We discuss our surgical philosophy concerning the subtle interplay between the size of the surgical margin taken and the resultant morbidity from ablative oncological. procedures, which is ever more evident in the treatment of head and neck malignancy. The extent of tissue resection is determined by the "trade off" between cancer control and the perioperative, functional and aesthetic morbidity and mortality of the surgery. We also discuss our dilemmas concerning recent minimally invasive endoscopic microsurgical. techniques for the trans-oral laser removal. (...) or co-ablation of aero-digestive tract tumours, which result in a minimal. surgical margin of oncological clearance. By a process of inductive argument as to the nature of the surgical margin, we consider whether the risks of taking a lesser margin with adjuvant therapy is justified by the attendant gain in reduced surgical morbidity and the possible costs in tumour control. (c) 2006 Elsevier Ltd. All rights reserved. (shrink)

A clinical trial on mitochondrial replacement therapy is currently being conducted and if this technique proves effective, National Health Service England will fund MRT through the highly specialised services funding stream. This paper considers whether MRT should be publicly funded by the NHS. Given the current financial pressure the NHS is experiencing, a comprehensive discussion is essential. There is yet to be a thorough discussion on MRT funding, perhaps because this is a small-scale issue and presumed to be covered by (...) the HSS budget. However, the source of funding has not been confirmed due to the trial’s incompletion. Upon its completion, reasoned decisions need to be made over the allocation of scarce NHS resources. It is therefore important to consider the following arguments in advance. Three arguments given against NHS funding of MRT will be evaluated. The first argument against NHS funding examines the HSS overspending its budget in an underfunded NHS, suggesting funding must be carefully reprioritised. Second, the ethical issue of allowing public access to a technique with insufficient evidence behind it will be explored. The final point considers the option of privately funding MRT and how this would affect the treatment’s development. After illustrating the weaknesses of such arguments, it will be concluded that MRT should be funded by the NHS. (shrink)

This is a transcript of a conversation between P F Strawson and Gareth Evans in 1973, filmed for The Open University. Under the title 'Truth', Strawson and Evans discuss the question as to whether the distinction between genuinely fact-stating uses of language and other uses can be grounded on a theory of truth, especially a 'thin' notion of truth in the tradition of F P Ramsey.

We take no issue with John Nolt's calculations in ‘How harmful are the average American's greenhouse gas emissions?’. That is, we accept that over the course of a typical American life...

The wicked problems that constitute sustainability require students to learn a different set of ethical skills than is ordinarily required by professional ethics. The focus for sustainability ethics must be redirected towards: (1) reasoning rather than rules, and (2) groups rather than individuals. This need for a different skill set presents several pedagogical challenges to traditional programs of ethics education that emphasize abstraction and reflection at the expense of experimentation and experience. This paper describes a novel pedagogy of sustainability ethics (...) that is based on noncooperative, game-theoretic problems that cause students to confront two salient questions: “What are my obligations to others?” and “What am I willing to risk in my own well-being to meet those obligations?” In comparison to traditional professional ethics education, the game-based pedagogy moves the learning experience from: passive to active, apathetic to emotionally invested, narratively closed to experimentally open, and from predictable to surprising. In the context of game play, where players must make decisions that can adversely impact classmates, students typically discover a significant gap between their moral aspirations and their moral actions. When the games are delivered sequentially as part of a full course in Sustainability Ethics, students may experience a moral identity crisis as they reflect upon the incongruity of their self-understanding and their behavior. Repeated play allows students to reconcile this discrepancy through group deliberation that coordinates individual decisions to achieve collective outcomes. It is our experience that students gradually progress through increased levels of group tacit knowledge as they encounter increasingly complex game situations. (shrink)

Pro-anorexia is an Internet-based movement that provides advice and support for the development/maintenance of an eating disorder. The movement is sometimes framed as a religion, with rituals, psalms, creeds and the invocation of a deity who personifies the ED. The latter aspect is likely to influence identities and behaviours as well as providing emotional support and motivation for community members. However, there is little sustained empirical analysis of how members themselves orient to and self-position within the religious discourse. Here, we (...) apply the concept of interdiscursivity to examine the construction of Ana as god. Drawing on a body of online interactions from one pro-ana website over a 47-day period, we discursively analyse members’ constructions of Ana and their relationship with her. With reference to biblical texts, we consider how these constructions directly reference concepts of Christian religion and faith. Implications for understanding pro-ana and interdiscursivity are discussed. (shrink)

Mestre, MacCann, Guil, and Roberts propose a model that suggests emotion regulation provides the mechanism through which ability emotional intelligence influences important outcomes. We argue that important nuance in our understanding of people’s choice of emotion regulation strategy can be gained by incorporating personality constructs such as trait emotional intelligence within this model.

It has been over two decades since Miranda Fricker labeled epistemic injustice, in which an agent is wronged in their capacity as a knower. The philosophical literature has proliferated with variants and related concepts. By considering cases in popular music, we argue that it is worth distinguishing a parallel phenomenon of art-interpretive injustice, in which an agent is wronged in their creative capacity as a possible artist. In section 1, we consider the prosecutorial use of rap lyrics in court as (...) a central case of this injustice. In section 2, we distinguish art-interpretive injustice from other categories already discussed in recent literature. In section 3, we discuss the relationship between genre discourse and identity prejudice. The case for recognizing the category of art-interpretive injustice is that it allows one to recognize a class of harms as being importantly related in ways that one would otherwise overlook. (shrink)

While strike action has been common since the industrial revolution, it often invokes a passionate and polarising response, from the strikers themselves, from employers, governments and the general public. Support or lack thereof from health workers and the general public is an important consideration in the justification of strike action. This systematic review sought to examine the impact of strike action on patient and clinician attitudes, specifically to explore (1) patient and health worker support for strike action and (2) the (...) predictors for supporting strike action and the reasons given for engaging in strike action. A systematic scoping review was employed to identify all relevant literature, followed by a textual narrative synthesis. A total of 34 studies met inclusion criteria. Support for strike action was largely context‐dependent. A range of factors impact support for strike action; broader cultural and structural factors, such as unionisation and general acceptance of strike action; systemic factors, such as the nature of the healthcare system, including infrastructure and work conditions; the strike itself and a range of individual factors, the most notable of which was being a student or in an early career stage. There were also some surprising results, for example, during doctors strike, nurses were provided with the opportunity to expand their role, which led to greater professional autonomy and job satisfaction. (shrink)

Using a fictional but representative general practice consultation, involving the diagnosis of irritable bowel syndrome in a patient who is anxious for some relief from the discomfort his condition entails, this paper argues that when both a drug fails to out-perform placebo and the condition in question is a functional illness with no demonstrable underlying pathology, then the action of the drug is not only no better than placebo, and it is also no different from it either. The paper also (...) argues that, in the circumstances of the consultation described, it is striking that current governance deems it ethical for a practitioner to prescribe either a drug or a placebo, both of which appear to rely for their effectiveness on a measure of concealment on the part of the doctor, yet deems it unethical for a practitioner openly to prescribe a harmless and enjoyable substance which is likely to be no less effective than either drug or placebo and is also likely to be better-tolerated and cheaper than the drug. (shrink)

Using covariant derivatives and the operator definitions of quantum mechanics, gauge invariant Proca and Lehnert equations are derived and the Lorenz condition is eliminated in U(1) invariant electrodynamics. It is shown that the structure of the gauge invariant Lehnert equation is the same in an O(3) invariant theory of electrodynamics.

Using national opinion survey data, this research addressed claims in political science that the American electorate is either poorly informed or dependent on party label cues. The results suggested that in situations with missing information, American voters can use their knowledge to successfully infer political party membership of candidates and vote their own party interests.

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by (...) a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

Two experiments examined the typicality structure of contrasting political categories. In Experiment 1, two separate groups of participants rated the typicality of 15 individuals, including political figures and media personalities, with respect to the categories Democrat or Republican. The relation between the two sets of ratings was negative, linear, and extremely strong, r = −.9957. Essentially, one category was treated as a mirror image of the other. Experiment 2 replicated this result, showing some boundary conditions, and extending the result to (...) liberal and conservative categories. The same method was applied to two other pairs of contrasting categories, healthy and junk foods, and male and female jobs. For those categories, the relation between contrasting pairs was weaker and there was less of a direct trade-off between typicality in one category versus typicality in its opposite. The results are discussed in terms of implications for political decision making and reasoning, and conceptual representation. (shrink)

Background Ethical climate refers to the shared perception of ethical norms and sets the scope for what is ethical and acceptable behaviour within teams. Aim This paper sought to explore perceptions of ethical climate amongst healthcare workers as measured by the Ethical Climate Questionnaire (ECQ), the Hospital Ethical Climate Survey (HECS) and the Ethics Environment Questionnaire (EEQ). Methods A systematic review and meta-analysis was utilised. PSYCINFO, CINAHL, WEB OF SCIENCE, MEDLINE and EMBASE were searched, and papers were included if they (...) sampled healthcare workers and used the ECQ, HECS or EEQ. Ethical consideration Ethical approval was not required. Results The search returned 1020 results. After screening, 61 papers were included ( n = 43 HECS, n = 15 ECQ, n = 3 EEQ). The overall sample size was over 17,000. The pooled mean score for the HECS was 3.60. Mean scores of individual studies ranged from 2.97 to 4.5. For the HECS studies, meta-regression was carried out. No relationship was found between the country of the studies, the study setting (ICU v non-ICU settings) or the mean years of experience that the sample had. For the ECQ, sub-scales had mean scores ranging from 3.41 (instrumental) to 4.34 (law) and were all observed to have significant and substantial heterogeneity. Three studies utilised the EEQ so further analysis was not carried out. Conclusions The above results provide insight into the variability of scores as measured by the HECS, ECQ and EEQ. To some extent, this variability is not surprising with studies carried out across 21 countries and in a range of healthcare systems. Results also suggest that it may be that more local and context specific factors are more important when it comes to predicting ethical climate. (shrink)

Dreyfus's model of expert skill acquisition is philosophically important because it shifts the focus on expertise away from its social and technical externalization in STS, and its relegation to the historical and psychological context of discovery in the classical philosophy of science, to universal structures of embodied cognition and affect. In doing so he explains why experts are not best described as ideologues and why their authority is not exclusively based on social networking. Moreover, by phenomenologically analyzing expertise from a (...) first person perspective, he reveals the limitations of, and sometimes superficial treatment that comes from, investigating expertise from a third person perspective. Thus, he shows that expertise is a prime example of a subject that is essential to science but can only be fully elaborated with the aid of phenomenological tools. However, both Dreyfus's descriptive model and his normative claims are flawed due to the lack of hermeneutical sensitivity. He assumes an expert's knowledge has crystallized out of contextual sensitivity plus experience, and that an expert has shed, during the training process, whatever prejudices, ideologies, hidden agendas, or other forms of cultural embeddedness, that person might have begun with. One would never imagine, from Dreyfus's account, that society could possibly be endangered by experts, only how society's expectations and actions could endanger experts. The stories of actual controversies not only shows things do not work the way Dreyfus claims, but also that it would be less salutary if they did. Such stories amount to counterexamples to Dreyfus's normative claims, and point to serious shortcomings in his arguments. (shrink)

Many adoptees face a number of challenges relating to separation from biological parents during the adoption process, including issues concerning identity, intimacy, attachment, and trust, as well as language and other cultural challenges. One common health challenge faced by adoptees involves lack of access to genetic-relative family health history. Lack of GRFHx represents a disadvantage due to a reduced capacity to identify diseases and recommend appropriate screening for conditions for which the adopted person may be at increased risk. In this (...) article, we draw out common features of traditionally understood “health disparities” in order to identify analogous features in the context of adoptees’ lack of GRFHx. (shrink)

To demarcate the limits of experimental knowledge, we probe the limits of what might be called an experiment. By appeal to examples of scientific practice from astrophysics and analogue gravity, we demonstrate that the reliability of knowledge regarding certain phenomena gained from an experiment is not circumscribed by the manipulability or accessibility of the target phenomena. Rather, the limits of experimental knowledge are set by the extent to which strategies for what we call ‘inductive triangulation’ are available: that is, the (...) validation of the mode of inductive reasoning involved in the source-target inference via appeal to one or more distinct and independent modes of inductive reasoning. When such strategies are able to partially mitigate reasonable doubt, we can take a theory regarding the phenomena to be well supported by experiment. When such strategies are able to fully mitigate reasonable doubt, we can take a theory regarding the phenomena to be established by experiment. There are good reasons to expect the next generation of analogue experiments to provide genuine knowledge of unmanipulable and inaccessible phenomena such that the relevant theories can be understood as well supported. This article is part of a discussion meeting issue ‘The next generation of analogue gravity experiments’. (shrink)

Health care is transitioning from genetics to genomics, in which single-gene testing for diagnosis is being replaced by multi-gene panels, genome-wide sequencing, and other multi-genic tests for disease diagnosis, prediction, prognosis, and treatment. This health care transition is spurring a new set of increased or novel liability risks for health care providers and test laboratories. This article describes this transition in both medical care and liability, and addresses 11 areas of potential increased or novel liability risk, offering recommendations to both (...) health care and legal actors to address and manage those liability risks. (shrink)

Dobbs v. Jackson Women’s Health continues a trajectory of U.S. Supreme Court jurisprudence that undermines the normative foundation of public health — the idea that the state is obligated to provide a robust set of supports for healthcare services and the underlying social determinants of health. Dobbs furthers a longstanding ideology of individual responsibility in public health, neglecting collective responsibility for better health outcomes. Such an ideology on individual responsibility not only enables a shrinking of public health infrastructure for reproductive (...) health, it facilitates the rise of reproductive coercion and a criminal legal response to pregnancy and abortion. This commentary situates Dobbs in the context of a long historical shift in public health that increasingly places burdens on individuals for their own reproductive health care, moving away from the possibility of a robust state public health infrastructure. (shrink)

BackgroundPlagiarism is common and threatens the integrity of the scientific literature. However, its detection is time consuming and difficult, presenting challenges to editors and publishers who are entrusted with ensuring the integrity of published literature.MethodsIn this study, the extent of plagiarism in manuscripts submitted to a major specialty medical journal was documented. We manually curated submitted manuscripts and deemed an article contained plagiarism if one sentence had 80 % of the words copied from another published paper. Commercial plagiarism detection software (...) was utilized and its use was optimized.ResultsIn 400 consecutively submitted manuscripts, 17 % of submissions contained unacceptable levels of plagiarized material with 82 % of plagiarized manuscripts submitted from countries where English was not an official language. Using the most commonly employed commercial plagiarism detection software, sensitivity and specificity were studied with regard to the generated plagiarism score. The cutoff score maximizing both sensitivity and specificity was 15 % (sensitivity 84.8 % and specificity 80.5 %).ConclusionsPlagiarism was a common occurrence among manuscripts submitted for publication to a major American specialty medical journal and most manuscripts with plagiarized material were submitted from countries in which English was not an official language. The use of commercial plagiarism detection software can be optimized by selecting a cutoff score that reflects desired sensitivity and specificity. (shrink)

A recent series of experiments have demonstrated that a classical fluid mechanical system, constituted by an oil droplet bouncing on a vibrating fluid surface, can be induced to display a number of behaviours previously considered to be distinctly quantum. To explain this correspondence it has been suggested that the fluid mechanical system provides a single-particle classical model of de Broglie’s idiosyncratic ‘double solution’ pilot wave theory of quantum mechanics. In this paper we assess the epistemic function of the bouncing oil (...) droplet experiments in relation to quantum mechanics. We find that the bouncing oil droplets are best conceived as an analogue illustration of quantum phenomena, rather than an analogue simulation, and, furthermore, that their epistemic value should be understood in terms of how-possibly explanation, rather than confirmation. Analogue illustration, unlike analogue simulation, is not a form of ‘material surrogacy’, in which source empirical phenomena in a system of one kind can be understood as ‘standing in for’ target phenomena in a system of another kind. Rather, analogue illustration leverages a correspondence between certain empirical phenomena displayed by a source system and aspects of the ontology of a target system. On the one hand, this limits the potential inferential power of analogue illustrations, but, on the other, it widens their potential inferential scope. In particular, through analogue illustration we can learn, in the sense of gaining how-possibly understanding, about the putative ontology of a target system via an experiment. As such, the potential scientific value of these extraordinary experiments is undoubtedly a significant one. (shrink)