For the successful achievement of evidence-based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a re-clarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to review outcome measures for (...) use in routine care settings. Central features include the user-centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence-based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care. (shrink)

Dr. Max Felix Silva, dean of the Graduate School of Philosophy and the senior students’ professor of critical theory, was still engrossed in discursively analyzing the transcripts of the peace negotiations between the government panel and the representatives of the Moro Islamic Liberation Front. He was trying to show his students the practical use of the German sociologist and philosopher Jürgen Habermas’ doctrine that in order to attain optimum results in a dialogue the participants should only use statements and actuations (...) that are truthful, sincere and appropriate all of the time. “Okay, class. You can be truthful but insincere, or you can be truthful and sincere but in an inappropriate way, or you can be appropriate and sincere but not truthful. The point of Habermas is simple: failing in just one of these triple criteria can already jeopardize the outcome of any consensus building. Ako ba ay nasusundan n’yo pa?”. (shrink)

Current focus in the health care ethics literature on the character of the practitioner has a reputable pedigree. Rather than offer a staple diet of Aristotelian ethics in the undergraduate curricula, perhaps instead one should follow Murdoch's suggestion and help the practitioner to develop vision and moral imagination, because this has a practical rather than a theoretical aim. The imaginative capacity of the practitioner plays an important part in both the quality of the nurse's role enactment and the moral strategies (...) which the nurse uses. It also plays a central part in the practitioner's ability to communicate with a patient and in the type of person which the practitioner becomes. Can the moral imagination be stimulated and nurtured? Some philosophers and literary critics argue that not only is this possible, but that literature is the means of doing so. If this is the case then a place should be made for literature in already crowded health care curricula. (shrink)

Compromise as a notion is frequently met in discussion and debate regarding many everyday decisions, including health care. It therefore seems that it may be of interest and value to try to give this some careful consideration. In the following pages, an attempt is made to discuss what one might mean when one uses this concept. Consideration is then given to some possible uses of compromise in health care. Having suggested that in certain situations compromise is a morally valuable process, (...) the author also considers some of the possible limits of compromise. (shrink)

A Charter on Medical Professionalism (CMA) has just recently been developed internationally, and the Canadian Medical Association is calling for public dialogue on medical professionalism now that reforms in the Canadian system of health care are imminent. We posit that good practices are at issue; we outline the essence of these in general and also specifically in the knowing, teaching and intervening components of practice. We also see challenges not to, but in, medical professionalism – first and foremost in the (...) profession's definition of good practices and the payer's confinement of insurance coverage to these. (shrink)

This exploratory study of ethical decision making by individuals in organizations found moral intensity, as defined by Jones (1991), to significantly influence ethical decision making intentions of managers. Moral intensity explained 37% and 53% of the variance in ethical decision making in two decision-making scenarios. In part, the results of this research support our theoretical understanding of ethical/unethical decision-making and serve as a foundation for future research.

Second harmonic generating (SHG) nanoprobes have recently emerged as versatile and durable labels suitable for in vivo imaging, circumventing many of the inherent drawbacks encountered with classical fluorescent probes. Since their nanocrystalline structure lacks a central point of symmetry, they are capable of generating second harmonic signal under intense illumination – converting two photons into one photon of half the incident wavelength – and can be detected by conventional two‐photon microscopy. Because the optical signal of SHG nanoprobes is based on (...) scattering, rather than absorption as in the case of fluorescent probes, they neither bleach nor blink, and the signal does not saturate with increasing illumination intensity. When SHG nanoprobes are used to image live tissue, the SHG signal can be detected with little background signal, and they are physiologically inert, showing excellent long‐term photostability. Because of their photophysical properties, SHG nanoprobes provide unique advantages for molecular imaging of living cells and tissues with unmatched sensitivity and temporal resolution. (shrink)

In this international and interdisciplinary collection of critical essays, distinguished contributors examine a crucial premise of traditional readings of Plato's dialogues: that Plato's own doctrines and arguments can be read off the statements made in the dialogues by Socrates and other leading characters. The authors argue in general and with reference to specific dialogues, that no character should be taken to be Plato's mouthpiece. This is essential reading for students and scholars of Plato.

Accounting ethics failures have seized headlines and cost investors billions of dollars. Improvement of the ethical reasoning and behavior of accountants has become a key concern for the accounting profession and for higher education in accounting. Researchers have asked a number of questions, including what type of accounting ethics education intervention would be most effective for accounting students. Some researchers have proposed virtue ethics as an appropriate moral framework for accounting. This research tested whether Smithian virtue ethics training, based on (...) Adam Smith’s “The Theory of Moral Sentiments”, is effective in improving accounting student’s cognitive moral development. This research used a pre-test, treatment, post-test, quasi-experimental design utilizing the Defining Issues Test 2 instrument to measure students’ CMD. Analysis of DIT-2 gain scores did show a significant improvement in subjects’ personal interest scores and a significant improvement in an overall measure of CMD, the DIT N2 index, whereas their DIT-2 post-conventional scores did not improve significantly. This research supports the proposition that the concepts contained in Smithian virtue ethics can contribute to an effective accounting ethics education intervention. However, further research is required to determine what concepts should be included to improve accounting students’ post-conventional moral reasoning. (shrink)

Salient stimuli presented at unattended locations are not always perceived, a phenomenon termed inattentional blindness. We hypothesized that inattentional blindness may be mediated by attentional inhibition. It has been shown that attentional inhibition effects are maximal near an attended location. If our hypothesis is correct, inattentional blindness effects should similarly be maximal near an attended location. During central fixation, participants viewed rapidly presented colored digits at a peripheral location. An unexpected black circle was concurrently presented. Participants were instructed to maintain (...) central fixation and name each color/digit, requiring focused attention to that location. For each participant, the critical stimulus was presented either near to or far from the attended location . In support of our hypothesis, inattentional blindness effects were maximal near the attended location, but only at intermediate task accuracy. (shrink)

Studying the similarities and differences in socio-communicative behavior between chimpanzees and bonobos is critical to increasing our understanding of the evolution of human sociality and communication. Both species rely heavily on the use of vocalizations during communicative interactions, although the form and function of these signals may vary between the two ape species. For example, bonobo vocalizations seem to be structurally more complex than those produced by chimpanzees, and calls seem to be directed to individuals not in immediate physical proximity. (...) Both species, however, make use of communicative signals from different modalities concurrently, particularly vocalizations and manual gestures. However, this multimodal communication is more commonly observed in chimpanzees when compared to bonobos, who more frequently use vocalizations exclusively, without signals from additional modalities. In addition, there are a number of marked differences in social characteristics between the two species. Though both species exhibit fission–fusion behavior, chimpanzees do so more often, potentially as a result of their habitat profile and foraging strategies. Differences also exist in terms of dominance and aggression. Chimpanzees live in largely patriarchal societies with strong male–male bonds, whereas bonobos tend to be matriarchal with strong female–female bonds. These differences in communicative and social characteristics are thought to be linked to the ecology of the respective habitats of the two apes and their strategies for resource exploitation. In all likelihood, similarities in feeding ecology played a crucial role in selecting for the advanced cognitive abilities of both species—e.g., producing meaningful communicative signals, regulating competition and group cohesion, and making and utilizing tools to aid in foraging. Similarly, differences in their respective habitats may have led to selection for characteristics resulting in the behavioral differences observed today between the two species. Therefore, a clearer understanding of the similarities and differences between the two species most closely related to humans will provide valuable information into our own evolution by elucidating those characteristics shared among humans and our ape ancestors and those derived in the hominin lineage. (shrink)

This volume attempts to show why ontology matters for a proper grasp of issues in bioethics. -/- Contemporary discussions on bioethics often focus on seeking solutions for a wide range of issues that revolve around persons. The issues in question are multi-layered, involving such diverse aspects as the metaphysical/ontological, personal, medical, moral, legal, cultural, social, political, religious, and environmental. In navigating through such a complex web of issues, it has been said that the central problems philosophers and bioethicists face are (...) ethical in nature. In this regard, biomedical sciences and technological breakthroughs take a leading role in terms of shaping the sorts of questions that give rise to ethical problems. For example, is it ethical to keep terminally ill patients alive on dialysis machines or artificial ventilators? Is it ethical to take someone’s vital organs upon death and transplant them into another person’s body without any prior consent from a deceased person? Reproductive techniques also raise complicated ethical issues involving in vitro fertilization, contraceptives, prenatal testing, abortions, and genetic enhancements. Moreover, biomedical issues raise ethical problems in regards to research on human subjects, stem cell research, and enhancement biotechnology. The beginning and end of life issues bring up their own complicated ethical conundrums involving, among other things, terminating life support and euthanasia. -/- This book approaches such complex bioethical questions by engaging in ground-level debates about the ontology of persons. This is a non-negotiable first step in taking steps forward in seeking a plausible solution(s) for the complex ethical problems in bioethics. Although the contributors in this book advance their arguments in their own ways, they all agree on one crucial methodological point: the importance of taking the ontology of persons for bioethics seriously. This is the spirit that brings the contributors of this book together as they seek to build their case(s) concerning the nature of persons. (shrink)

We characterize strict Mittag-Leffler modules in terms of free realizations of positive primitive formulas, and rings over which projectives are trivial in terms of various notions of separability of strict Mittag-Leffler modules. © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Sustainable products are engineered to reduce environmental, ecological, and human costs of consumption. Not all consumers value sustainable products, however, and this poses negative societal implications. Using self-expansion theory as a guide, we explore how an individual’s general sense of belonging—or the perception that one is accepted and valued by others in the broader social world—alters their responses to sustainable products. Five experimental studies and a field study demonstrate that individuals lower in belonging respond less favorably to sustainable products in (...) terms of evaluations and willingness to pay than individuals higher in belonging. Process evidence shows that the extent to which individuals low in belonging perceive that collective, sustainable choices will impact them personally drives this result and that belonging does not impact responses to conventional (i.e., non-sustainable) products. However, perceiving a shared human experience—or that individuals share some important, basic similarities with all people—attenuates the negative effect of low belonging on responses to sustainable products for consumers both low and high in belonging. This research has significant implications for businesses and society given the growing sense of disconnect in modern society. (shrink)

Few studies exist which look at psychological factors associated with physician sexual misconduct. In this study, we explore family dysfunction as a possible risk factor associated with physician sexual misconduct. Six hundred thirteen physicians referred to a continuing medical education (CME) course for sexual misconduct were administered the FACES-II survey, a validated and reliable measure of family dynamics. The survey was part of a self-learning activity. We collected data from February 2000 to February 2009. Participants were predominantly white, middle-aged males (...) who represented the full range of medical specialties. Their results were compared against a sample of 177 physicians. The FACES-II is a self-report test that measures family of origin (the family in which one was raised) dynamics on two dimensions (1) flexibility, ranging from too flexible (chaotic) to not flexible enough (rigid) and (2) cohesion ranging from too close (enmeshed) to not close enough (disengaged). The most common family pattern observed among physicians accused of sexual misconduct was rigid flexibility paired with disengaged cohesion, indicative of unhealthy family functioning. This pattern was significantly different than the pattern observed in the comparison group. Physicians who engage in sexual misconduct are more likely to have family of origin dysfunction. Ethics is developmental and learned in one’s family of origin. Family of origin dynamics may be one risk factor predisposing one to ethical violations. These findings have important implications for screening, education, and treatment across the medical education continuum. (shrink)

McGavin, PA The Holy Father often speaks without a prepared text, and it is amazing how accurately he reads in transcription. This was brilliantly so in Light of the World interviews. Even his brief words at pages 118-119 on condoms - so breathlessly and inaccurately treated in the media - are so cast as to withstand close scrutiny. It is with this recognition that I address his lack of precision and perception in speaking on the question of homosexuality and sacred (...) ordination. (shrink)

Health care organizations are increasingly asked to show accountability about their performance. This paper proposes that accountability can best be achieved through evaluative methods that are based on evidence regarding the relationship between processes of care and expected outcomes. Root cause analysis (RCA) is used as an illustration of how a generic method of inquiring can be transformed into an ongoing monitoring, evaluation, user education and accountability strategy. The role of performance indicators, as well as patient and community expectations, is (...) discussed. (shrink)

Rationale, aims and objectives To compare the pharmacotherapeutic approaches to diabetic hypertension of family physicians (FPs) and general practitioners (GPs). Methods A retrospective prescription-based study was conducted in 15 out of a total of 20 health centres, involving 115 primary care physicians – 77 FPs and 38 GPs, representing 74% of the primary care physicians of Bahrain. Prescriptions were collected during May and June 2000 to comprise a study population of 1266 diabetic-hypertensive patients. Results As monotherapy, angiotensin-converting enzyme (ACE) inhibitors (...) (37.9%) and β-blockers (38.3%) were the most commonly prescribed classes of antihypertensives by FPs and GPs, respectively. Calcium channel blockers (CCBs) were ranked third by both categories of physicians. For two-drug combinations, a β-blocker and an ACE inhibitor was the combination of choice for both physician categories. Patients managed by the FPs were more likely to receive a β-blocker–CCB combination (17.4 vs. 14.9%) or a diuretic–ACE inhibitor combination (16.7 vs. 11.4%) and less likely to receive a β-blocker–diuretic combination (11.8 vs. 16.7%) than those managed by the GPs. The proportion of patients receiving antihypertensive combinations was 40.6 and 38.5% for FPs and GPs, respectively. While the GPs prescribed CCB as a monotherapy to the elderly most often, the FPs choice was a β-blocker. Diuretics were less preferred by both FPs and GPs. β-Blocker–ACE inhibitor was again the most preferred combination of both FPs and GPs. FPs prescribed CCB–β-blocker combinations more often than GPs (P = 0.01), whereas CCB–ACE inhibitor combinations were less preferred (P = 0.09). A trend towards excessive use of short-acting nifedipine as monotherapy for elderly patients, both by FPs and by GPs, was noticed. Glibenclamide, alone or in combination with metformin, was the foremost antidiabetic drug prescribed by FPs and GPs. Middle-aged (45–64 years) patients seen by GPs were more likely to receive glibenclamide than those treated by FPs (P = 0.001) and less likely to receive gliclazide (P = 0.01). Combinations of a β-blocker with either glibenclamide or insulin were prescribed considerably more often by GPs.Conclusions Within the same practice setting, a substantial difference was observed between FPs and GPs in terms of preference for different classes of drugs in the management of diabetic hypertension. The compliance of both FPs and GPs was suboptimal; overall, the compliance of the FPs was closer to the recommended guidelines, however. Educational programmes should specifically address these inadequacies in order to improve the quality of health care. (shrink)

This study investigates the relative influences of professional values and selected demographic variables on the ethical perceptions of services marketing professionals. The relationship between ethical perceptions and ethical judgments of service marketers is also examined. The data were obtained from a mail survey of the American Marketing Association's professional members of service industries. The survey results indicate a positive relationship between a service professional's professional values and his/her perceptions of ethical problems. The results also suggest that ethical judgments of a (...) service professional can be partially explained by his/her perceptions of ethical problems. Implications of the research findings were discussed. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

This paper offers an account of a fallacy we will call bothsiderism, which is to mistake disagreement on an issue for evidence that either a compromise on, suspension of judgment regarding, or continued discussion of the issue is in order. Our view is that this is a fallacy of a unique and heretofore untheorized type, a fallacy of meta-argumentation. The paper develops as follows. After a brief introduction, we examine a recent bothsiderist case in American politics. We use this as (...) a pivot point to survey the theoretical literature on the fallacy. The most prominent theory is that bothsiderism is a case of dialogue-shifting. This view fails, we maintain, to explain how bothsiderism might be persuasive. We argue, rather, bothsiderism is a kind of meta-argumentative fallacy. (shrink)

The essays in this volume are based on addresses given during a colloquium on free logic, modal logic, and related areas held at the University of California in 1968. The majority of the contributors are well known for their writings in these fields and their papers are as illuminating as they are technical. In the first paper, Lambert and Bas C. Van Fraassen apply free logic to several controversies in quantified modal logic. One of these is Putman's argument that 'Nothing (...) is both red and green all over' can be had as a theorem of modal logic. Lambert and Van Fraassen provide a counter example to this claim and then show that the argument only holds in systems allowing possible individuals. Jaako Hintikka's essay also deals with 'free' modal logics in much the same way as Hintikka's other papers and discusses some of the criticisms of Quine of the entire enterprise of quantified modal logic. In another paper, H. Leblanc and R. K. Meyer provide truth-value semantics for the theory of types and hence an alternative semantic structure for functional calculi of any order. In addition to these essays, there are papers by R. Thomason and Dana Scott on modal logic, J. Vickers on probability logic, and Peter Woodruff on truth value gaps. To anyone interested in these various areas this collection is sure to be welcome.--R. P. M. (shrink)