Advances in genetic and genomic research have introduced challenges in obtaining informed consent for research in low and middle-income settings. However, there are only few studies that have explored challenges in obtaining informed consent in genetic and genomic research in Africa and none in South Africa. To start filling this gap, we conducted an empirical study to investigate the efficacy of informed consent procedures for an H3Africa genomic study on Rheumatic Heart Disease at the University of Cape Town in South (...) Africa. The main aim of the study was to understand ethical challenges in obtaining informed consent in the RHDGen study. We used a qualitative study methodology involving in-depth interviews and participant observations. Our study participants were RHDGen cases, healthy controls and research staff involved in the recruitment of RHDGen cases and controls. In total, we conducted 32 in-depth interviews with RHDGen cases and controls, 2 in-depth interviews with research staff and 57 direct observations of the consent procedures of RHDGen cases and controls. The interviews were conducted in English, audio-recorded and transcribed verbatim. Data were analyzed using thematic content analysis. The study was conducted in 3 sites within Cape Town, South Africa. Most healthy controls joined the RHDGen study in order to be screened for rheumatic heart disease. A majority of RHDGen cases decided to join the RHDGen study because of therapeutic misconception. The ethical challenges that impacted on obtaining informed consent in the RHDGen study were complex. In this study, the main challenges were diagnostic misconception among RHDGen controls and therapeutic misconception among RHDGen cases. (shrink)

Scientific disagreements sometimes persist even if scientists fully share results of their research. In this paper we develop an agent-based model to study the impact of diverging diagnostic values scientists may assign to the evidence, given their different background assumptions, on the emergence of polarization in the scientific community. Scientists are represented as Bayesian updaters for whom the diagnosticity of evidence is given by the Bayes factor. Our results suggest that an initial disagreement on the diagnostic (...) value of evidence can, but does not necessarily, lead to polarization, depending on the sample size of the performed studies and the confidence interval within which scientists share their opinions. In particular, the more data scientists share,the more likely it is that the community will end up polarized. (shrink)

The paper investigates the epistemological and communicative competences the experts need to use and communicate evidence in the reasoning process leading to diagnosis. The diagnosis and diagnosis communication are presented as intertwined processes that should be jointly addressed in medical consultations, to empower patients’ compliance in illness management. The paper presents defeasible reasoning as specific to the diagnostic praxis, showing how this type of reasoning threatens effective diagnosis communication and entails that we should understand diagnostic evidence (...) as defeasible as well. It argues that metaphors might be effective communicative devices to let the patients understand the relevant defeasors in the diagnostic reasoning process, helping to improve effective diagnosis communication, and also encouraging a change in patients’ beliefs and attitudes on their own experience of illness and illness’ management. (shrink)

In most areas of medicine, the physician's primary task is to diagnose the patient's presenting problem by correctly identifying the underlying pathology causing that problem. Diagnoses are established through a process of correlating the information obtained from an interview with the patient about his history of illness and circumstances, with additional evidence of the underlying disease derived from physical examination findings and/or the results of laboratory investigations and diagnostic imaging. In contemporary health care, various movements that call for (...) a shift in clinical care away from underlying disease pathology toward understanding people and their experience of disease are receiving growing... (shrink)

This paper reviews the recent (post-DSM) history of subjective and semi-structured methods of psychiatric diagnosis, as well as evidence for the superiority of structured and computer-aided diagnostic techniques. While there is evidence that certain forms of therapy are effective for alleviating the psychiatric suffering, distress, and dysfunction associated with certain psychiatric disorders, this paper addresses some of the difficult methodological and ethical challenges of evaluating the effectiveness of therapy.

In lieu of an abstract, here is a brief excerpt of the content:Diagnostic WannabesJennifer Radden, PhD (bio)Saunders explores challenges for the clinician faced with self-styled sufferers from attention deficit hyperactivity disorder, post-traumatic stress disorder, bipolar disorder, autism spectrum disorder (ASD), and fibromyalgia. The diagnostic system was not meant to be used as “a scaffold for identity,” she points out. Yet wannabe patients now step into the clinic wielding self-proclaimed diagnoses as social identities. Saunders explains the context where such (...) phenomena arise, and offers guidelines for clinicians addressing this new reality. To do so, she enlists Rashed’s innovative normative approach to the so-called boundary problem of assigning, and providing justification for, the contested line between normal and disordered. The boundary problem itself seems to rise to prominence during our current era of increasingly dimensional thinking, it is worth noting, with psychiatric diagnoses taken to refer to points on a continuum, rather than to discrete categorical disease entities.On the likely sources of these ‘diagnostic’ social identities, as well as reasons why certain diagnoses attach to them more commonly than others, Saunders points to social trends (including what she asserts to be a “post-stigma” cultural environment), the failure of efforts to identify neurobiological markers for psychiatric disorder, the ubiquity of social media, the algorithms themselves, and the hyperconnected existence of contemporary times. Such narratives also offer the comforts of a sense of belonging and explanations for perceived inadequacies, she rightly observes.Despite today’s virtual and other inducements, the problem introduced here is not an entirely new one. The first part of the seventeenth century in Europe saw an apparent “epidemic” of what was known as “melancholy,” a condition associated with the spleen, whose symptoms loosely resembled those of today’s depression and anxiety. Much of this suffering was undeniably real, but much was a fashionable, identity-conferring pose. “Every distemper of the body now is complicated with spleen,” the poet John Donne ironically observes in a letter dated 1622, “and when we were young men we scarce ever heard of the spleen. In our declinations now, every accident is accompanied with heavy clouds of melancholy”1 (Gosse, 2019). By then, the Melancholic Man (or homo melancholicus), with his surfeit of spleen, was an unmistakable character type—or social identity, as we would now say. Recognized and saluted in centuries-long literary and illustrative traditions, the type was an anchoring element of the humoral medicine which, despite the gradual emergence of more empirical science, had endured since Galenic times.Melancholy’s closest descendants, affective depressive and anxiety disorders, are today less evident among the troubling identities Saunders discusses—somewhat preempted, she points out, by more cognitively-based diagnoses such as ASD. [End Page 279] This is itself an ironic reminder of the vagaries of cultural attitudes, cautioning us to remember the broader context where these particular social identities are selected for emulation and adoption.The lure of the melancholy man’s2 social identity is well understood: already normalized, within the humoral system in which excess black bile afflicted roughly one in four people, it had been valorized for centuries—arguably by Aristotelian writing (in the dubious ‘Problems’), during the Renaissance by Ficino, and Shakespeare—even by Freud in his 1916 ‘Mourning and Melancholia.’ Through most of Western history, the positive attributes and benefits of the dark moods of melancholy have needed no further explaining or justifying. They glow with glamorous associations.Applying Rashed’s conditions for appropriately acknowledging and recognizing the fit of a person’s chosen social identity, Saunders‘ guidance for clinicians clarifies boundary matters. And it illustrates how to understand, regulate and communicate the appropriate norms in ways that can dissuade those whose personal growth and mental health are not served by claiming such identities.With at least some of the popular social identities Saunders describes, I think we can helpfully continue the comparison with the homo melancholicus. For the ‘neurodiversity’ rhetoric of our own times contains forces promoting both the normalization and the valorization of syndromes such as ASD. Pointing to analogies with differences of gender, ethnicity and culture, neurodiversity theorizing argues for a respect for, and appreciation of, difference. Mental or cognitive variations are equally natural and valuable, it is... (shrink)

Aims: The Research Diagnostic Criteria for Temporomandi¬bular Disorders (RDC/TMD) Axis I diagnostic algorithms were demonstrated to be reliable but below target sensitivity and specificity. Empirical data supported Axis I algorithm revisions that were valid. Axis II instruments were shown to be both reliable and valid. An international consensus workshop was convened to obtain recommendations and finalization of new Axis I diagnostic algorithms and new Axis II instruments. Methods: A comprehensive search of published TMD diagnostic literature was (...) followed by review and consensus via a formal structured process by a panel of experts for revision of the RDC/TMD. Results: The recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for pain diagnoses and valid criteria for the most common pain-related TMDs and for one intra-articular disorder. The Axis II protocol retains selected RDC/TMD screening instruments augmented with new instruments to better assess the interactions between pain and psychosocial functioning. A comprehensive classification system is also presented. Conclusion: The recommended evidence-based DC/TMD protocol is appropriate for use in both the clinical and research settings. Simple Axis I and II screening tests augmented by validated Axis I and Axis II instruments allow for identification of simple to complex TMD patients. (shrink)

Scientific and medical practice both relate to and differ from each other, as do discussions of how to handle decisions under uncertainty in the laboratory and clinic respectively. While studies of science have pointed out that scientific practice is more complex and messier than dominant conceptions suggest, medical practice has looked to the rigour of scientific and statistical methods to address clinical uncertainty. In this article, we turn to epistemological studies of the laboratory to highlight how clinical practice already has (...) strategies for dealing with messiness. We draw on Hans-Jo ̈rg Rheinberger’s Toward a History of Epistemic Things, in which he invokes the metaphor of a spider’s web to explain the role of tacit practices in experimental biochemistry for helping practitioners manage messiness. We argue that diagnostic practices in clinical medicine employ similar, albeit codified, procedures to evaluate epistemic significance, ensure sensitivity to the unforeseen, and allow focused grounds for action. We consider three practices: (a) the pre-set structure of medical records, ensuring broad coverage in initial anamnesis, (b) the use of lists of differential diagnoses and ongoing ‘anchoring and adjusting’ as inquiry progresses, and (c) shared decision-making as an occasion to synthesize empirical evidence and reopen inquiry for potential missed information. We end by suggesting that while philosophy of medicine may learn from laboratory epistemology, the sciences may learn something from medical practice. (shrink)

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

We raise a problem of applicability of RCTs to validate nuclear diagnostic imaging tests. In spite of the wide application of PET and other similar techniques that use radiopharmaceuticals for diagnostic purposes, RCT-based evidence on their validity is sparse. We claim that this is due to a general conceptual problem that we call Prevalence of Treatment, which arises in connection with designing RCTs for testing any diagnostic procedure in the present context of medical research, and is (...) particularly apparent in this case. We also identify three practical reasons why RCTs do not qualify as the best option for PET validation, which have to do with specific characteristics of nuclear diagnostic imaging, and of radiopharmaceuticals. The paper is meant to contribute both to the philosophical discussion on the EBM hierarchy of evidence, and on the specific debate on radiopharmaceuticals in nuclear medicine. (shrink)

The dispute over Socrates’ apparent endorsement of hedonism in the Protagoras has persisted for ages among scholars and students of Plato’s work. The solution to the query concerning the seriousness and sincerity of Socrates’ argument from hedonism established in the dialogue is of considerable importance for the interpretation of Plato’s overall moral theory, considering how blatantly irreconcilable the defense of this doctrine is with Plato’s other early dialogues. In his earlier works, Socrates puts supreme importance on virtue and perfection of (...) the soul, so the puzzle apparent in the Protagoras merits a thorough examination.Several scholars have argued that, since Socrates’ defense of hedonism in this work clashes significantly with his views on morality in other dialogues, Socrates must only have been defending hedonism ironically, or with the intention of “diagnosing” his opponent’s point of view. In this paper, I examine the approaches according to which Socrates didn’t in fact mean to defend hedonism, but merely used it as a diagnostic tool; I argue that there is no compelling evidence for this resolution of Socrates’ defense of hedonism, and that the views that attempt to defend it really have no convincing grounds for it apart from the desire to reconcile the Protagoras with other Socratic dialogues. (shrink)

The dispute over Socrates’ apparent endorsement of hedonism in the Protagoras has persisted for ages among scholars and students of Plato’s work. The solution to the query concerning the seriousness and sincerity of Socrates’ argument from hedonism established in the dialogue is of considerable importance for the interpretation of Plato’s overall moral theory, considering how blatantly irreconcilable the defense of this doctrine is with Plato’s other early dialogues. In his earlier works, Socrates puts supreme importance on virtue and perfection of (...) the soul, so the puzzle apparent in the Protagoras merits a thorough examination.Several scholars have argued that, since Socrates’ defense of hedonism in this work clashes significantly with his views on morality in other dialogues, Socrates must only have been defending hedonism ironically, or with the intention of “diagnosing” his opponent’s point of view. In this paper, I examine the approaches according to which Socrates didn’t in fact mean to defend hedonism, but merely used it as a diagnostic tool; I argue that there is no compelling evidence for this resolution of Socrates’ defense of hedonism, and that the views that attempt to defend it really have no convincing grounds for it apart from the desire to reconcilethe Protagoras with other Socratic dialogues. (shrink)

With regard to facial emotion recognition, previous studies found that specific facial regions were attended more in order to identify certain emotions. We investigated whether a preferential search for emotion-specific diagnostic regions could contribute toward the accurate recognition of facial emotions. Twenty-three neurotypical adults performed an emotion recognition task using six basic emotions: anger, disgust, fear, happiness, sadness, and surprise. The participants’ exploration patterns for the faces were measured using the Moving Window Technique (MWT). This technique presented a small (...) window on a blurred face, and the participants explored the face stimuli through a mouse-controlled window in order to recognize the emotions on the face. Our results revealed that when the participants explored the diagnostic regions for each emotion more frequently, the correct recognition of the emotions occurred at a faster rate. To the best of our knowledge, this current study is the first to present evidence that an exploration of emotion-specific diagnostic regions can predict the reaction time of accurate emotion recognition among neurotypical adults. Such findings can be further applied in the evaluation and/or training (regarding emotion recognition functions) of both typically and atypically developing children with emotion recognition difficulties. (shrink)

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

The notion of a severe test has played an important methodological role in the history of science. But it has not until recently been analyzed in any detail. We develop a generally Bayesian analysis of the notion, compare it with Deborah Mayo’s error-statistical approach by way of sample diagnostic tests in the medical sciences, and consider various objections to both. At the core of our analysis is a distinction between evidence and confirmation or belief. These notions must be (...) kept separate if mistakes are to be avoided; combined in the right way, they provide an adequate understanding of severity. Those who think that the weight of the evidence always enables you to choose between hypotheses “ignore one of the factors (the prior probability) altogether, and treat the other (the likelihood) as though it ...meant something other than it actually does. This is the same mistake as is made by someone who has scruples about measuring the arms of a balance (having only a tape measure at his disposal ...), but is willing to assert that the heavier load will always tilt the balance (thereby implicitly assuming, although without admitting it, that the arms are of equal length!). (Bruno de Finetti, Theory of Probability)2. (shrink)

Two facets of diagnostic reasoning related to scientific thinking are recognizing the difference between confounded and unconfounded evidence and selecting appropriate interventions that could provide learners the evidence necessary to make an appropriate causal conclusion. The present study investigates both these abilities in 3- to 6-year-old children. We found both competence and developmental progress in the capacity to recognize that evidence is confounded. Similarly, children performed above chance in some tasks testing for the selection of a (...) controlled test of a hypothesis. However, these capacities were unrelated, suggesting that preschoolers’ nascent understanding of the control-of-variables strategy may not be driven by a metacognitive understanding that confounded evidence does not support a unique causal conclusion, and requires further investigation. (shrink)

Scholars in philosophy, political science, and the policy community have recently advocated for a ‘sticks and carrots’, or conditional-coercion, approach to human rights violations. On this model, rights violators are conceived of as rational agents who should be rewarded for good behavior and punished for bad behavior by other states seeking to improve human rights abroad. External states concerned about human rights abroad should impose punishments against foreign rights violators, and these punitive measures should not be lifted until rights violations (...) in target countries cease. Against these scholars, I argue that the conditional-coercion model is mistaken. In this article, I explicate the ‘sticks and carrots’ approach to human rights, criticize it on both theoretical and empirical grounds, and suggest an alternative approach that I term rights diagnostics. The model I propose is sensitive to the internal political struggles in rights violating states and the incentive structures faced by rights violators. This model takes account of relevant empirical evidence on the role of external coercion and inducements in producing institutional change. I conclude by sketching an institutional design that would potentially implement ‘rights diagnostics’ policy.1. (shrink)

Many physicians assert that new cost-control mechanisms inappropriately interfere with clinical decision-making. They claim that high costs arise from poorly practiced medicine, and argue that effective utilization of resources is best promoted by advancing the scientific and ethical ideals of medicine. However, the claim is not warranted by empirical evidence. In this essay, I show how it rests upon aesthetic considerations associated with diagnostic elegance. I first consider scientific rationality generally. After a review of analytical empiricist and socio-historical (...) approaches in the philosophy of science, a form of Kant's aesthetic is used to explain how scientific discovery and justification are linked, and to show how meta-theoretical considerations associated with the goals and method of science work together with exemplars of practice. This analysis enables us to understand how the ideals of medicine as a science guide the initial patient history and physical exam in such a way that a parsimonious use of tests is indicated. Aesthetic considerations unite the basic scientific and ethical commitments of the modern medical paradigm and are central for rightly understanding clinical judgment. (shrink)

Cognitive diagnostic models show great promise in language assessment for providing rich diagnostic information. The lack of a full understanding of second language listening subskills made model selection difficult. In search of optimal CDM that could provide a better understanding of L2 listening subskills and facilitate accurate classification, this study carried a two-layer model selection. At the test level, A-CDM, LLM, and R-RUM had an acceptable and comparable model fit, suggesting mixed inter-attribute relationships of L2 listening subskills. At (...) the item level, Mixed-CDMs were selected and confirmed the existence of mixed relationships. Mixed-CDMs had better model and person fit than G-DNIA. In addition to statistical approaches, the content analysis provided theoretical evidence to confirm and amend the item-level CDMs. It was found that semantic completeness pertaining to the attributes and item features may influence the attribute relationships. Inexplicable attribute conflicts could be a signal of suboptimal model choice. Sample size and the number of multi-attribute items should be taken into account in L2 listening cognitive diagnostic modeling studies. This study provides useful insights into the model selection and the underlying cognitive process for L2 listening tests. (shrink)

A diagnostic judgment of a teacher can be seen as an inference from manifest observable evidence on a student’s behavior to his or her latent traits. This can be described by a Bayesian model of in-ference: The teacher starts from a set of assumptions on the student (hypotheses), with subjective probabilities for each hypothesis (priors). Subsequently, he or she uses observed evidence (stu-dents’ responses to tasks) and knowledge on conditional probabilities of this evidence (likelihoods) to revise (...) these assumptions. Many systematic deviations from this model (biases, e.g. base-rate neglect, inverse fallacy) are reported in literature on Bayesian reasoning. In a teacher’s situation the information (hypotheses, priors, likelihoods) is usually not explicitly represented numerically (as in most research on Bayesian reasoning), but only by qualitative esti-mations in the mind of the teacher. In our study, we ask to which extent individuals (approximately) apply a rational Bayesian strategy or resort on other biased strategies of processing information for their diagnostic judgments. We explicitly pose this question with respect to non-numerical settings. To investigate this question, we developed a scenario that visually displays all relevant information (hypotheses, priors, likelihoods) in a graphically displayed hypothesis space (called “hypothegon”) – without recurring to numerical representations or mathematical procedures. 42 pre-service teach-ers were asked to judge the plausibility of different misconceptions of six students based on their responses to decimal comparison tasks (e.g. 3.39 > 3.4). Applying a Bayesian classification proce-dure, we identified three updating strategies: A Bayesian update strategy (BUS, processing all probabilities), a combined evidence strategy (CES, ignoring the prior probabilities but including all likelihoods), and a single evidence strategy (SES, only using the likelihood of the most probable hypothesis). In study 1, an instruction on the relevance of using all probabilities (priors and likelihoods) only weakly increased the processing of more information. In study 2, we found strong evidence that a visual explication of the prior-likelihood interaction led to an increase of processing the interaction of all relevant information. These results show that the phenomena found in general research on Bayesian reasoning in numerical settings extend to diagnostic judgments in non-numerical settings. (shrink)

In light of recent advances in machine learning for medical applications, the automation of medical diagnostics is imminent. That said, before machine learning algorithms find their way into clinical practice, various problems at the epistemic level need to be overcome. In this paper, we discuss different sources of uncertainty arising for clinicians trying to evaluate the trustworthiness of algorithmic evidence when making diagnostic judgments. Thereby, we examine many of the limitations of current machine learning algorithms (with deep learning (...) in particular) and highlight their relevance for medical diagnostics. Among the problems we inspect are the theoretical foundations of deep learning (which are not yet adequately understood), the opacity of algorithmic decisions, and the vulnerabilities of machine learning models, as well as concerns regarding the quality of medical data used to train the models. Building on this, we discuss different desiderata for an uncertainty amelioration strategy that ensures that the integration of machine learning into clinical settings proves to be medically beneficial in a meaningful way. (shrink)

According to the shared signal hypothesis the impact of facial expressions on emotion processing partially depends on whether the gaze is directed toward or away from the observer. In autism spectrum disorder several aspects of face processing have been found to be atypical, including attention to eye gaze and the identification of emotional expressions. However, there is little research on how gaze direction affects emotional expression processing in typically developing individuals and in those with ASD. This question is investigated here (...) in two multimodal experiments. Experiment 1 required processing eye gaze direction while faces differed in emotional expression. Forty-seven children participated. Their Autism Diagnostic Observation Schedule scores ranged from 0 to 6 in the experiment. Event-related potentials were sensitive to gaze direction and emotion, but emotion processing did not depend on gaze direction. However, for angry faces the gaze direction effect on the N170 amplitude, as typically observed in TD individuals, diminished with increasing ADOS score. For neutral expressions this correlation was not significant. Experiment 2 required explicit emotion classifications in a facial emotion composite task while eye gaze was manipulated incidentally. A group of 22 children with ASD was compared to a propensity score-matched group of TD children. The same comparison was carried out for a subgroup of nine children with ASD who were less trained in social cognition, according to clinician’s report. The ASD group performed overall worse in emotion recognition than the TD group, independently of emotion or gaze direction. However, for disgust expressions, eye tracking data revealed that TD children fixated relatively longer on the eyes of the stimulus face with a direct gaze as compared with averted gaze. In children with ASD we observed no such modulation of fixation behavior as a function of gaze direction. Overall, the present findings from ERPs and eye tracking confirm the hypothesis of an impaired sensitivity to gaze direction in children with ASD or elevated autistic traits, at least for specific emotions. Therefore, we conclude that multimodal investigations of the interaction between emotional processing and stimulus gaze direction are promising to understand the characteristics of individuals differing along the autism trait dimension. (shrink)

This article describes the development and validation of a diagnostic test of German and its integration in a programme of formative assessment during a one-year initial teacher-training course. The test focuses on linguistic aspects that cause difficulty for trainee teachers of German as a foreign language and assesses implicit and explicit grammatical knowledge as well as students' confidence in this knowledge. Administration of the test to 57 German speakers in four groups (first-year undergraduates, fourth-year undergraduates, postgraduate trainees, and native (...) speakers) provided evidence of its reliability and validity. (shrink)

The profession of medicine is predicated upon an ethical mandate: first do no harm. However, critics charge that the medical profession’s culture and its public health mission are being undermined by the pharmaceutical industry’s wide-ranging influence. In this article, we analyze how drug firms influence psychiatric taxonomy and treatment guidelines such that these resources may serve commercial rather than public health interests. Moving beyond a conflict-ofinterest model, we use the conceptual and normative framework of institutional corruption to examine how organized (...) psychiatry’s dependence on drug firms has distorted science. We suggest that academic-industry relationships have led to the corruption of the evidence base upon which accurate diagnosis and sound treatment depend. We describe the current dependency corruption and argue that transparency alone is not a solution — and sometimes even produces iatrogenic effects. Furthermore, we argue that the corruption of the evidence base for diagnostic and practice guidelines renders obsolete the traditional informed consent process, and we offer suggestions for reforming this process. (shrink)

The possibility that industry is exerting an undue influence on the culture of medicine has profound implications for the profession's public health mission. Policy analysts, investigative journalists, researchers, and clinicians have questioned whether academic-industry relationships have had a corrupting effect on evidence-based medicine. Psychiatry has been at the heart of this epistemic and ethical crisis in medicine. This article examines how commercial entities, such as pharmaceutical companies, influence psychiatric taxonomy and treatment guidelines. Using the conceptual framework of institutional corruption, (...) we show that organized psychiatry's dependence on drug firms has led to a distortion of science. We describe the current dependency corruption and argue that transparency alone is not a solution. We conclude by taking the position that the corruption of the evidence base in diagnostic and practice guidelines has compromised the informed consent process, and we suggest strategies to address this problem. (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)

Forensic evidence often involves an evaluation of whether two impressions were made by the same source, such as whether a fingerprint from a crime scene has detail in agreement with an impression taken from a suspect. Human experts currently outperform computer-based comparison systems, but the strength of the evidence exemplified by the observed detail in agreement must be evaluated against the possibility that some other individual may have created the crime scene impression. Therefore, the strongest evidence comes (...) from features in agreement that are also not shared with other impressions from other individuals. We characterize the nature of human expertise by applying two extant metrics to the images used in a fingerprint recognition task and use eye gaze data from experts to both tune and validate the models. The Attention via Information Maximization model quantifies the rarity of regions in the fingerprints to determine diagnosticity for purposes of excluding alternative sources. The CoVar model captures relationships between low-level features, mimicking properties of the early visual system. Both models produced classification and generalization performance in the 75%–80% range when classifying where experts tend to look. A validation study using regions identified by the AIM model as diagnostic demonstrates that human experts perform better when given regions of high diagnosticity. The computational nature of the metrics may help guard against wrongful convictions, as well as provide a quantitative measure of the strength of evidence in casework. (shrink)

We distinguish three aspects of medical diagnosis: generating new diagnostic hypotheses, selecting hypotheses for further pursuit, and evaluating their probability in light of the available evidence. Drawing on Peirce’s account of abduction, we argue that hypothesis generation is amenable to normative analysis: physicians need to make good decisions about when and how to generate new diagnostic hypothesis as well as when to stop. The intertwining relationship between the generation and selection of diagnostic hypotheses is illustrated through (...) the analysis of a detailed clinical case study. This interaction is not adequately captured by the existing probabilistic, decision-theoretic models of the threshold approach to clinical decision-making. Instead, we propose to conceptualize medical diagnosis in terms of strategic reasoning. (shrink)

This paper examines the basic question of how we can come to form accurate beliefs about the world when we do not fully know how good or bad our evidence is. Here, we show, using simulations with otherwise optimal agents, the cost of misjudging the quality of our evidence. We compare different strategies for correctly estimating that quality, such as outcome‐ and expectation‐based updating. We also identify conditions under which misjudgment of evidence quality can nevertheless lead to (...) accurate beliefs, as well as those conditions where no strategy will help. These results indicate both where people will nevertheless succeed and where they will fail when information quality is degraded. (shrink)

In June 2020, Gilead agreed to provide the USA with 500 000 doses of remdesivir—an antiviral drug which at that time was percieved to show promise in reducing the recovery time for patients with COVID-19. This quantity represented Gilead’s then full production capacity for July and 90% of its capacity for August and September. Similar deals are evident around access to proposed vaccines for COVID-19, and such deals are only likely to increase. These attempts to secure preferential access to medicines (...) and vaccines, so-called vaccine/treatment nationalism, jeopardise supplies of life-saving treatments and vaccines available elsewhere, and jeopardise global equitable distribution of such vaccines/treatments more generally. Much of the focus to date has been on States’ role in negotiating such deals. However, such developments also demonstrate the power patent holders have in controlling access to life-saving healthcare, determining who obtains access first and at what price. This article argues that the extent of control currently given to patent holders for COVID-19 must be questioned. This article demonstrates that patents have significant implications for healthcare acting as private governance tools over patented inventions. It is only by greater probing of patent holders’ role in delivering access to medicines, diagnostics and vaccines for COVID-19 that equitable global equitable access can be achieved. (shrink)

Cognitive diagnostic assessment has been developed rapidly to provide fine-grained diagnostic feedback on students’ subskills and to provide insights on remedial instructions in specific domains. To date, most cognitive diagnostic studies on reading tests have focused on retrofitting a single booklet from a large-scale assessment. Critical issues in CDA involve the scarcity of research to develop diagnostic tests and the lack of reliability and validity evidence. This study explored the development and validation of the (...) class='Hi'>Diagnostic Chinese Reading Comprehension Assessment for primary students under the CDA framework. Reading attributes were synthesized based on a literature review, the national curriculum criteria, the results of expert panel judgments, and student think-aloud protocols. Then, the tentative attributes were used to construct three booklets of reading comprehension items for 2–6 graders at three key stages. The assessment was administered to a large population of students in grades 2–6 from 20 schools in a district of Changchun City, China. Q-matrices were compared and refined using the model-data fit and an empirical validation procedure, and five representative cognitive diagnostic models were compared for optimal performance. The fit indices suggested that a six-attribute structure and the G-DINA model were best fitted for the reading comprehension assessment. In addition, diagnostic reliability, construct, internal and external validity results were provided, supporting CDM classifications as reliable, accurate, and useful. Such diagnostic information could be utilized by students, teachers, and administrators of reading programs and instructions. (shrink)

Forms of Artificial Intelligence (AI) are already being deployed into clinical settings and research into its future healthcare uses is accelerating. Despite this trajectory, more research is needed regarding the impacts on patients of increasing AI decision making. In particular, the impersonal nature of AI means that its deployment in highly sensitive contexts-of-use, such as in healthcare, raises issues associated with patients’ perceptions of (un) dignified treatment. We explore this issue through an experimental vignette study comparing individuals’ perceptions of being (...) treated in a dignified and respectful way in various healthcare decision contexts. Participants were subject to a 2 (human or AI decision maker) x 2 (positive or negative decision outcome) x 2 (diagnostic or resource allocation healthcare scenario) factorial design. We found evidence of a “human bias” (i.e., a preference for human over AI decision makers) and an “outcome bias” (i.e., a preference for positive over negative outcomes). However, we found that for perceptions of respectful and dignified interpersonal treatment, it matters more who makes the decisions in diagnostic cases and it matters more what the outcomes are for resource allocation cases. We also found that humans were consistently viewed as appropriate decision makers and AI was viewed as dehumanizing, and that participants perceived they were treated better when subject to diagnostic as opposed to resource allocation decisions. Thematic coding of open-ended text responses supported these results. We also outline the theoretical and practical implications of these findings. (shrink)

We discuss a case where medically optimal investigations of health problems in a donor-conceived child would require their egg donor to participate in genetic testing. We argue that it would be justified to contact the egg donor to ask whether she would consider this, despite her indicating on a historical consent form that she did not wish to take part in future research and that she did not wish to be informed if she was found to be a carrier of (...) a ‘harmful inherited condition’. We suggest that we cannot conjecture what her current answer might be if, by participating in clinical genetic testing, she might help reach a diagnosis for the donor-conceived child. At the point that she made choices regarding future contact, it was not yet evident that the interests of the donor-conceived child might be compromised by her answers, as it was not foreseen that the egg donor’s genome might one day have the potential to enable diagnosis for this child. Fertility consent forms tend to be conceptualised as representing incontrovertible historical boundaries, but we argue that rapid evolution in genomic practice means that consent in such cases is better seen as an ongoing and dynamic process. It cannot be possible to compel the donor to aid in the diagnosis of the donor-conceived child, but she should be given the opportunity to do so. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Impact of Clinicians on the Diagnostic ManualThomas A. Widiger (bio)Keywordsdiagnosis, classification, DSM, taxonomy, clinical judgmentSurveys of clinicians’ opinions can be very informative. There is a long tradition within medicine that new disorders are discovered within clinical practice. The original edition of the American Psychiatric Association’s (APA) diagnostic manual (DSM) was based in large part on clinical experience. The recent editions have been governed more heavily by (...) more systematic research (Widiger and Clark 2000), but many of the new additions are still said to come from clinical practice. As described for the development of DSM-III (APA 1980), “if there is general agreement among clinicians, who would be expected to encounter the condition, that there are a significant number of patients who have it and that its identification is important in their clinical work, it is included in the classification” (Spitzer, Sheehy, and Endicott 1977, 3).Clinicians can also be surveyed with regard to their opinions concerning a proposed revision. The ultimate consumers of a diagnostic manual are practicing clinicians and any effort to develop an official nomenclature should consider the opinions of the persons who must use the classification within their clinical practice (First et al. 2004; Sadler 2005). Clinicians can also be surveyed (or studied) with respect to how the diagnostic manual is being implemented. Much of this research has demonstrated that clinicians might be failing to apply the diagnostic manual in a reliable or valid manner (Garb 2005; Kutchins and Kirk 1997).It is perhaps obvious, however, that a diagnostic manual should not be governed primarily by clinical opinion or current clinical practice. The authors of DSM-III (APA 1980) and DSM-III-R (APA 1987) indicated that they would include a new diagnosis within the official nomenclature if a group of clinicians indicated that it was important to their clinical practice (Spitzer et al. 1977). This liberal threshold led to the decision of the DSM-III-R Task Force to include such diagnoses as paraphiliac rapism, self-defeating personality disorder, and sadistic personality disorder despite the lack of systematic research supporting their validity and the likelihood that these new diagnoses would have harmful social and forensic applications (Widiger 1995). These diagnoses no longer even appear within the appendix of DSM-IV-TR (APA 2000) for proposed diagnoses needing further study.The authors of DSM-III avoided opinion surveys because “no one wanted to repeat the scene of the general membership voting on a presumably ‘scientific’ issue, as was done in 1973 on the [End Page 277] issue of the elimination of homosexuality from the DSM-II classification” (Spitzer, Williams, and Skodol 1980, 152). Matters of construct validity should probably be addressed through systematic research rather than through opinion polls. Decisions should be informed by a fair hearing of the diversity of perspectives, and these viewpoints and perspectives should be systematically and enthusiastically solicited. Nevertheless, the most scientifically valid decision may at times be “politically incorrect.” The authors of the diagnostic manual should have the authority to make innovative decisions that are scientifically justified even when they are contrary to general clinical consensus (Widiger and Clark 2000).Some persons, though, do suggest that the diagnostic manual should be modeled on how disorders are being diagnosed within clinical practice. This is perhaps most readily evident in the proposals of Westen and Shedler (2000) to diagnose mental disorders via prototypal matching. They eschew the provision of specific and explicit criterion sets in favor of simply matching the patient to a global (e.g., paragraph description) of a prototypic case. A purported strength of this approach is that it is said to “conform to the way clinicians think about psychiatric diagnoses” (First and Westen 2007, 473).There are, however, concerns with respect to prototypal matching. First, it is not really clear that clinicians actually provide diagnoses in this manner. There are data to suggest that clinicians instead reach a diagnostic decision on the basis of just one or two individual diagnostic criteria rather than matching to a global prototype (Herkov and Blashfield 1995).More important, it is unclear whether the diagnostic manual should in fact emulate what is occurring within clinical practice. There is a... (shrink)

The following topics are considered: - 1) Computer-based medical consultation: good doctors have the capacity to make right guesses. - 2) Elementary diagnostic logic: illness as a boolean combination of signs or symptoms, diagnosis as a deductive process. - 3) Clinical decision under uncertainty: partial and/or elusive evidence, overlapping types. - 4) Local heuristic strategies: (1) statistical methods, (2) probabilistic (bayesian) methods, (3) fuzzy methods and Mycin-type expert systems. - 5) General heuristic strategies: representing medical knowledge (rules, nets, (...) frames), simulating expert behavior. - 6) Diagnostic inference and pattern recognition: natural species vs. expert judgement. (shrink)

The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, currently in its fourth edition and considered the reference for the characterization and diagnosis of mental disorders, has undergone various developments since its inception in the mid-twentieth century. With the fifth edition of the DSM presently in field trials for release in 2013, there is renewed discussion and debate over the extent of its relative successes - and shortcomings - at iteratively incorporating scientific evidence on the often (...) ambiguous nature and etiology of mental illness. Given the power that the DSM has exerted both within psychiatry and society at large, this essay seeks to analyze variations in content and context of various editions of the DSM, address contributory influences and repercussion of such variations on the evolving landscape of psychiatry as discipline and practice over the past sixty years. Specifically, we document major modifications in the definition, characterization, and classification of mental disorders throughout successive editions of the DSM, in light of shifting trends in the conceptualization of psychopathology within evolving schools of thought in psychiatry, and in the context of progress in behavioral and psychopharmacological therapeutics over time. We touch upon the social, political, and financial environments in which these changes took places, address the significance of these changes with respect to the legitimacy (and legitimization) of what constitutes mental illness and health, and examine the impact and implications of these changes on psychiatric practice, research, and teaching. We argue that problematic issues in psychiatry, arguably reflecting the large-scale adoption of the DSM, may be linked to difficulties in formulating a standardized nosology of psychopathology. In this light, we highlight 1) issues relating to attempts to align the DSM with the medical model, with regard to increasing specificity in the characterization of discrete mental disease entities and the incorporation of neurogenetic, neurochemical and neuroimaging data in its nosological framework; 2) controversies surrounding the medicalization of cognition, emotion, and behavior, and the interpretation of subjective variables as 'normal' or 'abnormal' in the context of society and culture; and 3) what constitutes treatment, enablement, or enhancement - and what metrics, guidelines, and policies may need to be established to clarify such criteria. (shrink)

BackgroundSevere brain injury is a leading cause of death and disability. Diagnosis and prognostication are difficult, and errors occur often. Novel neuroimaging methods can improve diagnostic and prognostic accuracy, especially in patients with prolonged disorders of consciousness (PDoC). Yet it is currently unknown how family caregivers understand this information, raising ethical concerns that disclosure of neuroimaging results could result in therapeutic misconception or false hope.MethodsTo examine these ethical concerns, we conducted semi-structured interviews with caregivers of patients with PDoC who (...) were enrolled in a concurrent neuroimaging research program designed to detect covert consciousness following severe brain injury. Caregivers held surrogate decision-making status for a patient. Interviews were conducted at two time points for each caregiver. The first interview occurred before the disclosure of neuroimaging results. The second occurred after disclosure. Descriptive analysis was applied to the data of four interview topics: (1) expectations for neuroimaging; (2) reactions to evidence of preserved cognition; (3) reactions to null results; and (4) understanding of the results and study.ResultsTwelve caregivers participated in the study; two caregivers shared surrogate decision-making status for one patient with PDoC. Twenty-one interviews were completed; one caregiver declined to participate in the post-disclosure interview. Three patients with PDoC associated with the study displayed evidence of covert consciousness. Overall, caregivers understood the neuroimaging research and results. Caregivers who received results of covert consciousness were generally pleased. However, there was some variation in expectations and reactions to these data and null results.ConclusionThis study, for the first time, reveals caregiver expectations for and reactions to neuroimaging evidence of covert consciousness in patients with PDoC. Caregivers understood the neuroimaging research and results, casting doubt on speculative ethical concerns regarding therapeutic misconception and false hope. However, disclosure of neuroimaging result could be improved. Pre-disclosure consultations might assist professionals in shaping caregiver expectations. Standardization of disclosure might also improve comprehension of the results. (shrink)

This book explores the epistemology and the methodology of political knowledge and social inquiry. What can we know, and how do we know? Friedrich V. Kratochwil and Ted Hopf question all foundational claims of inquiry and envisage science as a self-reflective practice. Brian Pollins and Fred Chernoff accept their arguments to some degree and explore the implications for logical positivism. David A. Waldner, Jack Levy, and Andrew Lawrence address the purpose and methods of research. They debate the role of explanation (...) versus prediction, the relationship of theory to evidence, and their implications for the Democratic Peace research program. A concluding chapter by Mark Lichbach offers a pluralistic reformulation of neopositivism. An alternative conclusion by Steven Bernstein, Richard Ned Lebow, Janice Gross Stein and Steven Weber contends that social science should be modeled on medicine and reformulated as a set of case-based diagnostic tools. The distinguishing feature of the book is the inclusion of authors who represent different approaches to social science and their willingness to engage with one another in a constructive debate. (shrink)

Studies of the role of imprinted genes in psychological phenomena are long overdue. The target article is comprehensive, presenting a wealth of important and convergent evidence, and provides an excellent point of departure for further research. However, the authors' evidentiary grasp exceeds the explicatory capacity of the proposed model. Greater genotypic and phenotypic precision would significantly enhance its predictive power.

Le mouvement posthumaniste, autre nom et radicalisation du transhumanisme, qui projette un homme dépassant sa condition corporelle par son hybridation aux machines, va bien avec notre temps. Ses partisans le conjuguent au futur : ils nous annoncent ce que l'avenir sera, sans s'embarrasser du moindre conditionnel hypothétique. Par leur assurance prophétique, ils veulent nous aspirer dans la spirale du temps technologique, renforçant ainsi la tyrannie du mode de vie que nous imposent déjà jour après jour les entrepreneurs du numérique, les (...) rois du silicium. Ce livre s'en prend d'abord aux deux arguments-phares du posthumanisme, celui de la liberté de "s'augmenter", de poursuivre le projet d'un homme émancipé de ses faiblesses naturelles, et celui des bienfaits de l'amélioration par les techniques. Il réfute sur leur propre terrain les fausses évidences sur lesquelles ces deux argumentaires reposent. Mais surtout, il élargit le débat à la question de l'emprise technologique sur nos sociétés, mettant en évidence le rôle de complice objective que joue à cet égard ce que l'auteur appelle la "Petite éthique", à savoir l'éthique libérale des droits individuels. Ainsi, le posthumanisme nous lance un défi démocratique : celui de se réapproprier notre avenir, c'est-à-dire de faire en sorte qu'il se conjugue non plus au futur obligé, mais au conditionnel politique. (shrink)

Evidence based medicine has much to offer, but a great deal remains to be done to create a better understanding of what it can and cannot do.The term EBM , as we use it nowadays, was introduced in 1992 by the same group of people who, years before, founded the discipline called “Clinical epidemiology” .1 CE stemmed essentially from the idea of adapting and expanding epidemiological methods to medical and health care decision making; CE was in fact defined as (...) “ the discipline dealing with the study of the occurrence of medical decisions in relation to their determinants”.1CE has been very successful in illustrating new ways of teaching medicine and training health professionals, and has positioned itself around the notion that “critical appraisal skills” are yet another set of essential abilities which—in addition to the interpersonal, diagnostic, and prognostic skills—a good doctor should master. An important by product of CE was documentation which showed that much of the available evidence on diagnosis, prognosis, and treatment of diseases was of poor methodological quality and quite often of dubious transferability to everyday clinical practice.This led to a strong call for improving the scientific basis of clinical practice, which was seen as too often dominated by practices of unproven effectiveness. This was the background for the 1992 Journal of the American Medical Association article that first used the term “evidence based medicine”.2In essence, proponents of EBM said that “all medical action of diagnosis, prognosis, and therapy should rely on solid quantitative evidence based on the best of …. (shrink)

This book explores the epistemology and the methodology of political knowledge and social inquiry. What can we know, and how do we know? Friedrich V. Kratochwil and Ted Hopf question all foundational claims of inquiry and envisage science as a self-reflective practice. Brian Pollins and Fred Chernoff accept their arguments to some degree and explore the implications for logical positivism. David A. Waldner, Jack Levy, and Andrew Lawrence address the purpose and methods of research. They debate the role of explanation (...) versus prediction, the relationship of theory to evidence, and their implications for the Democratic Peace research program. A concluding chapter by Mark Lichbach offers a pluralistic reformulation of neopositivism. An alternative conclusion by Steven Bernstein, Richard Ned Lebow, Janice Gross Stein and Steven Weber contends that social science should be modeled on medicine and reformulated as a set of case-based diagnostic tools. The distinguishing feature of the book is the inclusion of authors who represent different approaches to social science and their willingness to engage with one another in a constructive debate. (shrink)

Revised simulation theory allows mental state attributions containing some or all of the attributor's genuine, non-simulated mental states. It is thought that this gives the revised theory an empirical advantage, because unlike theory theory and rationality theory, it can explain egocentric bias. I challenge this view, arguing that theory theory and rationality theory can explain egocentricity by appealing to heuristic mindreading and the diagnosticity of attributors' own beliefs, and that these explanations are as simple and consistent as those provided by (...) revised simulation theory. (shrink)

In vitro fertilisation ‘add-ons’ are therapeutic or diagnostic tools developed in an endeavour to improve the success rate of infertility treatment. However, there is no conclusive evidence that these interventions are a beneficial or effective adjunct of assisted reproductive technologies. Additionally, IVF add-ons are often implemented in clinical practice before their safety can be thoroughly ascertained. Yet, patients continue to request and pay large sums for such additional IVF tools. Hence, this essay set out to examine if it (...) is ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it. In order to determine what is ethical—namely, morally good and righteous, the question was considered in relation to three key values of medical ethics—autonomy, beneficence and non-maleficence. It was determined that providing IVF add-ons might be morally acceptable in specific circumstances, if true informed consent can be given, there is a potential of cost-effective physiological or psychological benefit and the risk of harm is minimal, particularly with regard to the unborn child. (shrink)

BackgroundThis study aimed at standardizing and providing preliminary evidence on the clinical usability of the Italian telephone-based Verbal Fluency Battery, which includes phonemic, semantic and alternate verbal fluency tasks.MethodsThree-hundred and thirty-five Italian healthy participants and 27 individuals with neurodegenerative or cerebrovascular diseases were administered the t-VFB. Switch number and cluster size were computed via latent semantic analyses. HPs underwent the telephone-based Mental State Examination and Backward Digit Span. Construct validity, factorial structure, internal consistency, test-retest and inter-rater reliability and equivalence (...) with the in-person Verbal Fluency tasks were assessed. Norms were derived via Equivalent Scores. Diagnostic accuracy against clinical populations was assessed.ResultsThe majority of t-VFB scores correlated among each other and with the BDS, but not with the MMSE. Switch number correlated with t-PVF, t-SVF, t-AVF scores, whilst cluster size with the t-SVF and t-AVF scores only. The t-VFB was underpinned by a mono-component structure and was internally consistent. Test-retest and inter-rater reliability were optimal. Each t-VFB test was statistically equivalent to its in-person version. Education predicted all t-VFB scores, whereas age t-SVF and t-AVF scores and sex only some t-SVF scores. Diagnostic accuracy against clinical samples was optimal.DiscussionThe t-VFB is a valid, reliable and normed telephone-based assessment tool for language and executive functioning, equivalent to the in-person version; results show promising evidence of its diagnostic accuracy in neurological populations. (shrink)

ObjectiveMisophonia is an unusually strong aversion to a specific class of sounds – most often human bodily sounds such as chewing, crunching, or breathing. A number of studies have emerged in the last 10 years examining misophonia in adults, but little is known about the impact of the condition in children. Here we set out to investigate the well-being profile of children with misophonia, while also presenting the first validated misophonia questionnaire for children.Materials and MethodsWe screened 142 children using our (...) novel diagnostic [the Sussex Misophonia Scale for Adolescents ]. This allowed us to identify a group of children already manifesting misophonia at that age – the first population-sampled cohort of child misophonics examined to date. Children and their parents also completed measures of well-being and creative self-construct.ResultsData show that children with misophonia have significantly elevated levels of anxiety and obsessive compulsive traits. Additionally children with misophonia have significantly poorer life-satisfaction, and health-related quality of life. As predicted, they show no differences in creative self-construct.ConclusionTogether our data suggest the first evidence in population sampling of poorer life outcomes for children with misophonia, and provide preliminary convergent and discriminant validation for our novel misophonia instrument. Our data suggest a need for greater recognition and therapeutic outlets for adolescents with misophonia. (shrink)

The debate on the validity of the evidence-based medicine (EBM) paradigm in psychiatry and psychotherapy has tended to be rather polarized. Critics of the paradigm maintain that there is a basic conflict between the general knowledge of treatment of groups of patients ('techne') and the contextual understanding of individual patients ('phronesis'). This paper argues that the existence of firm general knowledge is crucial to the legitimacy of the psychiatric as well as the medical profession as a whole, and defends (...) the controlled clinical trial as a central instrument to establish such knowledge. At the same time, however, the paradigm does not solve the old Aristotelian techne–phronesis dilemma, which seems to be more or less inescapable. Focusing on psychotherapy, the paper discusses problems connected with the 'techne-oriented' use of diagnostic principles and of therapy manuals, the criteria for therapeutic progress, and the apparent conflict between experimental efficacy and practical effectiveness. (shrink)

Some brain injured patients are left in a permanent vegetative state, i.e., they have irreversibly lost their capacity for consciousness but retained some autonomic physiological functions, such as breathing unaided. Having discussed the controversial nature of the permanent vegetative state as a diagnostic category, we turn to the question of the patients’ ontological status. Are the permanently vegetative alive, dead, or in some other state? We present empirical data from interviews with relatives of patients, and with experts, to support (...) the view that the ontological state of permanently vegetative patients is unclear: such patients are neither straightforwardly alive nor simply dead. Having defended this view from counter-arguments we turn to the practical question as to how these patients ought to be treated. Some relatives and experts believe it is right for patients to be shifted from their currently unclear ontological state to that of being straightforwardly dead, but many are concerned or even horrified by the only legally sanctioned method guaranteed to achieve this, namely withdrawal of clinically assisted nutrition and hydration. A way of addressing this distress would be to allow active euthanasia for these patients. This is highly controversial; but we argue that standard objections to allowing active euthanasia for this particular class of permanently vegetative patients are weakened by these patients’ distinctive ontological status. (shrink)