The aim of this paper is to explore the conditions under which generalisation from single case studies, in the sense of making inferences concerning a wider class of phenomena beyond a case, is reasonable. Two sets of conditions, in particular, provide the basis for our consideration of this issue. The first is an exploration of the impressive amount of empirical knowledge that is contained within the theories that are used to make observations, to classify phenomena, and to understand and interpret (...) cases. The second is recognition of the role of a pattern of inference known as abduction, or inference to the best explanation, in drawing conclusions from case studies. It is argued that these two conditions, when applied to the procedures for conducting case studies, can be used to defend, as reasonable, the making of certain provisional generalisations from single cases. An epistemological procedure for testing and further justifying these generalisations, with a particular emphasis on dealing with the problem of confirmation bias, is then discussed and recommended. (shrink)

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)

Wisdom is a multi-component trait that is important for mental health and well-being. In this study, we sought to understand gender differences in relative strengths in wisdom. A total of 659 individuals aged 27–103 years completed surveys including the 3-Dimensional Wisdom Scale and the San Diego Wisdom Scale. Analyses assessed gender differences in wisdom and gender’s moderating effect on the relationship between wisdom and associated constructs including depression, loneliness, well-being, optimism, and resilience. Women scored higher on average on the 3D-WS (...) but not on the SD-WISE. Women scored higher on compassion-related domains and on SD-WISE Self-Reflection. Men scored higher on cognitive-related domains and on SD-WISE Emotion Regulation. There was no impact of gender on the relationships between wisdom and associated constructs. Women and men have different relative strengths in wisdom, likely driven by sociocultural and biological factors. Tailoring wisdom interventions to individuals based on their profiles is an important next step. (shrink)

Objectives The objectives of the study are to understand the current practice of informed consent in medical research in public hospitals in Shanghai, and to share our views with other countries, especially developing countries. Methods In the study, 145 consent forms (CFs) of the selected research projects in eight public hospitals with ethics committees in Shanghai were audited, and the principle investigators (PIs) of these research projects and 40 student subjects who had participated in clinical drug tests were surveyed by (...) questionnaires. Results The CFs of medical researches in public hospitals with ethics committees in Shanghai were generally acceptable. However, there were some defects in the CFs. Although most of the surveyed PIs had correct recognition of informed consent, some processes of informed consent were not in accordance with generally accepted requirements. A large number of the PIs considered the greatest difficulty with informal consent was lack of correct recognition of subjects or legally authorised representatives on medical research. Discussion Informed consent in medical research should consider the research ethics, the background of potential subjects, the local resources and culture of medical research. In addition, special protection is needed for student subjects in informed consent as well as efforts for building and restoring the public's trust in biomedical research. Conclusion The informed consent in Shanghai's public hospitals with ethics committees was generally acceptable and the achievement of adequate informed consent is influenced by many factors. (shrink)

Evidence suggests divergent thinking is the cognitive basis of creative thoughts. Neuroimaging literature using resting-state functional connectivity has revealed network reorganizations during divergent thinking. Recent studies have revealed the changes of network organizations when performing creativity tasks, but such brain reconfigurations may be prolonged after task and be modulated by the trait of creativity. To investigate the dynamic reconfiguration, 40 young participants were recruited to perform consecutive Alternative Uses Tasks for divergent thinking and two resting-state scans were used for mapping (...) the brain reorganizations after AUT. We split participants into high- and low-creative groups based on creative achievement questionnaire and targeted on reconfigurations of the two brain networks: default-mode network and the network seeded at the left inferior frontal gyrus because the between-group difference of AUT-induced brain activation located at the left IFG. The changes of post-AUT RSFCs indicated the prolonged effect of divergent thinking. More specifically, the alterations of RSFCIFG−AG and RSFCIFG−IPL in the high-creative group had positive relationship with their AUT performances, but not found in the low-creative group. Furthermore, the RSFC changes of DMN did not present significant relationships with AUT performances. The findings not only confirmed the possibility of brain dynamic reconfiguration following divergent thinking, but also suggested the distinct IFGN reconfiguration between individuals with different creativity levels. (shrink)

The target article retains the traditional account of saccades as conjugate eye movements. However, recent single-unit recordings of premotor cells in the saccade pathway (excitatory burster neurons [EBNs]) found that they do not encode conjugate eye velocity, but rather, monocular eye velocity. These data argue against the traditional concept of saccades as inherently conjugate. Instead, they suggest a monocular mechanism in the sensorimotor transformation stage of saccade generation. This commentary will discuss the implications of these data for the saccade generation (...) model proposed in Findlay & Walker's target article. (shrink)

Abstract Objective Intuitive inquiry meditation is a unique form of Buddhist Zen/Chan practice in which individuals actively and intuitively utilize the cognitive functions to cultivate doubt and explore the concept of the self. This event-related potential (ERP) study aimed to investigate the neural correlates by which long-term practice of intuitive inquiry meditation induces flexibility in self-schema processing, highlighting the role of doubt and belief processes in this exploration. Methods Twenty experienced and eighteen beginner meditators in intuitive inquiry meditation were recruited (...) for this ERP study. The interactions of doubt and belief processes with concepts of the self and Buddha were investigated. A 128-channel electroencephalography (EEG) system was used to collect EEG data. The ERP data were processed and analyzed using EEGLAB. Results The data showed a double dissociation between beginners and experienced meditators (monks) in the concepts of the self and Buddha: intuitive inquiry meditation reduced the brain activity of beginners when viewing Buddha image but not when viewing a picture of themselves. However, in experienced meditators, intuitive inquiry meditation reduced brain activity when they viewed images of themselves but not when they viewed Buddha image. Further event-related spectral perturbation (ERSP) analysis revealed that experienced meditators had a greater theta spectral power and higher intertrial coherence (ITC), indicating that they could more flexibly modulate ongoing cognitive processes than beginner meditators. Conclusion Intuitive inquiry meditation could help beginner meditators detach from the concept of Buddha but not from that of the self. However, in experienced meditators, the opposite was true. ERSP analysis showed that only experienced meditators exhibited significant alterations in brain activity dynamics during intuitive inquiry meditation, which might enable these practitioners to become spontaneously detached from the concept of the self. These findings revealed the neural mechanism by which long-term practice of intuitive inquiry meditation can influence the doubting process and its effect on self-schema processing. (shrink)

Volume 20, Issue 5, June 2020, Page 38-40.

Perhaps the central focus of American bioethics has been to push against medical paternalism on the grounds that it impedes the autonomy of patients—that is, their ability to make choices of their...

Objectives The objective of this research was to develop ethics accreditation standards for hospitals. Research design Our research methods included a literature review, an expert focus group, the Delphi technique and a hospital survey. The entire process was separated into two stages: (1) the development of a draft of hospital ethics accreditation standards; and (2) conducting a nationwide hospital survey of the proposed standards. Results This study produced a tentative draft of hospital ethics accreditation standards comprised of six chapters and (...) 62 standards based on the expert focus group and Delphi technique. The six chapters are: Medical ethics policies, regulations and leadership; The establishment and operation of a medical ethics committee; The establishment and operation of research-related ethics committees; Medical ethics education; Organisational ethical climate; and Respect for patients' rights and establishment of good hospital-patient relationships. The hospital survey indicated that the concept of an organisational ethical climate was new to most hospital managers, most hospitals disliked the idea of having a separate hospital ethics accreditation system, and small hospitals were concerned about their ability to comply with all of the standards. Conclusions Regardless of whether hospital ethics accreditation can be a stand-alone accreditation or just part of existing hospital accreditation programmes, we hope this draft can serve as a good reference for future endeavours by hospital accreditation authorities. (shrink)

OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)

In summary, the creation and maintenance of the Wistar Rats as standardized animals can be attributed to the breeding work of Helen Dean King, coupled with the management and husbandry methods of Milton Greenman and Louise Duhring, and with supporting documentation provided by Henry Donaldson. The widespread use of the Wistar Rats, however, is a function of the ingenuity of Milton Greenman who saw in them a way for a small institution to provide service to science. Greenman's rhetoric, as captured (...) in his Director's Reports, prepared annually from 1905 until his death in 1937, shows that he was unusually sensitive to his times and to the economics of science and of society. In the era when biology was being defined, he recognized in the rat the potential to be a living analog to the pure chemicals that legitimated experimental science. From management literature he extracted the ideals of uniformity of product, standards of quality, and efficiency of production, applying them to scientific practice to generate an animal model that thrives as standard equipment in laboratories throughout the world today.I will close with a quote from Frederick W. Taylor that is a cogent statement of the contribution to science and scientific progress made by standardized tools and their creators. Equating the surgeon and the workman, Taylor wrote: [He is given] the finest implements, each one of which has been the subject of special study and development ... [and] the very best knowledge of his predecessors; and, provided with standard implements and methods which represent the best knowledge of the world up to date, he is able to use his own originality and ingenuity to make real additions to the world's knowledge, instead of reinventing things which are old.Standardized tools, whether surgeons' implements or laboratory-bred rats, are one of the vehicles for carrying scientific knowledge forward from generation to generation. In this sense, Greenman's Wistar Rats have done their job, in his words, of “providing service to science.”. (shrink)

Access to legal information is fundamental to access to justice. Yet accessibility refers not only to making legal documents available to the public, but also rendering legal information comprehensible to them. A vexing problem in bringing legal information to the public is how to turn formal legal documents such as legislation and judgments, which are often highly technical, to easily navigable and comprehensible knowledge to those without legal education. In this study, we formulate a three-step approach for bringing legal knowledge (...) to laypersons, tackling the issues of navigability and comprehensibility. First, we translate selected sections of the law into snippets (called CLIC-pages), each being a small piece of article that focuses on explaining certain technical legal concept in layperson’s terms. Second, we construct a Legal Question Bank, which is a collection of legal questions whose answers can be found in the CLIC-pages. Third, we design an interactive CLIC Recommender. Given a user’s verbal description of a legal situation that requires a legal solution, CRec interprets the user’s input and shortlists questions from the question bank that are most likely relevant to the given legal situation and recommends their corresponding CLIC pages where relevant legal knowledge can be found. In this paper we focus on the technical aspects of creating an LQB. We show how large-scale pre-trained language models, such as GPT-3, can be used to generate legal questions. We compare machine-generated questions against human-composed questions and find that MGQs are more scalable, cost-effective, and more diversified, while HCQs are more precise. We also show a prototype of CRec and illustrate through an example how our 3-step approach effectively brings relevant legal knowledge to the public. (shrink)

Fourteen healthy children (13.8±2.2 years, range 10 to 16; M:F=5:9) received 30 Hz intermittent theta burst transcranial magnetic stimulation (iTBS) with a stimulation intensity of 70% of resting motor threshold (RMT) with a total of 300 (iTBS300) pulses. All volunteers were free of neurologic, psychiatric and serious medical illnesses, not taking any neuropsychiatric medications, and did not have any contraindications to Transcranial Magnetic Stimulation. Changes in the mean amplitudes of motor-evoked potentials from baseline following iTBS were expressed as a ratio (...) and assessed from 1 to 10 minutes (BLOCK1) and 1 to 30 minutes (BLOCK2) using repeated-measures analysis of variance. All 14 subjects completed iTBS300 over the dominant primary motor cortex (M1) without any clinically reported adverse events. ITBS300 produced significant M1 facilitation (F5,65=3.165, p=0.01) at BLOCK1 and trend level M1 facilitation at BLOCK2 (F10,129=1.69, p=0.089). Although iTBS300 (stimulation duration of 92 seconds at 70% RMT) delivered over M1 in typically developed children was well-tolerated and produced on average significant facilitatory changes in cortical excitability, the post-iTBS300 neurophysiologic response was variable in our small sample. ITBS300-induced changes may represent a potential neuroplastic biomarker in healthy children and those with neuro-genetic or neuro-psychiatric disorders. However, a larger sample size is needed to address safety and concerns of response variability. (shrink)

In The Pragmatics of Text Messaging: Making Meaning in Messages Michelle A. McSweeney seeks to explore the meaning to be found in the labyrinth of text messaging language, and offers explanations b...

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. (...) The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank. (shrink)

Adverse events that harm patients can also have a harmful impact on health care workers. A few health care organizations have begun to provide psychological support to these Second Victims, but there is uncertainty over whether these discussions are admissible as evidence in malpractice litigation or disciplinary proceedings. We examined the laws governing the admissibility of these communications in 5 states, and address how the laws might affect participation in programs designed to support health care workers involved in adverse events. (...) We found that privilege is uneven from stateto- state, and also unclear. Ambiguity alone could have a chilling effect on Second Victim programs. We propose legislation to protect volunteer and health care worker communications provided by peer counselors, or failing this, updating of statutory provisions to explicitly include these communications within the ambit of existing protections. Enhancing protections could help to foster an environment of healing for both patients and caregivers. (shrink)

The harmful impact of an adverse event ripples beyond injured patients and their families to affect physicians, nurses, and other health care staff that are involved. These “Second Victims” may experience intense feelings of anxiety, guilt, and fear. They may doubt their clinical competence or ability to continue working at all. Some go on to suffer post-traumatic stress disorder and depression.Medical institutions long ignored this problem, preferring to believe that adverse events, or “errors,” occur due to incompetence — the unfortunate (...) work of a few “bad” practitioners who deserve, if anything, a reprimand for their negligence. Study after study has rejected this attribution and shown that adverse events in health care stem primarily from systemic flaws, not “bad apples.” Devastating errors, in other words, can, do, and always will happen in the care of competent, well-trained, and caring practitioners. (shrink)

The ordering tendency in binary f -Ti solid solution containing 3sp or 4sp simple-metal or 3d transition-metal solute is investigated systematically by the linear muffin-tin orbital method within the atomic sphere approximation . We demonstrated that the effective pairwise interaction energy in a solid solution is equal to half the solute-solute interaction energies and can be evaluated by a supercell total energy approach. The calculations of EPI energy both with and without volume relaxation of the supercells and local density of (...) states show that the EPI energies of Ti-SM and Ti-TM solutions are dominated by different factors. For Ti-SM solutions, the EPI energies are of large absolute values with a negative sign, indicating strong ordering tendency in these solutions. The volume relaxation does not alter the EPI energy substantially. The calculated LDOS shows that the ordering tendency in Ti-SM solutions may be related to the hybridization between the electrons of the SM atoms when they are close to each other. For most Ti-TM solutions, if calculated without relaxation, the absolute EPI energies are very small; however, if calculated with relaxation, they are of relatively large positive values, indicating a clustering tendency in these solutions. By combining the calculated EPI energy and Flinn's model for short-range order strengthening, the increase in critical shear stress ‰ sro due to SRO is estimated for Ti-SM alloys, and the results qualitatively agree with experiment. (shrink)

Informed by D. W. Winnicott’s object relations theory, and focused on the role of Things in constituting the world that is the object of Arendtian care, this essay examines Hannah Arendt’s treatment in The Human Condition of two liminal examples, cultivated land and poetry, that hover on the borders of Labor, Work, and/or Action. Cultivated land could belong to Work because cultivation leaves a lasting mark on the land, but it is assigned to Labor because land, once it is left (...) uncultivated, returns to nature, Arendt says. Poetry could belong to Action, which is the realm of meaning-making speech, but it is assigned to Work because, Arendt argues, poetry’s memorability ultimately depends on its writtenness and, once it is written, it becomes a Thing possessed of the object permanence characteristic of Work’s objects. But cultivated land also has a textualized form; it, too, can be written down as, for example, in the form of mapping. Why does Arendt not consider this? What possibilities of political thought or action might have been opened had she done so? Working through these questions with particular reference to colonial cartography, and reading Kafka’s The Castle alongside Brian Friel’s Translations, this essay explores practices of participatory mapping and land sabbatical that might make of land a “Thing” in Arendt’s sense. Noting the Biblical origins of land sabbatical and that Arendt’s move in the Work section from cultivated land to text/poem retraces George Steiner’s diasporic journey “From Homeland to Text,” I suggest that The Human Condition, commonly called Arendt’s most Greek text, may have a Jewish unconscious. (shrink)

Neural markers, such as the mismatch negativity, have been used to examine the phonological underspecification of English feature contrasts using the Featurally Underspecified Lexicon model. However, neural indices have not been examined within the approximant phoneme class, even though there is evidence suggesting processing asymmetries between liquid and glide phonemes. The goal of this study was to determine whether glide phonemes elicit electrophysiological asymmetries related to [consonantal] underspecification when contrasted with liquid phonemes in adult English speakers. Specifically, /ɹɑ/ is categorized (...) as [+consonantal] while /wɑ/ is not specified [i.e., ]. Following the FUL framework, if /w/ is less specified than /ɹ/, the former phoneme should elicit a larger MMN response than the latter phoneme. Fifteen English-speaking adults were presented with two syllables, /ɹɑ/ and /wɑ/, in an event-related potential oddball paradigm in which both syllables served as the standard and deviant stimulus in opposite stimulus sets. Three types of analyses were used: traditional mean amplitude measurements; cluster-based permutation analyses; and event-related spectral perturbation analyses. The less specified /wɑ/ elicited a large MMN, while a much smaller MMN was elicited by the more specified /ɹɑ/. In the standard and deviant ERP waveforms, /wɑ/ elicited a significantly larger negative response than did /ɹɑ/. Theta activity elicited by /ɹɑ/ was significantly greater than that elicited by /wɑ/ in the 100–300 ms time window. Also, low gamma activation was significantly lower for /ɹɑ/ vs. /wɑ/ deviants over the left hemisphere, as compared to the right, in the 100–150 ms window. These outcomes suggest that the [consonantal] feature follows the underspecification predictions of FUL previously tested with the place of articulation and voicing features. Thus, this study provides new evidence for phonological underspecification. Moreover, as neural oscillation patterns have not previously been discussed in the underspecification literature, the ERSP analyses identified potential new indices of phonological underspecification. (shrink)