Objective: To determine whether the marks in the third year Objective Structured Clinical Examination were affected by the collusion reported by the students themselves on an electronic discussion board.Design: A review of the student discussion, examiners’ feedback and a comparison of the marks obtained on the 2 days of the OSCE.Participants: 255 third year medical students.Setting: An OSCE consisting of 15 stations, administered on three sites over 2 days at a UK medical school.Results: 40 students contributed to the discussion on (...) the electronic discussion board. The main points raised were perceived inequity between students who did, or did not, have prior knowledge of the station content, and the lack of honesty and professionalism of their peers. Most contributors claimed to have received, or knew of others receiving, prior knowledge, but none confessed to passing on information. No significant difference was observed in the overall mark for the OSCE on day 1 ) and day 2 ). On day 2, marks were considerably greater for four stations and markedly lower for three stations. It was not obvious why collusion should affect these station marks. A clear indication of the effects of collusion could only be obtained from a single subsection of an individual station where 82 students on day 2 incorrectly gave the diagnosis from day 1.Conclusion: Marks do not provide a sound inference of student collusion in an OSCE and may mask the aspects of professional development of students. (shrink)

There is a popular hypothesis that performance on implicit and explicit memory tasks reflects 2 distinct memory systems. Explicit memory is said to store those experiences that can be consciously recollected, and implicit memory is said to store experiences and affect subsequent behavior but to be unavailable to conscious awareness. Although this division based on awareness is a useful taxonomy for memory tasks, the authors review the evidence that the unconscious character of implicit memory does not necessitate that it be (...) treated as a separate system of human memory. They also argue that some implicit and explicit memory tasks share the same memory representations and that the important distinction is whether the task (implicit or explicit) requires the formation of a new association. The authors review and critique dissociations from the behavioral, amnesia, and neuroimaging literatures that have been advanced in support of separate explicit and implicit memory systems by highlighting contradictory evidence and by illustrating how the data can be accounted for using a simple computational memory model that assumes the same memory representation for those disparate tasks. (shrink)

In this study we examine college cheating behaviors of business students compared to non-business students, and investigate possible antecedents to cheating in an effort to better understand why and when students cheat. We specifically examine power values; we found that they were positively related to academic cheating in our sample, and that choice of major (business or non-business) partially mediated the relationship between power values and cheating. We also considered the extent to which students provide justifications for their cheating, and (...) found that business students were more likely to justify (rationalize) their cheating behaviors. Finally, we update the literature in terms of the ways students cheat. We assess newer forms of academic cheating, as increased accessibility to information via the Internet and smartphones may have changed the ways and ease with which students cheat – a particularly relevant topic currently, as many classes have moved online during the COVID-19 pandemic. In our study, cheating was especially prevalent when taking quizzes or tests or completing homework online. We found that only 10% of participants reported never engaging in any of the cheating behaviors we examined. (shrink)

With the current problems surrounding the unethical behaviour of companies and the growth in public awareness of environmental issues, it was inevitable that governments would introduce legislation covering sensible company obligations. This paper examines the issues surrounding legislation in corporate social responsibility and attempts to relate them to stakeholder management. In the long run, companies that take an active interest in such legislation will be in a particularly strong position to develop strong market positioning strategies.

John Lavery's The First Wounded, London Hospital, August 1914 records a memorable event in the First World War. This painting and the archives of the Royal London Hospital provide a fascinating insight into the nursing and medical care of these early war casualties.

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

The intent of ethics is to establish a set of standards that will provide a framework to modify, regulate, and possibly enhance moral behaviour. Eleven focus groups were conducted with physicians from six culturally distinct countries to explore their perception of formalized, written ethical guidelines (i.e., codes of ethics, credos, value and mission statements) that attempt to direct their ethical practice. Six themes emerged from the data: lack of awareness, no impact, marginal impact, other codes or value statements supersede, personal (...) codes or values dictate, and ethical guidelines are useful. Overall, codes were valued only when they were congruent with existing personal morality. The findings suggest the need to re-evaluate the purpose, content, and delivery of codes for them to improve their function in promoting ethical conduct. (shrink)

Selection on grandparental investment is more complex than Coall & Hertwig (C&H) propose. Patterns of investment are subject to an intergenerational conflict over how resources should be distributed to maximize fitness. Grandparents may be selected to distribute resources unevenly, while their descendants will be selected to manipulate investment in their own favor. Here we outline the evolutionary basis of this conflict.

In their recent article, Erbay et al considered whether a seriously injured patient should be able to refuse treatment if the refusal was based on a (mis)interpretation of religious doctrine. They argued that in such a case ‘what is important…is whether the teaching or philosophy used as a reference point has been in fact correctly perceived’ (p 653). If it has not been, they asserted that this eroded the patient's capacity to make an autonomous decision and that therefore, in such (...) cases, it is the role of the healthcare professional (HCP) to ‘assist patients to think more clearly and rationally’ (p 653). There are, however, a number of problems with the reasons why Erbay et al suggest we should help patients to rationalise their decisions and how HCPs should go about this. In this article, the author explores some of their main arguments regarding consent and rationality (particularly in relation to religious beliefs), as well as Erbay et al's normative claim that HCPs have an obligation to promote autonomy by helping patients to come to a ‘rational’ decision. Ultimately, the author agrees that the (temporary) solution to the dilemma presented in this scenario (which was to insert an intravenous cannula into the patient in order to allow an infusion of fluids in the event that he changed his mind) seemed both pragmatic and ethically permissible. However, it is suggested that the arguments which underpin this conclusion in Erbay et al's article are largely unsound. (shrink)

This study viewed students majoring in public relations as prospective public relations practitioners and explored their perceptions about corporate social responsibility (CSR) as their job attraction condition. The results showed that the students perceived CSR to be an important ethical fit condition of a company. One of the significant findings is that CSR can be an effective reputation management strategy for prospective employees, particularly when a company’s business is suffering. In examining the effect of CSR efforts on attitudinal and behavioral (...) outcomes, person–organization (P–O) fit appeared to serve as a mediator between CSR performances and organizational attractiveness. (shrink)

This descriptive study was undertaken to identify the degree of ethical sensitivity of staff nurses and to analyze the differences in ethical sensitivity in terms of both general and ethics-related characteristics. Participants were 236 staff nurses working in general hospitals in Korea. Ethical sensitivity was measured by means of an instrument developed by the researchers. The results showed that the mean score for the degree of ethical sensitivity was 0.71 out of a possible maximum score of 1 (range 0.30 to (...) 0.97). For general characteristics, there was a significant difference in ethical sensitivity according to age (F (df 2233)-3.99, P-0.02). For characteristics related to ethics, there was a significant difference in ethical sensitivity according to attitude towards the nursing profession (F (df 4231)-2.94, P-0.03). It is therefore recommended that a training program reflecting these variables be developed to enhance staff nurses’ ethical sensitivity. (shrink)

This longitudinal study examined the development of moral judgement in 37 nursing students attending a university in Suwon, Korea. The participants completed the Korean version of the Defining Issues Test to allow analysis of their level of moral judgement. The development of moral judgement was quantified using ‘the moral development score’ at each stage (i.e. the six stages detailed by Kohlberg) and the ‘P(%) score’ (a measure of the overall moral judgement level). The results were as follows: (1) the moral (...) development score for stage 5A was consistently the highest across the four years of the students’ course, showing significant differences in some sociodemographic factors including home, birth order and monthly income; and (2) the P(%) score was higher in fourth-year (47.47 ± 11.21) than in first-year (46.13±9.73) students. There was no significant difference in the P(%) score according to sociodemographic factors. Further studies will examine in detail the correlation between curriculum and moral judgement development. We suggest that courses in ethics education should be made more relevant. (shrink)

Background Metaphors are central to the human understanding of complex issues; through the immediate associations they evoke and frame problems and suggest solutions. Our suggestion of Music in the Park as a metaphor for health systems reform brings to the forefront the environmentally diverse but bounded spaces of health services that offer a variety of attractors within their confines, while pushing into the background organizational and economic concerns.Reflections Parks, like health services, are embedded in their local landscape, serving their (...) communities, but most importantly parks are public spaces, publically funded, ideally offering universal access and equity and to be shared by all who want to go there.Music, like health, is tangible, technical and scientific, yet ultimately experiential and based on meaning. While it encompasses a wide range of styles and approaches, music making requires as its most important skill active listening which brings with it to be ‘in the moment’, to take personal risks and to draw energy and inspiration from the participants. Hence ‘audiences’ are equally active participants because music only has meaning if it internally resonates with the listener and only can exist in what is a co-constructed experience.Conclusions Music in the Park is a metaphor for primary health care systems based on shared values of experts and unique local communities. Health professionals are players in this arena, who develop and practise the full range of their skills in response to individual and community needs and preferences. Their leadership works through inspiration and empowerment, making patients ‘co-producers’ of their own health and ‘co-shapers’ of their health services. (shrink)

The aim of the study is to develop theoretic and methodological recommendations and practical activities for the positive social, managerial, organizational and economic development of historical and cultural tourist destinations. In theoretical terms: the role of historical and cultural tourist destination in the development of the region has been established; the historical and cultural tourist destinations have been identified; the author’s classification of historical and cultural tourist destinations has been developed basing tourist visiting activeness; the author’s methodological approach to the (...) diagnosis and creating tools for development of historical and cultural tourist destinations, comprehensively taking into account resource and factor components, has been presented. In practical terms: variations of the activities aimed at the positive development of historical and cultural tourist destinations have been proposed; the description of measures aimed at the creation of a historical and cultural complex on the example of the designed historical and cultural complex “Stara Samar” has been given. The results of the study are applicable for a wide range of historical and cultural tourist attractions: territories, landscapes and elements of landscapes, historical settlements, parks, film studios, historical and cultural heritage sites, history and culture monuments, burial sites, places of worship, sites of social cultural infrastructure. The author’s recommendations provide obtaining commercial results and ensuring a social and cultural effect for businessmen, managers, local communities in the management of existing or in the creation of new historical and cultural tourist destinations. (shrink)

This paper investigates a well-known case of simultaneous discovery in twentieth-century chemistry, the origins of the concept of hybridisation, in the light of Kuhn's insights. There has been no ambiguity as to who discovered this concept, when it was "rst in print, and how important it was. The full-#edged form of the concept was published in 1931 independently by two American scientists John C. Slater (1900}1976) and Linus Pauling (1901}1994), although both of them had made their ideas public earlier: Slater (...) at the American Physical Society meetings in 1930, and Pauling in the Proceedings of the National Academy of Sciences in 1928. Slater and Pauling both argued for the necessity of using an s orbital as well as three p orbitals in the carbon atom in order to explain carbon's four valences and the tetrahedral structure of methane. The metaphor &hybridisation' for denoting this mix of s and p orbitals was "rst used by Robert S. Mulliken and J. H. Van Vleck before gaining currency with the scienti"c community around 1935.2 The concept of hybridisation was indeed indispensable for extending the quantum-mechanical interpretation of the chemical bond as an electron pairing from diatomic molecules to polyatomic ones. To be sure, the emergence of hybridisation attests to scientists' growing interest in exploring the borderland between physics and chemistry, a trend that led to the creation of physical chemistry in the late nineteenth century and of chemical physics and quantum chemistry in the 1920s and 30s. Slater and Pauling themselves experienced and on many occasions talked about the fruitfulness of interdisciplinary research; and historians have legitimately illuminated their works by examining them in this broad context.3 Yet the careful analysis of their research notes and published papers reveals that Slater and Pauling were working in quite disparate disciplinary traditions, with di!erent approaches, for di!erent audiences, and towards di!erent goals. The aim of this paper is to explore their di!erent routes to a common destination*hybridisation*and thereby to explicate tensions existing between physics and chemistry amidst the institutional and conceptual overlapping of the two disciplines. (shrink)

This paper critically examines two objections and raises a new objection against the besire theory of moral judgment. Firstly, Smith (1994) observes that a belief that p tends to expire whereas a desire that p tends to endure on the perception that not p. His observation does not refute the sophisticated version of the besire theory that to besire that p is to believe that p and to desire to act in accordance with the belief that p. Secondly, Zangwill (2008) (...) claims that the strength of motivation may vary while the degree of belief remains constant. Besirists would reply that a besire admits of both degree and strength. Finally, I argue that the belief that p endures while the desire to act on the belief that p expires with the introduction of a new bodily condition, and hence that the belief and the desire are distinct mental states. (shrink)

This paper revisits the “Hwang case,” which shook Korean society and the world of stem cell research in 2005 with the fraudulent claim of creating patient-specific embryonic stem cells. My goal is to overcome a human-centered, Korea-oriented narrative, by illustrating how materials can have an integral role in the construction and judgment of fraud. To this end, I pay attention to Woo Suk Hwang’s lab at Seoul National University as a whole, including human and nonhuman agents, that functioned as what (...) I call sociomaterial technology, and Gerald P. Schatten at the University of Pittsburgh, Hwang’s collaborator, who played a crucial role in demonstrating the potency of this technology to the members of the scientific community. By recasting the whole event as the “case of Hwang and Schatten,” I argue that fraud is, like all knowledge claims, a sociotechnical construct, and that matters of fraud are locally judged. Fraud leaves its mark on materials, but I show that material evidence alone never tells the whole story and instead can be used to limit the range of responsibility. (shrink)

BackgroundAlthough the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.MethodsThis multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from (...) January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.ResultsOf 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).ConclusionsAfter the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed. (shrink)

Clinical trials play a prominent role today in medicine, but are not without controversy. These issues start from the day physicians begin their specialization process in medical school and continues onto their day-to-day practice as attendings with referral patterns and resulting financial incentives. This combined with the lack of training in basic issues of epistemology and statistics, allows poor interpretations of clinical trials to reign free. A proposal to integrate the notion of severity to help remedy these issues are made (...) by ensuring that studies are tested “As Severe As Reasonably Possible” will put P-values, multiplicity adjustments, and model checking in their rightful place. In light of this, multiple clinical trials are examined with an in-depth analysis of erroneous statistical inferences taken from phase III randomized trials, non-inferiority, early phase, as well as observational studies. Severe testing in the setting of medicine will help with alleviate some of the issues with the current misinterpretation of clinical studies. (shrink)

This volume grew out of a dissatisfaction with some issues that seem to be rooted in the Empiricist tradition. At least since Locke, that which is perceived has enjoyed a major share in any systematic account of what we claim to know. A main purpose of this study therefore is first to distinguish, and subsequently to relate, what can be perceived and what can be under stood. To this end, the account of persons and personal identity begins with a description (...) of selected types of sense perceptions. While writing a good part of the discussion on vision, I had the advantage of questioning Dr. P. B. Loder about the properties of light. She not only clarified some issues, but prevented several errors from creeping into the text, a result for which I am very grateful. I should like also to express my appreciation to Mrs. G. K. Stamm-Okkinga, who provided hospitality and a friendly interest from the beginning of this study. Finally I wish to thank Miss I. Ris and Mr. W. de Regt for their careful and resourceful preparation of the typescript. (shrink)

Westworld is a television series on HBO (2016–present), based on a movie of the same name by Michael Crichton. The plot of the show is wide-reaching. The first season shows us an adult theme park where android “hosts” serve the wealthy “guests.” Seasons two and three show the attempt of the hosts to escape this servitude, and then, in a twist, help humans do the same outside of the parks. This chapter links all three seasons of Westworld to theories (...) of colonization. First, it explores the types of colonialism as they pertain to Westworld. Then it looks at the various scopes of colonization in Westworld – the colonization of space, time, and psychic space. Next, it explores the psychology of colonizers and the colonized as it pertains to the show. Lastly, it explores possible forms of liberation from colonization that the show has to offer. (shrink)

BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled multi-center study (...) was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (−8.5%) and non-mentored (−13.9%) residents (p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50).ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice. (shrink)

BackgroundThe Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of futile life-sustaining treatment, and its enactment caused a big controversy in Korean society. However, no study has evaluated whether the actual implementation of life-sustaining treatment has decreased after the enforcement of this law. This study aimed to compare the provision of patient consent before and after the enforcement of this law among cancer patients who visited a tertiary university (...) hospital's emergency room to understand the effects of this law on the clinical care of cancer patients.MethodsThis retrospective single cohort study included advanced cancer patients aged over 19 years who visited the emergency room of a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the length of hospital stay. The consent rates to perform cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes.ResultsThe length of hospital stay decreased after the law was enforced from 4 to 2 days (p = 0.001). The rates of direct transfers to secondary hospitals and nursing hospitals increased from 8.2 to 21.2% (p = 0.001) and from 1.0 to 9.7%, respectively (p < 0.001). The consent rate for admission to the ICU decreased from 6.7 to 2.3% (p = 0.032). For CPR and CRRT, the consent rates decreased from 1.0 to 0.0% and from 13.9 to 8.8%, respectively, but the differences were not significant (p = 0.226 and p = 0.109, respectively).ConclusionAfter the enforcement of the Life Extension Medical Decision law, the length of stay in the tertiary university hospital decreased in patients who established their life-sustaining treatment plans in the emergency room. Moreover, the rate of consent for ICU admission decreased. (shrink)