this enterprise of ‘evidence-based neuroethics’. In the first half of the paper, we begin by highlighting the challenges we face in investigating changes to PIAAAS following DBS, explaining (...) how different trial designs may be of different degrees of utility, depending on how changes to PIAAAS following DBS are manifested. In particular, we suggest that the trial designs Gilbert et al. call for may not be able to tell us whether or not DBS directly causes changes to personality. However, we suggest that this is not the most significant question about this phenomenon; the most significant question is whether these changes should matter morally, however they are caused. We go on to suggest that neuroethical analyses of novel neuro-interventions should be carried out in accordance with the levels of evidence hierarchy outlined by the Centre for Evidence-Based Medicine, and explain different ways in which neuroethical analyses of changes to PIAAAS can be evidence-based on this framework. In the second half of the paper, we explain how philosophical neuroethics can play an important role in contributing to mechanism-based reasoning about potential effects on PIAAAS following DBS, a form of evidence that is also incorporated into the CEBM levels of evidence hierarchy. (shrink)

Modern technologies have enabled the development of dynamic game- and simulation-based assessments to measure psychological constructs. This has highlighted their potential for supplementing other assessment modalities, such as self-report. This study describes the development, design, and preliminary validation of a simulation-based assessment methodology to measure psychological resilience—an important construct for multiple life domains. The design was guided by theories of resilience, and principles of evidence-centered design and stealth assessment. The system analyzed log files from (...) a simulated task to derive individual trajectories in response to stressors. Using slope analyses, these trajectories were indicative of four types of responses to stressors: thriving, recovery, surviving, and succumbing. Using Machine Learning, the trajectories were predictive of self-reported resilience with high accuracy, supporting construct validity of the simulation-based assessment. These findings add to the growing evidence supporting the utility of gamified assessment of psychological constructs. Importantly, these findings address theoretical debates about the construct of resilience, adding to its theory, supporting the combination of the “trait” and “process” approaches to its operationalization. (shrink)

Evidence based-policy (EBP) is a popular research paradigm in the applied social sciences and within government agencies. Informally, EBP represents an explicit commitment to applying scientific methods to public affairs, in contrast to ideologically-driven or merely intuitive “common-sense” approaches to public policy. More specifically, the EBP paradigm places great weight on the results of experimental research designs, especially randomised controlled trials (RCTs), and systematic literature reviews that place evidential weight on experimental results. One hope is that such research (...) designs and approaches to analysing the scientific literature are sufficiently robust that they can settle what really ‘works’ in public policy. Can EBP succeed in displacing reliance on domain-specific expertise? On our account, this is seldom, if ever, the case. The key reason for this is that underlying this approach is generally an appeal to argument by induction, which always requires further assumptions to underwrite its validity, and if not induction, some other argument form that also requires assumptions that are very often not validated for the case at hand. (shrink)

BackgroundThe concept of evidence-based medicine has strongly influenced the appraisal and application of empirical information in health care decision-making. One principal characteristic of this concept is the distinction between "evidence" in the sense of high-quality empirical information on the one hand and rather low-quality empirical information on the other hand. In the last 5 to 10 years an increasing number of articles published in international journals have made use of the term "evidence-based ethics", making a (...) systematic analysis and explication of the term and its applicability in ethics important.DiscussionIn this article four descriptive and two normative characteristics of the general concept "evidence-based" are presented and explained systematically. These characteristics are to then serve as a framework for assessing the methodological and practical challenges of evidence-based ethics as a developing methodology. The superiority of evidence in contrast to other empirical information has several normative implications such as the legitimization of decisions in medicine and ethics. This implicit normativity poses ethical concerns if there is no formal consent on which sort of empirical information deserves the label "evidence" and which does not. In empirical ethics, which relies primarily on interview research and other methods from the social sciences, we still lack gold standards for assessing the quality of study designs and appraising their findings.ConclusionThe use of the term "evidence-based ethics" should be discouraged, unless there is enough consensus on how to differentiate between high- and low-quality information produced by empirical ethics. In the meantime, whenever empirical information plays a role, the process of ethical decision-making should make use of systematic reviews of empirical studies that involve a critical appraisal and comparative discussion of data. (shrink)

Now in its fourth edition, Rational Diagnosis and Treatment: Evidence-Based Clinical Decision - Making is a unique book to look at evidence-based medicine and the difficulty of applying evidence from group studies to individual patients._ The book analyses the successive stages of the decision process and deals with topics such as the examination of the patient,_the reliability of clinical data, the logic of diagnosis, the fallacies of uncontrolled therapeutic experience and the need for randomised clinical (...) trials and meta-analyses. It is the main theme of the book that, whenever possible, clinical decisions must be based on the evidence from clinical research, but the authors also explain the pitfalls of such research and the problems involved in applying evidence from groups of patients to the individual patient._ For this new edition, the sections on placebo and meta-analysis and on alternative medicine have been thoroughly updated, and there is more focus on insufficient reporting of harms of interventions. The sections on different research designs describe advantages and limitations, and the increased medicalisation and the effects of cancer screening on health people are noted. A section on academic freedom when clinicians collaborate with industry and ghost authors is added._ This essential reference work integrates the science and statistical approach of evidence-based medicine with the art and humanism of medical practice; distinguishing between data, sets of data, knowledge and wisdom, and their application. Such an intellectually challenging book is ideal for both medical students and doctors who require theoretical and practical clinical skills to help ensure that they apply theory in practice. (shrink)

The Evidence-Based Medicine (EBM) movement is an ideological force in health research and health policy which asks for allegiance to two types of methodological doctrine. The first is the highly quotable motherhood statement: for example, that we should make conscientious, explicit and judicious use of current best evidence (paraphrasing Sackett). The second type of doctrine, vastly more specific and in practice more important, is the detailed methodology of design and analysis of experiments. This type of detailed (...) methodological doctrine tends to be simplified by commentators but followed to the letter by practitioners. A number of interestingly dumb claims have become entrenched in prominent versions of these more specific methodological doctrines. I look at just a couple of example claims, namely: Any randomised controlled trial (RCT) gives us better evidence than any other study. Confidence intervals are always useful summaries of at least part of the evidence an experiment gives us about a hypothesis. To offer a positive doctrine which might move us past the current conflict of micro-theories of evidence, I propose a mild methodological pluralism: in any local context in which none of a variety of scientific methodologies is clearly and uncontentiously right, researchers should not be discouraged from using any methodology for which they can provide a good argument. (shrink)

Evidence-Centered Design (ECD) is a framework for the design and development of assessments that ensures consideration and collection of validity evidence from the onset of the test design. Blending learning and assessment requires integrating aspects of learning at the same level of rigor as aspects of testing. In this paper we describe an expansion to the ECD framework (termed e-ECD) such that it includes the specifications of the relevant aspects of learning at each of the (...) three core models in the ECD, as well as making room for specifying the relationship between learning and assessment within the system. The framework proposed here does not assume a specific learning theory or particular learning goals, rather it allows for their inclusion within an assessment framework, such that they can be articulated by researchers or assessment developers that wish to focus on learning. (shrink)

Everything we do in life involves a connection with information, experience and know-how: together these represent the most valuable of intangible human assets encompassing our history, cultures and wisdom. However, the more easily new technologies gather information, the more we are confronted with our limited capacity to distinguish between what is essential, important or merely ‘nice-to-have’. This article presents the case study of a multilingual Knowledge Management System, the Business enabling e-Platform that gathers and protects tacit knowledge, as the key (...) to developing structured intellectual capital, while acknowledging the urgent need here to integrate Ethics-by-design alongside AI-by-design, in view of the far-reaching consequences involved, for good or ill. It also explains how a beneficial Circular Economy of Knowledge depends on evidence-based answers, and how harmonising taxonomies, terminology and standards promotes global trust as the basis for the unhindered transfer of tacit knowledge between generations in a way that benefits everyone. (shrink)

Social impact bonds have emerged as an innovative financial instrument designed to support the social service sector in delivering innovative social programs. In particular, SIBs can be used to finance prevention of homelessness among those regarded as vulnerable. There is little evidence that outcomes from SIB-funded programs are significantly different compared to more traditional programs. This is the first scoping review of academic and gray literature that explores the main features and outcomes from all SIBs for homelessness based (...) on evidence, addressing an important gap in the literature. The scoping review provides a transparent and comprehensive approach for mapping areas of this research. A total of 73 studies and articles were found eligible for inclusion. These concerned 32 SIBs for homelessness implemented in the United Kingdom, the United States, Australia, and Belgium. The review found that academic papers on SIBs for homelessness lack evidence-based analysis, while gray literature lacks transparency, especially in evaluation method and outcome. We found that fourteen projects met their target outcomes. The common features of these SIBs were a navigator intervention model, effective partnership working, and use of Special Purpose Vehicles. Our findings show that it is necessary for the managers of SIBs to improve outcome metrics and evaluation methods, support target groups fairly, and attract more private investors to finance SIBs for better addressing homelessness. (shrink)

Objective: To examine the role of explainability in machine learning for healthcare (MLHC), and its necessity and significance with respect to effective and ethical MLHC application. Study Design and Setting: This commentary engages with the growing and dynamic corpus of literature on the use of MLHC and artificial intelligence (AI) in medicine, which provide the context for a focused narrative review of arguments presented in favour of and opposition to explainability in MLHC. Results: We find that concerns regarding explainability (...) are not limited to MLHC, but rather extend to numerous well-validated treatment interventions as well as to human clinical judgment itself. We examine the role of evidence-based medicine in evaluating unexplainable treatments and technologies, and highlight the analogy between the concept of explainability in MLHC and the related concept of mechanistic reasoning in evidence-based medicine. Conclusion: Ultimately, we conclude that the value of explainability in MLHC is not intrinsic, but is instead instrumental to achieving greater imperatives such as performance and trust. We caution against the uncompromising pursuit of explainability, and advocate instead for the development of robust empirical methods to successfully evaluate increasingly inexplicable algorithmic systems. (shrink)

Everyone, it seems, is talking and arguing about Evidence-Based Practice. Those therapies and assessments designated as EBP increasingly determine what is taught, researched, and reimbursed in health care. But exactly what is it, and how do you do it? The second edition of Clinician's Guide to Evidence-Based Practices is the concise, practitioner-friendly guide to applying EBPs in mental health. Step-by-step it explains how to conduct the entire EBP process-asking the right questions, accessing the best available research, (...) appraising the research, translating that research into practice, integrating that research with clinician expertise and patient characteristics, evaluating the entire enterprise, attending to the ethical considerations, and when done, moving the EBP process forward by teaching and disseminating it. This book will help you:. Formulate useful questions that research can address. Search the research literature efficiently for best practices. Make sense out of the research morass, sifting wheat from chaff. Incorporate patient values and diversity into the selection of EBP. Blend clinician expertise with the research evidence. Translate empirical research into practice. Ensure that your clients receive effective, research-supported services. Infuse the EBP process into your organizational setting and training methods. Identify and integrate ethics in the context of EBP Coauthored by a distinguished quartet of clinicians, researchers, and a health care librarian, the Clinician's Guide has become the classic for graduate students and busy professionals mastering EBP. ". (shrink)

This paper presents the Futurium platform used by Digital Futures, a foresight project launched by the European Commission's Directorate General for Communications Networks, Content and Technology (DG CONNECT). Futurium was initially developed with the primary purpose of hosting and curating visions and policy ideas generated by Digital Futures (Digital Futures was launched in July 2011 by DG CONNECT's Director General Robert Madelin following a prior DG CONNECT exercise called Digital Science.). However, it has turned into a platform on which to (...) experiment with new policymaking models based on scientific evidence and stakeholder participation, referred to in this paper as ‘Policy Making 3.0’. The platform hosts an online foresight toolkit to facilitate the joint creation of ideas to help design future policies. It leverages the potential of social networks, open data, semantic and knowledge mining technologies as well as participatory brainstorming techniques to engage stakeholders and harness their views and creativity to better inform policies that matter to them. The Futurium distinguishes between different variables, reflecting the emotional vs. rational mindsets of the participants, and offers the possibility to frame the engagement and co-creation process into multiple phases of a workflow. Futurium was developed to support Digital Futures, but its open architecture makes it easily adaptable to any policymaking/decision-making context where thinking ahead, participation, scientific evidence and agility are needed. Futurium is an early prototype implementation of the Policy Making 3.0 model, which is a long-term vision requiring further investigation and experimentation. The Futurium production website can be seen here: ec.europa.eu/digital-agenda/futurium. (shrink)

It is argued that in deterministic contexts evidence for causal relations states whether a boundary condition makes a difference or not to a phenomenon. In order to substantiate the analysis, I show that this difference/indifference making is the basic type of evidence required for eliminative induction in the tradition of Francis Bacon and John Stuart Mill. To this purpose, an account of eliminative induction is proposed with two distinguishing features: it includes a method to establish the causal irrelevance (...) of boundary conditions by means of indifference making, which is called strict method of agreement, and it introduces the notion of a background against which causal statements are evaluated. Causal statements thus become three-place-relations postulating the relevance or irrelevance of a circumstance C to the examined phenomenon P with respect to a background B of further conditions. To underline the importance of evidence in terms of difference/indifference making, I sketch two areas, in which eliminative induction is extensively used in natural and engineering sciences. One concerns exploratory experiments, the other engineering design methods. Given that a method is discussed that has been used for centuries, I make no claims to novelty in this paper, but hope that the combined discussion of several topics that are still somewhat underrepresented in the philosophy of science literature is of some merit. (shrink)

One of the Top 10 Books That Will Change Your Life in 2017 - Live Happy Magazine Grow Your Grit—How You Can Develop the Critical Ingredient for Success Grit—defined as our perseverance and passion for long-term goals—is now recognized as one of the key determinants for achievement and life satisfaction. In an age that provides us with a never-ending stream of distractions and quick-and-easy solutions, how do we build this essential quality? "This book is designed to help you screen out (...) the spam of life and cultivate authentic grit in every setting," writes Caroline Miller. With Getting Grit, this bestselling author brings you an information-rich and practical guide for developing the qualities needed to persevere over obstacles—not just toughness and passion, but also humility, patience, and kindness. Join her as she shares research-based insights and practices on: • Learning grit—how you can enhance your willpower and rewire your brain for resilience • The key traits of gritty people—what the latest research reveals • The three kinds of "false grit" and how to recognize them in yourself • The courage to fail—tools for turning your setbacks into your greatest teachers • Daring to dream big—guidance for building your capacity to take risks and aim higher • No one succeeds alone—tips for gathering your support team and inspiring others • The role of self-compassion, gratitude, and spirituality in building grit "I’ve come to believe that gritty behavior is a positive force that does more than help us rise to our own challenges," writes Caroline Miller. "When we embody the best qualities of grit, we become a role model for others who want to become better people, and help them awaken greater possibilities for themselves." Whether you’re seeking to grow beyond your limits at work, at home, on the sporting field, or in any leadership role, Getting Grit is a powerful resource to help you bring out the qualities that will help you succeed and thrive. (shrink)

Relationships, jobs, and health behaviors-these are what New Year's resolutions are made of. Every year millions resolve to adopt a better diet, exercise more, become fit, or lose weight but few put into practice the health behaviors they aspire to. For those who successfully begin, the likelihood that they will maintain these habits is low. Healthcare professionals recognize the importance of these, and other, health behaviors but struggle to provide their patients with the tools necessary for successful maintenance of their (...) medical regimens. The thousands of research papers that exist on patient adherence and health behavior change can leave professionals overwhelmed. This book synthesizes the results from more than 50 years of empirical research, resulting in simple, powerful, and practical guidance for health professionals who want to know the most effective strategies for helping their clients to put long-term health-relevant behavior changes into practice. It advocates a straightforward 3-ingredient model: Before a person can change, they must know what change is necessary ; desire the change ; and then have the tools to achieve and maintain the change. This book is designed to be informative and compelling, but its numerous anecdotes and examples render it engaging and entertaining, as well. Written for a practitioners and students of medicine, chiropractic, osteopathy, nursing, health education, physician assistant programs, dentistry, clinical and health psychology, marriage and family counseling, social work, school psychology, and care administrators -- and for lay persons who wish to take an active role in their health, this book brings together major empirically-based findings within the field and provides succinct, evidence-based recommendations and strategies for using these findings to make real changes. (shrink)

The second wave of devastating consequences of the COVID-19 pandemic has been linked to dramatic declines in well-being. While much of the well-being literature is based on descriptive and correlational studies, this paper evaluates a growing body of causal evidence from high-quality randomized controlled trials (RCTs) that test the efficacy of positive psychology interventions (PPIs). This systematic review analyzed the findings from 25 meta-analyses, 42 review papers, and the high-quality RCTs of PPIs designed to generate well-being that were (...) included within those studies. Findings reveal PPIs have the potential to generate well-being even during a global pandemic, with larger effect sizes in non-Western countries. Four exemplar PPIs—that have been tested with a high-quality RCT, have positive effects on well-being, and could be implemented during a global pandemic—are presented and discussed. Future efforts to generate well-being can build on this causal evidence and emulate the most efficacious PPIs to be as effective as possible at generating well-being. However, the four exemplars were only tested in WEIRD (Western, Educated, Industrial, Rich, and Democratic) countries but seem promising for implementation and evaluation in non-WEIRD contexts. This review highlights the overall need for more rigorous research on PPIs with more diverse populations and in non-WEIRD contexts to ensure equitable access to effective interventions that generate well-being for all. (shrink)

Chronic diseases are recognized as a leadingcause of mortality, morbidity, health careutilization and cost. A constant tailoring ofcare to the actual needs of individualpatients, complexity and long duration are thedistinguishing features of chronic diseasemanagement.

The study of rare diseases has long been an area of challenge for medical researchers, with agonizingly slow movement towards improved understanding of pathophysiology and treatments compared with more common illnesses. The push towards evidence-based medicine (EBM), which prioritizes certain types of evidence over others, poses a particular issue when mapped onto rare diseases, which may not be feasibly investigated using the methodologies endorsed by EBM, due to a number of constraints. While other trial designs have been (...) suggested to overcome these limitations (with varying success), perhaps the most recent and enthusiastically adopted is the application of artificial intelligence to rare disease data. This paper critically examines the pitfalls of EBM (and its trial design offshoots) as it pertains to rare diseases, exploring the current landscape of AI as a potential solution to these challenges. This discussion is also taken a step further, providing philosophical commentary on the weaknesses and dangers of AI algorithms applied to rare disease research. While not proposing a singular solution, this article does provide a thoughtful reminder that no ‘one-size-fits-all’ approach exists in the complex world of rare diseases. We must balance cautious optimism with critical evaluation of new research paradigms and technology, while at the same time not neglecting the ever-important aspect of patient values and preferences, which may be challenging to incorporate into computer-driven models. (shrink)

Used appropriately, reliance on science distinguishes public health from policymaking driven more by theory and opinion and enhances trust in public health interventions. Evidence-based vaccine policymaking aims to control communicable disease by urging decision makers to base policies on the best available evidence rather than politics or personal views. The results of this approach, such as smallpox eradication, have been dramatic. Historically, mandatory childhood vaccination has been perhaps the most successful evidence-based tool in combating many (...) epidemics. Philosophically, vaccination mandates correspond to the legal system’s dual role in codifying what society deems undesirable behavior and declaring beneficial social norms and values consistent with understandings of the social contract. Despite their effectiveness and philosophical grounding, vaccination mandates present serious legal and ethical questions. Public health policymakers have a continuing responsibility to rely on evidence not only as a basis for generating policy, but also for evaluating and improving elements of its legal design. (shrink)

It is well-established that the experience of nature produces an array of positive benefits to mental well-being. Much less is known about the specific attributes of green space which produce these effects. In the absence of translational research that links theory with application, it is challenging to design urban green space for its greatest restorative potential. This translational research provides a method for identifying which specific physical attributes of an environmental setting are most likely to influence preference and restoration (...) responses. Attribute identification was based on a triangulation process invoking environmental psychology and aesthetics theories, principles of design founded in mathematics and aesthetics, and empirical research on the role of specific physical attributes of the environment in preference or restoration responses. From this integration emerged a list of physical attributes defining aspects of spatial structure and environmental content found to be most relevant to the perceptions involved with preference and restoration. The physical attribute list offers a starting point for deciphering which scene stimuli dominate or collaborate in preference and restoration responses. To support this, functional definitions and metrics—efficient methods for attribute quantification are presented. Use of these research products and the process for defining place-based metrics can provide (a) greater control in the selection and interpretation of the scenes/images used in tests of preference and restoration and (b) an expanded evidence base for well-being designers of the built environment. (shrink)

This paper investigates how the features of CEO equity-based compensation are associated with the agency costs of monitoring in an Australia setting. We find that audit fees significantly increase when firms award large equity grants to CEOs, which is consistent with the notion that auditors perceive higher risk associated with large equity incentives. However, by empirically testing auditors’ responses to the adoption of performance-vesting provisions, we document evidence that it is the use of accounting-based hurdles that potentially (...) encourages unethical reporting issues. We report that audit fees are negatively associated with the use of market-based hurdles, while accounting-based hurdles lead to significantly higher audit fees but combination hurdles lower audit fees. To reduce the possible undesirable properties of accounting-based hurdles, firms adopt longer vesting periods to provide more balanced future-oriented incentives. Practical implications include the remuneration committee being aware of the hidden costs of poorly designed CEO compensation packages and avoiding undesirable ethical implications, particularly, where the CEO has significant power over the corporation. (shrink)

Institutional Review Board decisions hinge on the availability and interpretation of information. This is demonstrated by the following well-known historical example. In 2001, 24-year-old Ellen Roche died from respiratory distress and organ failure as a result of her participation in a study at Johns Hopkins Asthma and Allergy Center. The non-therapeutic physiological study, “Mechanisms of Deep Inspiration-Induced Airway Relaxation,” was designed to examine airway hyperresponsiveness in healthy individuals in order to better understand the pathophysiology of asthma. Participants inhaled hexamethonium, a (...) chemical ganglionic blocker that was not FDA-approved for use as specified in the experimental protocol. Risks of inhaling hexamethonium, including lung damage, had been reported in the 1950s and ‘60s. An investigation conducted after Roche's death determined that the study's principal investigator had failed to adequately search the medical literature; the protocol submitted for IRB review cited articles indexed in online literature databases that went back only as far as the 1970s. (shrink)

The agroecological transition of agriculture not only requires changes in practices but also in ways of thinking and in their underlying values. Agroecology proposes broad scientific principles that need to be adapted to the singularities of each farm. This contextualization leads to the identification of agroecological practices that work locally and could serve as evidence-based practices to be transferred to local practitioners. This strategy was tested in a 4-year experiment conducted with dairy-sheep farmers in the South of France. (...) The aim was to collectively engage in the agroecological transition. Our work focused on the creation of a diagnostic tool that was used to analyze local farms and identify virtuous practices to be promoted locally as evidence-based practices. But this strategy came up against the complexity and singularity of the situations to be transformed: not only was no evidence found but the construction of the diagnostic tool itself led to controversy concerning the models of agriculture to be promoted. The experiment then took a pragmatic turn: on-farm workshops were organized to enable farmers to benefit from the professional judgment of peer farmers who were willing to help their colleagues accomplish their agroecological transition. The diagnostic tool, which was designed to be prescriptive, was then used to judge the social acceptability of solutions that made sense in each farmer’s own situation. Our experiment led us to conclude that managing the agro-ecological transition of farmers and their farming system is better conceived as a value-based process than as an evidence-based one. (shrink)

This chapter discusses a problematic relation between user-friendly design and manipulation. Some specific features of the design of a website can make it a more or less potent tool for manipulation. In particular, features that can be summed up as creating a user-friendly experience are also manipulation-friendly. The ease of using a website also makes it easier to be manipulated via the website. The chapter provides an argument that this can be explained as a less intellectually virtuous engagement (...) with websites that are more user-friendly. It is simply more difficult to mobilize suitable intellectual virtues when the website is quick and easy to use. For instance, when Google Search presents search results quickly and easily users become less intellectually cautious and independent than they ought to be. The chapter discusses a mechanism that links user-friendly design to an overly trusting attitude towards a website that leads to this intellectually careless behaviour. This link is support with empirical evidence based on processing fluency effects. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Towards a Design-Based Analysis of Emotional Episodes”Margaret A. Boden (bio)The theoretical work of Wright, Sloman, and Beaudoin is a significant contribution to our understanding of the nature and function of emotions, and potentially also to therapeutic method. Their message that emotions, as controlling and scheduling mechanisms, are essential to any complex intelligent system (that is: one with multiple and potentially conflicting motives, and situated in (...) a changing and unfriendly world) is important. It encourages cognitive psychologists to regard emotions as a central aspect of intelligence, not to sideline (or even to forget) them, as is too often done. In addition, it shows—at least in general outline—how emotions might be understood in computational terms.Critics of computational psychology too often assume that emotions and motivation must lie outside its scope. This is not so, although it is true that relatively little computational work has been done in this area. Interestingly, the very early days of AI saw a comparatively high proportion of models of multiple goal-seeking, affective processes, and even personality (see, for example, the papers in Tomkins and Messick 1963). But, inevitably, these were so crude as to be almost useless in illuminating the nature of emotion and motivation. As AI-workers and their psychologist colleagues found to their cost, it is difficult enough to model the pursuit of one goal, never mind the pursuit of several mutually conflicting goals. Accordingly, personality and emotion soon faded from the scene as preferred topics of computational research—but not before I too had argued that they could, in principle, be so addressed (Boden 1965; 1972).I suggested—in the sketchiest terms—that the concepts of William McDougall’s personality theory could be interpreted in a computational fashion (Boden 1965; 1972). His concept of sentiment, for example, marks what Wright et al. call “goal-sets,” and his master sentiment of self-regard relates to the descriptive and normative aspects of the self-image to which they draw our attention. He even described emotions as (conscious) control mechanisms, enabling the subject to monitor the incipient excitement of distinct types of motivation, and (sometimes) to adjust behavior so as to facilitate or inhibit the otherwise-inevitable response. What the target-authors have done is to put subtle and sophisticated computational flesh onto these minimalist theoretical bones.McDougall himself, of course, will be turning in his grave. He saw affect as partly conscious (as well as dispositional), and argued that consciousness—and purposive behavior too—cannot possibly [End Page 135] be given a mechanistic, or physicalist, explanation. Despite Wright et al.’s persuasive anti-reductionist remarks about the necessity for highly abstract (psychological) levels of explanation, he would not have accepted that such explanations could be computationally grounded. He even insisted that the neurophysiological ground of goal-seeking behavior involved a special sort of energy, or horme, intrinsically directed to specific ends. Presumably, no professional reader today would agree with McDougall on that point. But many may agree with him about consciousness. And many more will insist that consciousness is a crucial aspect—perhaps the crucial aspect—of emotion. Such critics will doubtless point out that our three authors explicitly “factor out,” or refuse to discuss, consciousness as such.Wright et al.’s rhetorical reserve on this point is defensible on two counts. First, even though emotions do involve conscious sensations, the dispositional and control aspects of affect are at least as important. Indeed, it is evident from the quotations from individuals reacting to bereavement that people often describe the phenomenology of grief in terms of these sorts of factors, rather than in a “purely qualitative” fashion (whatever that might be). Even so, these dispositional aspects of emotion are often overlooked, or regarded as less significant than the conscious phenomenology. And second, theoretical psychologists in general sideline consciousness: either they ignore it entirely, or they take it for granted philosophically and ask about the conditions under which it appears or disappears. They are well advised to do so, since we do not yet understand this concept (more accurately: this mixed bag of related concepts) at the philosophical level. Even a journal whose title has “Philosophy” as its leading... (shrink)

Background: The experimental method to acquire knowledge about efficacy and efficiency of medical procedures is well established in evidence-based medicine. A method to attain evidence about the significance of diseases and interventions from the patients' perspectives taking into account their right to self-determination about their lives and bodies has however not been sufficiently characterized.Design: Identification of a method to acquire evidence about the clinical significance of disease and therapeutic options from the patients' perspectives.Arguments: Communication between (...) patient and physician is analyzed as the method to attain evidence about what is at stake for individual patients in disease and therapy. It is the method that enables physicians to directly take into account patients' disease experiences and their aims regarding treatments. These patients' perspectives in turn determine the clinical significance of diagnoses and therapeutic options, if patient-autonomy is taken seriously.Conclusions: A full account of evidence-based medicine needs to include experimentation and communication between physician and patient as equally important methods to attain evidence necessary to practice patient-oriented medicine. The communicative method is especially important for primary physicians as they direct patients within the medical system to have their medical problems most effectively and efficiently addressed. (shrink)

An active engagement with arts in general and visual arts in particular has been hypothesized to yield beneficial effects beyond arts itself. So-called cognitive and socio-emotional “transfer” effects into other domains have been claimed. However, the empirical basis of these hopes is limited. This is partly due to a lack of experimental comparisons, theory-based designs, and objective measurements in the literature on transfer effects of arts education. Therefore, the aim of the present study was to design and experimentally (...) investigate a theory-based visual-arts education program for adolescents aged between 12 and 19 years. The program was delivered in a museum context in three sessions and was expected to yield specific and objectively measurable transfer effects. To conduct a randomized field trial, three strictly parallelized and standardized art courses were developed, all of which addressed the topic of portrait drawing. The courses mainly differed regarding their instructional focus, which was either on periods of art history, on the facial expression of emotions, or on the self-perception of a person in the context of different social roles. In the first and more “traditional” course portrait drawing was used to better understand how portraits looked like in former centuries. The two other courses were designed in a way that the artistic engagement in portrait drawing was interwoven with practicing socio-emotional skills, namely empathy and emotion recognition in one course and understanding complex self-concept structures in the other. We expected positive socio-emotional transfer effects in the two “psychological” courses. We used an animated morph task to measure emotion recognition performance and a self-concept task to measure the self-complexity of participants before and after all three courses. Results indicate that an instructional focus on drawing the facial expressions of emotions yields specific improvements in emotion recognition, whereas drawing persons in different social roles yields a higher level of self-complexity in the self-concept task. In contrast, no significant effects on socio-emotional skills were found in the course focussing on art history. Therefore, our study provides causal evidence that visual-arts programs situated in an art-museum context can advance socio-emotional skills, when designed properly. (shrink)

The ideology of evidence-base medicine (EBM) has dramatically altered the way we think, conceptualize, philosophize and practice medicine. One of its major pillars is the appraisal and classification of evidence. Although important and beneficial, this process currently lacks detail and is in need of reform. In particular, it largely focuses on three key dimensions (design, [type I] alpha error and beta [type II] error) to grade the quality of evidence and often omits other crucial aspects of (...) evidence such as biological plausibility, reproducibility, generalizability, temporality, consistency and coherence. It also over-values the randomized trial and meta-analytical techniques, discounts the biasing effect of single centre execution and gives insufficient weight to large and detailed observational studies. Unless these aspects are progressively included into systems for grading, evaluating and classifying evidence and duly empirically assessed (according to the EBM paradigm), the EBM process and movement will remain open to criticism of being more evidence-biased than evidence-based. (shrink)

The role to be played by multi-stakeholder partnerships in addressing the ‘wicked problems’ of sustainable development is made explicit by the seventeenth Sustainable Development Goal. But how do these partnerships really work? Based on the analysis of four sustainability-oriented innovation initiatives implemented in Belgium, Italy, Germany, and France, this study explores the roles and mechanisms that collaborating actors may enact to facilitate the pursuit of sustainable development, with a particular focus on non-profit organizations. The results suggest that collaborative innovations (...) for sustainability contribute simultaneously to the fulfilment of different Sustainable Development Goals, reaching beyond their original intent, and that the value being created has the potential to reinforce such roles and mechanisms. These partnerships are prompted and managed by non-profit organizations that act as metagovernors of collaborative innovation processes as they play the roles of cultural spreaders, enablers, relational brokers, service provides, and influencers. These findings will help policy-makers and practitioners in the public and non-profit sector to identify and utilize emerging opportunities for value creation through collaborative innovation, and to better design existing and prospective collaborative efforts aimed at sustainable objectives, thereby supporting progress towards the implementation of Agenda 2030. (shrink)

Reducing inequalities in health and the determinants of health is a widely acknowledged health policy goal, and methods for measuring inequalities and inequities in health are well developed. Yet, the evidence base is weak for how to achieve these goals. There is a lack of high-quality randomised controlled trials reporting impact on the distribution of health and non-health benefits and lack of methodological rigour in how to design, power, measure, analyse and interpret distributional impact in RCTs. Our overarching (...) aim in this paper is to contribute to the emerging effort to improve transparency and coherence in the theoretical and conceptual basis for RCTs on effective interventions to reduce health inequity. We endeavour to achieve this aim by pursuing two more specific objectives. First, we propose an overview of three broader health equity frameworks and clarify their implications for the measurement of health inequality in RCTs. Second, we seek to clarify the relationship between theory and translational challenges that researchers would need to attend to, in order to ensure that equity-relevant RCTs are coherently grounded in theory. (shrink)

An argument evaluation inventory distinguishing between different levels of theory-evidence differentiation was designed corresponding to the levels of argument observed in argument generation tasks. Five scenarios containing everyday theories about a social problem, and arguments to support those theories were presented to 170 participants from two age groups (15 and 22 years) and different educational tracks. Participants had to rate the validity of arguments proposed by a story figure, to support the theory, to choose the best argument, and to (...) justify their choice. The rating task proved to be very difficult for all age groups, with only 49% of the university students consistently rating valid evidence-based arguments higher than flawed arguments. Competence improved with age and educational level. In the choice task more than 80% of the adults preferred an argument that reflected theory-evidence differentiation over mere theory elaboration or flawed reasoning. However, only adults with a university education were able to also explicitly justify their choice. Overall, these findings imply that laypersons have similar conceptual problems in differentiating theory from evidence as it has been reported for evidence generation tasks (Kuhn, 1991). Performance on the choice task suggests that some implicit awareness of differences between theory and evidence may precede a full, explicit understanding. Implications for education are discussed. (shrink)

© 2015 NATCO, The Organization for Transplant Professionals.Despite the known benefits of kidney transplant, less than 30% of the 615 000 patients living with end-stage renal disease in the United States have received a transplant. More than 100 000 people are presently on the transplant waiting list. Although the shortage of kidneys for transplant remains a critical factor in explaining lower transplant rates, another important and modifiable factor is patients' lack of comprehensive education about transplant. The purpose of this article (...) is to provide an overview of known best practices from the broader literature that can be used as an evidence base to design improved education for ESRD patients pursuing a kidney transplant. Best practices in chronic disease education generally reveal that education that is individually tailored, understandable for patients with low health literacy, and culturally competent is most beneficial. Effective education helps patients navigate the complex health care process successfully. Recommendations for how to incorporate these best practices into transplant education design are described. Providing more ESRD patients with transplant education that encompasses these best practices may improve their ability to make informed health care decisions and increase the numbers of patients interested in pursuing transplant. (shrink)

Background and Objectives People living with dementia have historically been excluded from qualitative research and their voices ignored due to the perception that a person with dementia is not able to express their opinions, preferences and feelings. Research institutions and organizations have contributed by adopting a paternalistic posture of overprotection. Furthermore, traditional research methods have proven to be exclusionary towards this group. The objective of this paper is to address the issue of inclusion of people with dementia in research and (...) provide an evidence-based framework for dementia researchers based on the five principles of human rights: Participation, Accountability, Non-discrimination and equality, Empowerment and Legality (PANEL). Design This paper adapts the PANEL principles to the research context, and uses evidence from the literature to create a framework for qualitative research in people with dementia. This new framework aims to guide dementia researchers in designing studies around the needs of people with dementia, to improve involvement and participation, facilitate research development and maximize research outcomes. Results A checklist is presented with questions related to the five PANEL principles. These questions cover ethical, methodological and legal issues that researchers may need to consider while developing qualitative research for people with dementia. Conclusions The proposed checklist offers a series of questions and considerations to facilitate the development of qualitative research in patients with dementia. It is inspired by current human rights work of recognized dementia researchers and organizations who have been directly involved in policy development. Future studies need to explore its utility in improving participation, facilitating ethics approvals and ensuring that outcomes are relevant to people with dementia. (shrink)

OBJECTIVE: (a) To measure the effect of a guideline-based training on the performance of ontology developers compared with the performance after unspecific training by a competency question based evaluation; and (b) to provide empirical evidence for the applicability of competency questions in formal ontology evaluation in general. BACKGROUND: A close connection between ontology development and ontology evaluation as quality management procedure can been attained with the use of competency questions. Competency questions are often used as a semi-formal (...) specification of requirements for an ontology under development. Hence they can also be used as evaluation instruments, in order to check how far an ontology fulfills these requirements. METHODS: A randomized controlled trial was conducted with two groups of 12 students each. The intervention consisted in a differential guideline-based training on ontology development vs. unspecific training. After a group-specific training focusing on three topics per group, performance of students was assessed with 12 exercises (2 exercises per topic), in which the students had to apply their skills. Different types of competency questions were elaborated for the analysis of the students' ontologies. We used the proportion of correct answers as a measure of ontology quality. RESULTS: On single topic level, the performance of ontology developers increased after guideline-based training for two out of the six topics: it increased from a proportion of 0.46 to 0.63 for the topic Process \& Participation and from 0.44 to 0.53 for the topic Collective Material Entity. In regression analysis, a positive correlation was shown between the performance of students on untrained topics and the performance after specific guideline-based training. Moreover, in multiple regression analysis an overall effect of specific training of 0.09 was calculated (p < 0.1). CONCLUSION: The results show an effect of a specific guideline-based training on the performance of ontology developers compared to the performance after unspecific training by an increase of about 10 \% on the rate of correct competency questions. In addition, this study has shown the general applicability of competency questions in a formal ontology evaluation scenario. However, the study also shows that the training of ontology developers and their performance evaluation is a tedious task. The resulting performance of ontology developers is more dependent on the a priori individual competencies than on the specific acquired skills after training. (shrink)

In an Internet of Things (IoT) environment, IoT devices are typically connected through different network media types such as mobile, wireless and wired networks. Due to the pervasive nature of such devices, they are a potential evidence source in both civil litigation and criminal investigations. It is, however, challenging to identify and acquire forensic artefacts from a broad range of devices, which have varying storage and communication capabilities. Hence, in this paper, we first propose an IoT network architecture for (...) the forensic purpose that uses machine learning algorithms to autonomously detect IoT devices. Then we posit the importance of focusing on the links between different IoT devices (e.g. whether one device is controlled or can be accessed from another device in the system), and design an approach to do so. Specifically, our approach adopts a graph for modelling IoT communications’ message flows to facilitate the identification of correlated network traffic based on the direction of the network and the associated attributes. To demonstrate how such an approach can be deployed in practice, we provide a proof of concept using two IoT controllers to generate 480 commands for controlling two IoT devices in a smart home environment and achieve an accuracy rate of 98.3% for detecting the links between devices. We also evaluate the proposed autonomous discovering of IoT devices and their activities in a TCP network by using real-world measurements from a public dataset of a popular off-the-shelf smart home deployed in two different locations. We selected 39 out of 81 different IoT devices for this evaluation. (shrink)

This study investigates the effect of each component of CEO compensation, including cash-based component (salary and bonus), equity-based component (stock grant and stock option), and other perks on disclosure of corporate social responsibility (CSR) information of global firms. The study uses 2SLS IV estimation method and a sample of 580 US-based firms in a seven-year period. The study finds that equity-based remuneration has a significant and positive impact on a firm's CSR disclosure while CEO salary, bonus, (...) and other perquisites have significant detrimental effects on CSR disclosure. The paper indicates that a CEO's motivation for CSR reporting might arise from stock grant and option; meanwhile, salary, bonus and other perks could demotivate the CEO in this regard. Our findings offer insight into designing CEO compensation packages to meet shareholders' interests and stakeholders' expectations for a sustainable business. (shrink)

The development of the curriculum for engineering education (course requirements as well as extra-curricular activities like study abroad and internships) should be based on a comprehensive understanding of engineers’ responsibilities. The responsibilities that are constitutive of being an engineer include striving to fulfill the standards of excellence set by technical codes; to improve the idealized models that engineers use to predict, for example, the behavior of alternative designs; and to achieve the internal goods such as safety and sustainability as (...) they are reflected in the design codes. Globalization has implications for these responsibilities and, in turn, for engineering education, by, for example, modifying the collection of possible solutions recognized for existing problems. In addition, international internships can play an important role in fostering the requisite moral imagination of engineering students. (shrink)

Biomedical deployments of data science capitalise on vast, heterogeneous data sources. This promotes a diversified understanding of what counts as evidence for health-related interventions, beyond the strictures associated with evidence-based medicine. Focusing on COVID-19 transmission and prevention research, I consider the epistemic implications of this diversification of evidence in relation to: (1) experimental design, especially the revival of natural experiments as sources of reliable epidemiological knowledge; and (2) modelling practices, particularly the recognition of transdisciplinary expertise (...) as crucial to developing and interpreting data models. Acknowledging such shifts in evidential, experimental and modelling practices helps avoid harmful applications of data-intensive methods. (shrink)

_In _Evidence, Politics, and Education Policy_, political scientists Lorraine M. McDonnell and M. Stephen Weatherford provide an original analysis of evidence use in education policymaking to help scholars and advocates shape policy more effectively._ The book shows how multiple types of evidence are combined as elected officials and their staffs work with researchers, advocates, policy entrepreneurs, and intermediary organizations to develop, create, and implement education policies. _Evidence, Politics, and Education Policy_ offers an in-depth understanding of the political environment (...) in which evidence is solicited and used. Two key case studies inform the book’s findings. The primary case—a major, multimethod study—examines the development and early implementation of the Common Core State Standards at the national level and in four states: California, Indiana, Massachusetts, and Tennessee. A comparative case analyzes the evidence used in Congressional hearings over the twenty-year history of the Children’s Health Insurance Program. Together, the two cases illustrate the conditions under which different types of evidence are used and, in particular, how federalism, the complexity of the policy problem, and the policy’s maturity shape evidence use. McDonnell and Weatherford focus on three leverage points for strengthening the use of research evidence in education policy: integrating research findings with value-based policy ideas; designing policies with incentives for research use built into their rules and organizational structures; and training policy analysts to promote the use of research in policymaking venues. (shrink)

Measurement outcomes are frequently used as evidence in favor of or against medical and surgical interventions, health policies, and system designs. Indeed, in the medical and health services research literature, outcomes are the currency of policy debate and decision making. Yet in the philosophy of science and philosophy of medicine, the measures used in evidence-based medicine (EBM) are rarely discussed. Rather, the focus here is almost exclusively on study design and hierarchies of evidence. This concentration (...) on the methodology of study design has meant that for practical purposes the measures used in randomized controlled trials, observational studies, audits, and so forth, appear as a “black box.” Yet as I argue in the first part of this article, an engagement with measurement can improve our understanding of EBM and the quality of our evidence. In the second part of the article, I develop such an engagement with one aspect of measurement, namely, the validity of patient-reported outcome measures. Here, I illustrate some of the complexity that is required to improve the validity of these measures and hence the validity of our study outcomes, that is, evidence. The concentration in philosophy of science on study design over measurement methodology perhaps reveals the interest that many philosophers of medicine have in causation, but there is more to the production of high-quality scientific evidence than securing the causal inference. (shrink)

How are inferences to design affected when one makes the (plausible) assumption that the universe is spatially infinite? I will show that arguments for the existence of God based on the improbable development of life don’t go through. I will also show that the model of design inferences promulgated by William Dembski is flawed. My model for design inferences has the (desirable) consequence that there are circumstances where a seeming miracle can count as evidence for (...) the existence of God, even if one would expect that type of event to naturalistically occur in a spatially infinite universe. (shrink)

Self‐management programmes provide strategies to optimise health while educating and providing resources for living with enduring illnesses. The current paper describes the development of a community‐based programme that combines a transdiagnostic approach to self‐management with mindfulness to enhance psychological coping for older people with long‐term multimorbidity. The six steps of intervention mapping (IM) were used to develop the programme. From a needs assessment, the objectives of the programme were formulated; the theoretical underpinnings then aligned to the objectives, which informed (...) programme design, decisions on implementation, programme adoption and evaluation steps. Bandura's social cognitive theory informed the methods and practical strategies of delivery. Among the features addressed with participants are transdiagnostic dimensions such as fatigue, pain, breathlessness, sleep disturbances. The programme utilises mindfulness to aid coping and ameliorate the psychological distresses associated with chronicity. Findings from an initial feasibility study and subsequent pilot assisted in conceptualising our programme. In conclusion, applying IM gave the planners confidence the programme is robust and evidence‐based with clearly articulated links between the behavioural goals and design elements to obtain the desired outcomes. (shrink)

I consider recent strategies proposed by econometricians for extrapolating causal effects from experimental to target populations. I argue that these strategies fall prey to the extrapolator’s circle: they require so much knowledge about the target population that the causal effects to be extrapolated can be identified from information about the target alone. I then consider comparative process tracing as a potential remedy. Although specifically designed to evade the extrapolator’s circle, I argue that CPT is unlikely to facilitate extrapolation in typical (...) econometrics and evidence-based policy applications. To argue this, I offer a distinction between two kinds of extrapolation, attributive and predictive, the latter being prevalent in econometrics and evidence-based policy. I argue that CPT is not helpful for predictive extrapolation when using the kinds of evidence that econometricians and evidence-based policy researchers prefer. I suggest that econometricians may need to consider qualitative evidence to overcome this problem. (shrink)

Previous work has shown that concerns of breast cancer patients after finishing radiotherapy are responsive to conversations with radiographers during the treatment period. This study seeks to further understand radiographer and patient experiences, determine shared priorities for improvement in clinical interaction and develop communication guidelines and training to help radiographers support patients.Methods: Using the principles of Experience-Based Co-Design, semi-structured interviews were held with N = 4 patients and N = 4 radiographers, followed by feedback events to validate findings. (...) Patients and radiographers exchanged experiences in a joint co-design session, agreed with shared priorities and generated ideas for further support. A survey was conducted for process evaluation. To scale up findings, UK-wide representatives from patient networks and radiographers and managerial staff provided consultative input utilizing an iterative, adaptive procedure.Results: Radiographers expressed a need for support with “difficult conversations,” especially those on Fear of Cancer Recurrence, and their appropriate management. Important pointers for reassuring communication were identified, including: being treated like a person, knowing what to expect, and space to ask questions. The co-design process was rated positively by both staff and patients. Thematic collation of findings and mapping these on literature evidence resulted in the “KEW” communication guidelines for radiographers: Know, Encourage, Warmth. National stakeholder consultations validated and helped fine-tune the training model. The resulting training package, included: trigger videos, a simulated patient scenario and interactive handouts on fears of cancer recurrence and the patient pathway.Conclusions: The co-design process captured good practice to help standardize quality in empathic communication in the radiotherapy service. The resulting KEW: Know, Encourage, Warmth guidelines, and training package are user-centered as well as evidence-based. Supplementing single-site co-design with national consultative feedback allows for the development of interventions that are relevant to the clinical practice, even in detail, and helps to generate appropriate buy-in for roll out on a wider scale after evaluation.Trial Registration:www.ClinicalTrials.gov ID: NCT03468881. (shrink)

Most phase III clinical trials today are explanatory. Because explanatory, or efficacy, trials test hypotheses under “ideal” conditions, they are not well suited to providing guidance on decisions made in most clinical care contexts. Pragmatic trials, which test hypotheses under “usual” conditions, are often better suited to this task. Yet, pragmatic, or effectiveness, trials are infrequently carried out. This mismatch between the design of clinical trials and the needs of health care professionals is frustrating for everyone involved, and explains (...) some of the challenges inherent in attempts to enhance knowledge translation and encourage evidence-based practice. The situation is more than simply frustrating, however; it is potentially unethical. Clinical trials must be socially valuable in order to (1) warrant the risks they impose on human research subjects and (2) fairly and efficiently assess new clinical interventions. Most bioethicists would agree that trials that have no social value, for instance, because their results do not have the potential to advance clinical care, should not be performed. What is less widely appreciated is that given limited research resources, trials that are more socially valuable should be preferred to trials that are less socially valuable when all else is equal. With respect to clinical trial design, I argue that while explanatory trials often have some social value, many have less social value than their pragmatic counterparts. On the basis of this general ethical assessment, I provide a preliminary defense of the position that clinical researchers should aim to conduct pragmatic trials, that is, that researchers face a burden of justification related to any idealizing elements added to trial designs. (shrink)

Interpersonal sensitivity, particularly threat of potential exclusion, is a critical condition in borderline personality disorder (BPD) which impairs patients’ social adjustment. Current evidence-based treatments include group components, such as mentalization-based group therapy (MBT-G), in order to improve interpersonal functioning. These treatments additionally focus on the therapeutic alliance since it was discovered to be a robust predictor of treatment outcome. However, alliance is a multidimensional factor of group therapy, which includes the fellow patients, and may thus be negatively (...) affected by the exclusion-proneness of BPD patients. The aim of this pilot study was to examine the predictive value of threat of social exclusion for the therapeutic alliance in MBT-G. In the first part of the study, social exclusion was experimentally induced in 23 BPD inpatients and 28 healthy subjects using the Cyberball paradigm, a virtual ball tossing game. The evoked level of threat was measured with the Need-Threat Scale (NTS) which captures four dimensions of fundamental human needs, i. e. the need for belongingness, for self-esteem, for control, and for a meaningful existence. In the second part of the study, therapeutic alliance was measured on three dimensions, the therapists, the fellow patients and the group as a whole, using the Group-Questionnaire (GQ-D). BPD patients scored higher in their level of threat according to the NTS in both, the inclusion and the exclusion condition. The level of threat after exclusion predicted impairments of the therapeutic alliance in MBT-G. It was associated with more negative relationships, lower positive bonding and a lower positive working alliance with the fellow patients and lower positive bonding to the group as a whole whilst no negative prediction of the alliance to the therapists was found. Consequently, our translational study design has shown that Cyberball is an appropriate tool to use as an approach for clinical questions. We further conclude that exclusion-proneness in BPD is a critical feature with respect to alliance in group treatments. In order to neutralize BPD patients’ exclusion bias, therapists may be advised to provide an “inclusive stance”, especially in initial sessions. It is also recommendable to strengthen patient to patient relations. (shrink)