Are psychotherapy clients who pay via health insurance more likely to receive Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994) diagnoses than identical clients who pay out of pocket? Previous research (Kielbasa, Pomerantz, Krohn, & Sullivan, 2004) indicates that when psychologists consider a mildly depressed or anxious client, payment method significantly influences diagnostic decisions. This study extends the scope of the previous study to include clients whose symptoms are even less severe. (...) Independent practitioners responded to vignettes of clients whose profiles deliberately included subclinical impairment and a high level of functioning. Half of the participants were told that the clients would pay via managed care; the other half were told that the clients would pay out of pocket. As in the earlier study, payment method had a highly significant impact on diagnosis such that relative to out-of-pocket clients, managed care clients were much more likely to be assigned DSM-IV diagnoses. In addition, a noteworthy percentage of participants assigned diagnoses regardless of payment method. Ethical implications are discussed. (shrink)

To what extent does payment method (managed care vs. out of pocket) influence the likelihood that an independent practitioner will assign a Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) diagnosis to a client? When a practitioner does diagnose, how does payment method influence the specific choice of a diagnostic category? Independent practitioners responded to a vignette describing a fictitious client with symptoms of depression or anxiety. In half of the vignettes, the fictitious (...) client intended to pay via managed care; in the other half, the fictitious client intended to pay out of pocket. Payment method had a very significant impact on diagnosis such that relative to out-of-pocket clients, managed care clients were much more likely to receive diagnoses and more likely to receive adjustment disorder diagnoses in particular. We discuss implications involving informed consent and other ethical issues. (shrink)

Maximum deviation global discrimination index is a new item selection method for cognitive diagnostic computerized adaptive testing that allows for attribute coverage balance. We developed the maximum limitation global discrimination index from MDGDI, which allows for both attribute coverage balance and item exposure control. MLGDI can realize the attribute coverage balance and exposure control of the item. Our simulation study aimed to evaluate the performance of our new method against maximum global discrimination index, modified maximum GDI, standardized (...) weighted deviation GDI, and constraint progressive with SWDGDI. The results indicated that under the condition of realizing the attribute coverage balance, MDGDI had the highest attribute classification accuracy; when the selection strategy accommodated the practical constraints of the attribute coverage balance and item exposure control, MLGDI had the highest attribute classification accuracy; adding the item exposure control mechanism to the item selection method reduces the classification accuracy of the attributes of the item selection method; and compared with GDI, MMGDI, SWDGDI, CP_SWDGDI, and MDGDI, MLGDI can better achieve the attribute-coverage requirement, control item exposure rate, and attribute correct classification rate. (shrink)

Previous research (Kielbasa, Pomerantz, Krohn, & Sullivan, 2004; Pomerantz & Segrist, 2006) indicates that when psychologists consider a client with symptoms of depression or anxiety, payment method significantly influences diagnostic decisions. This study extends the scope of the previous research to consider clients with symptoms of social phobia and attention deficit hyperactivity disorder (ADHD). Psychologists in independent practice responded to vignettes of clients whose descriptions deliberately included subclinical impairment. Half of the participants were told that the clients would (...) pay via managed care; the other half were told that the clients would pay out-of-pocket. Confirming previous studies, payment method had a highly significant impact on diagnosis such that compared to out-of-pocket clients, managed care clients were much more likely to be assigned Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) diagnoses. Ethical implications relate to informed consent, accuracy and truthfulness in diagnosis, and psychologists' integrity. (shrink)

The aim of the article is to show how the use of diagnostic methods allows identifying patterns and problems of corporations functioning, providing identification of directions and strategies for further development of their business. Theoretical and methodological basis of the research is a scientific works of scientists in the field of business diagnostics and strategic development, who studied diagnostics in the system of responding to business development problems, identifying areas for improving strategic management, financial statements of corporations of Daimler (...) Group (Germany), Tesla Motors (USA) and Toyota Motor (Japan) and own research results. The methodological basis of the study is a set of general and special methods used to achieve the goal of the research and includes: theoretical generalization and synthesis – in analyzing the content of scientific works on business diagnostics and strategic management; observation – to obtain primary information about the state of business of automotive companies in the world; indicator and integrated assessment – to assess the state of business and the effectiveness of strategic management of automotive corporations; information and logical analysis – when determining the issues and patterns of business development of corporations; problem-target method – to justify the choice of business development strategies; causation-result method – to obtain definitive conclusions. The results of the study of the state of business of the world's leading automotive corporations revealed the dependence of business efficiency on the degree of efficiency of strategic management of their activities, and identified types of strategies that will promote further development of automotive corporations – integrated, concentrated, diversified or globalized growth. The practical significance of the obtained results lies in their usefulness for strategic management for Daimler Group, Tesla Motors, Toyota Motor Corporation. (shrink)

The purpose of cognitive diagnostic modeling is to classify students' latent attribute profiles using their responses to the diagnostic assessment. In recent years, each diagnostic classification model makes different assumptions about the relationship between a student's response pattern and attribute profile. The previous research studies showed that the inappropriate DCMs and inaccurate Q-matrix impact diagnostic classification accuracy. Artificial Neural Networks have been proposed as a promising approach to convert a pattern of item responses into a (...) class='Hi'>diagnostic classification in some research studies. However, the ANNs methods produced very unstable and unappreciated estimation unless a great deal of care was taken. In this research, we combined ANNs with two typical DCMs, the deterministic-input, noisy, “and” gate model and the deterministic-inputs, noisy, “or” gate model, within a semi-supervised learning framework to achieve a robust and accurate classification. In both simulated study and real data study, the experimental results showed that the proposed method could achieve appreciated performance across different test conditions, especially when the diagnostic quality of assessment was not high and the Q-matrix contained misspecified elements. This research study is the first time of applying the thinking of semi-supervised learning into CDM. Also, we used the validating test to choose the appropriate parameters for the ANNs instead of using typical statistical criteria. (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)

Background Most studies on medical reasoning focus on contemporary allopathic practitioners. Here, the significance of diagnostic sense in Nizāmī ‘Arūzī’s Four Discourses (Chahār Maqāle), an influential text that circulated widely throughout the Islamic world, is explored. Methods After a brief introduction, key passages are translated on how doctors should cultivate analytical skills. Results Nizāmī ‘Arūzī cites three sources of diagnostic authority: (1) education in the texts of medical experts, (2) formal logic and (3) belief in the power of (...) God. Conclusions ‘Arūzī’s methods, though rooted in a religious faith that may seem foreign to contemporary doctors and educators, has much to recommend regarding its clarity of approach, its high ethical standards and expectations of doctors, and its commitment to best practices for the patient. Crosscultural studies of medical education and professionalism can offer valuable insights by demonstrating how doctors across history and geography have grappled with the common concerns of diagnosis and treatment. (shrink)

Focusing on computational studies of pericyclic reactions from the late twentieth century into the twenty-first century, this paper argues that computational diagnostics is a key methodological development that characterize the management and coordination of plural approximation methods in computational organic chemistry. Predictive divergence between semi-empirical and ab initio approximation methods in the study of pericyclic reactions has issued in epistemic dissent. This has resulted in the use of diagnostics to unpack computational greyboxes in order to critically assess the effect of (...) specific misrepresentations on predictive accuracy given that approximations and idealizations must be made to render computational models tractable. Furthermore, benchmarking is used to determine the applicability of approximation methods depending on how accurate the results need to be in a given research context. The epistemology of benchmarking consists of the co-generation of data sets in a hybrid computational–experimental form used to standardize computational methods but does not determine a unique quantitative method to be used across computational organic chemistry. (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.

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)

Some nonparametric allocation methods are proposed for use in computer-aided medical diagnostics. It may be expected that the replacement of the widely employed parametric models by these methods leads to more realistic results, because the assumptions which are used by parametric models and which are never fulfilled in practice become unnecessary. The overestimation of the discriminating power arising from the non-fulfillment of parametric assumptions are avoided.

The current rise of neurodevelopmental disorders poses a critical need to detect risk early in order to rapidly intervene. One of the tools pediatricians use to track development is the standard growth chart. The growth charts are somewhat limited in predicting possible neurodevelopmental issues. They rely on linear models and assumptions of normality for physical growth data – obscuring key statistical information about possible neurodevelopmental risk in growth data that actually has accelerated, non-linear rates-of-change and variability encompassing skewed distributions. Here, (...) we use new analytics to profile growth data from 36 newborn babies that were tracked longitudinally for 5 months. By switching to incremental (velocity-based) growth charts and combining these dynamic changes with underlying fluctuations in motor performance – as the transition from spontaneous random noise to a systematic signal – we demonstrate a method to detect very early stunting in the development of voluntary neuromotor control and to flag risk of neurodevelopmental derail. (shrink)

This essay offers a diagnosis of what may be at stake in the current preoccupation with defining science‐based educational research. The diagnosis unfolds in several readings: The first is a charitable and considerate appraisal that draws attention to the fact that advocating experimental methods as important to a science of educational research is not an inherently evil thing to do. Subsequent readings are grimmer, suggesting more deleterious consequences of the science‐based research movement for the entire enterprise of educational practice and (...) research. The central thesis of the essay is that making arguments about method and science the focal point in the current quarrel may be largely beside the point. Instead, educational researchers should join the political and public conversation about the place of educational science in society and about how science is both implicated in and confronts the politics of what counts as knowledge. (shrink)

“Geneticization” is a term used to describe the ways in which the science of genetics is influencing society at large and medicine in particular; it has important implications for the process of diagnostics. Because genetic diagnostics produces knowledge about genetic disease and predisposition to disease, it is essentially influenced by these innovations in the disease concept. In this paper, I argue that genetic diagnostics presents new ethical challenges not because the diagnostic process or method in genetic diagnostics is (...) ethically different in kind from traditional medical diagnostics, but because it relies on a neo-ontological concept of disease in a context of genetic reductionism. Geneticization has not produced a radically new concept of disease, however, but has introduced innovations into the classical ontological concept of disease. When this new concept of disease is held in tandem with genetic reductionism, we are led to the absurd conclusion that disease is the very essence of the human being. I argue that neither the neo-ontological concept of disease nor genetic reductionism is necessary for a proper understanding of genetic diagnostics. (shrink)

In this paper I shall try to analyse appropriate logic and actual methods as a preliminary to developing expert systems that will simulate clinical diagnosis. It is doubtful that all diagnoses address the same kind of problem and hence no one logic will suffice. Sometimes the signs and symptoms manifest an underlying disorder that cannot be observed directly (the substantialist model); sometimes there seems to be no underlying disorder and the diagnosis is a rearrangement of the data (the nominalist model). (...) In deciding their merits in the particular case, we must identify the sources of variation; what is meant by saying that the data are independent; and what can be meant by wrong diagnosis and misclassification. Problems arise in human diagnosis because the data may be false, even lies; because the known list of diseases is not exhaustive; and because the probability of multiple unrelated diseases increases with age. Special difficulties arise from homeostasis (which is fundamental in defining and understanding disease) because the primary disturbances may be hard to distinguish from the homeostatic responses to them. (shrink)

This article solves the problem of ensuring database decision-making in conditions of growing uncertainty and risks based on the results of business diagnostics is solved in this article. The main purpose of the research is to further develop the methodology of forming an analytical database for making management decisions. The following methods formed the methodological basis of the research: abstract-logical – used to generalize theoretical approaches and confirm the practical significance of solving the problem of decision-making in conditions of uncertainty (...) and risk; system analysis – when building a model of decision-making while coordinating areas and methods of business diagnostics; generalization – when drawing conclusions based on research results. The results of solving the problem of decision-making by improving the methodological approach in selecting areas and methods of business diagnostics in the conditions of growing uncertainty and risks are given in the article. The results of the research have practical value for companies that seek to reduce uncertainty and risk in the decision-making process in business management. (shrink)

What is the value of an early diagnosis of dementia in the absence of effective treatment? There has been a lively scholarly debate over this question, but until now patients have not played a large role in it. Our study supplements biomedical research into innovative diagnostics with an exlporation of its meanings and values according to patients. Based on seven focusgroups with patients and their care-givers, we conclude that stakeholders evaluate early diagnostics with respect to whether and how they expect (...) it to empower their capacity to care. They value it, for instance, with respect to whether it explains experienced complaints, allows to start a process of psychological acceptance and social adaptation to the expected degeneration, contributes to dealing with anxieties, informs adequately about when to start preparing for the end of life, informs the planning of a request for euthanasia, or allows society to deal with a growing amount of dementia patients. Our study suggests that information about disease is considered ‘harmful’ or ‘premature’ when recipients feel unable to act on that information in their care. The results of this research offers input to further ethical research. It invites to adopt a care perspective in evaluation and to seek ways to prevent the ‘harm’ that such diagnostic methods can bring about. (shrink)

These two companion volumes provide a comprehensive review and critical evaluation of the major DSM-III and DSM-III-R child disorders. Their major goal is to provide diagnostic and assessment guidelines that are based on scientific literature in specific clinical domains. Each chapter contains a discussion of the historical background of a particular diagnosis, definitional issues, a critical but selective review of the literature addressing the diagnosis in question, proposed changes in the diagnostic criteria based on the available literature, and (...) proposed assessment models and methods based on the designated criteria. Given the scientific bases for many of these discussions of diagnostic criteria, these two volumes will serve professionals and graduate students in a wide variety of fields: clinical child psychology, child psychiatry, pediatrics, pediatric and school psychology, special education, social work, and other child mental health specialties. (shrink)

These two companion volumes provide a comprehensive review and critical evaluation of the major DSM-III and DSM-III-R child disorders. Their major goal is to provide diagnostic and assessment guidelines that are based on scientific literature in specific clinical domains. Each chapter contains a discussion of the historical background of a particular diagnosis, definitional issues, a critical but selective review of the literature addressing the diagnosis in question, proposed changes in the diagnostic criteria based on the available literature, and (...) proposed assessment models and methods based on the designated criteria. Given the scientific bases for many of these discussions of diagnostic criteria, these two volumes will serve professionals and graduate students in a wide variety of fields: clinical child psychology, child psychiatry, pediatrics, pediatric and school psychology, special education, social work, and other child mental health specialties. (shrink)

These two companion volumes provide a comprehensive review and critical evaluation of the major DSM-III and DSM-III-R child disorders. Their major goal is to provide diagnostic and assessment guidelines that are based on scientific literature in specific clinical domains. Each chapter contains a discussion of the historical background of a particular diagnosis, definitional issues, a critical but selective review of the literature addressing the diagnosis in question, proposed changes in the diagnostic criteria based on the available literature, and (...) proposed assessment models and methods based on the designated criteria. Given the scientific bases for many of these discussions of diagnostic criteria, these two volumes will serve professionals and graduate students in a wide variety of fields: clinical child psychology, child psychiatry, pediatrics, pediatric and school psychology, special education, social work, and other child mental health specialties. (shrink)

Research Ethics, Volume 18, Issue 4, Page 265-280, October 2022. Concerns around comprehension and recall of consent information by research participants have typically been associated with low health and research literacy levels. In genomics research, this concern is heightened as the scientific and ethical complexities of genetics research, such as biobanking, genetic susceptibility, data sharing, and incidental findings may be more difficult for potential research participants to understand. However, challenges to research participants’ comprehension of consent information may be compounded by (...) factors beyond health and research literacy levels. To identify factors that may impact research participants’ understanding and recall of consent information, we designed a qualitative study to explore whether participants enrolled in a tuberculosis genetics study in Cameroon understood the objectives of the study, the risks and benefits and certain key aspects of the study such as biobanking and data sharing. The results showed that research participants had limited understanding and/or recall of the TBGEN-Africa study goals and methods. Some participants were of the opinion that TBGEN-Africa was not a genetics study because tuberculosis is not an inheritable condition. Factors that may have hindered understanding and/or recall of study information are diagnostic misconception, and information overload and situational vulnerability. There is a need for improved practices to support research participants’ understanding of consent information in genetics studies including designing the consent process in ways that minimize psychological distress and diagnostic/therapeutic misconception. (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)

The presence and role of microbes in human cancers has come full circle in the last century. Tumors are no longer considered aseptic, but implications for cancer biology and oncology remain underappreciated. Opportunities to identify and build translational diagnostics, prognostics, and therapeutics that exploit cancer's second genome—the metagenome—are manifold, but require careful consideration of microbial experimental idiosyncrasies that are distinct from host‐centric methods. Furthermore, the discoveries of intracellular and intra‐metastatic cancer bacteria necessitate fundamental changes in describing clonal evolution and selection, (...) reflecting bidirectional interactions with non‐human residents. Reconsidering cancer clonality as a multispecies process similarly holds key implications for understanding metastasis and prognosing therapeutic resistance while providing rational guidance for the next generation of bacterial cancer therapies. Guided by these new findings and challenges, this Review describes opportunities to exploit cancer's metagenome in oncology and proposes an evolutionary framework as a first step towards modeling multispecies cancer clonality. Also see the video abstract here: https://youtu.be/-WDtIRJYZSs. (shrink)

Bayesian networks can be employed to cognitive diagnostic assessment. Most of the existing researches on the BNs for CDA utilized the MCMC algorithm to estimate parameters of BNs. When EM algorithm and gradient descending learning method are adopted to estimate the parameters of BNs, some challenges may emerge in educational assessment due to the monotonic constraints cannot be satisfied in the above two methods. This paper proposed to train the BN first based on the ideal response pattern data (...) contained in every CDA and continue to estimate the parameters of BN based on the EM or the GD algorithm regarding the parameters based on the IRP training method as informative priors. Both the simulation study and realistic data analysis demonstrated the validity and feasibility of the new method. The BN based on the new parameter estimating method exhibits promising statistical classification performance and even outperforms the G-DINA model in some conditions. (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)

Calibration errors are inevitable and should not be ignored during the estimation of item parameters. Items with calibration error can affect the measurement results of tests. One of the purposes of the current study is to investigate the impacts of the calibration errors during the estimation of item parameters on the measurement accuracy, average test length, and test efficiency for variable-length cognitive diagnostic computerized adaptive testing. The other purpose is to examine the methods for reducing the adverse effects of (...) calibration errors. Simulation results show that calibration error has negative effect on the measurement accuracy for the deterministic input, noisy “and” gate model, and the reduced reparameterized unified model; the average test lengths is shorter, and the test efficiency is overestimated for items with calibration errors; the compensatory reparameterized unified model is less affected by the calibration errors, and the classification accuracy, average test length, and test efficiency are slightly stable in the CRUM framework; methods such as improving the quality of items, using large calibration sample to calibrate the parameters of items, as well as using cross-validation method can reduce the adverse effects of calibration errors on CD-CAT. (shrink)

Exploring the early development of an area of medical literature can inform contemporary medical debates. Different methods of inference include deduction, induction, abduction, and inference to the best explanation. I argue that early shaken baby research is best understood as using abduction to tentatively suggest that infants with unexplained intracranial and ocular bleeding have been assaulted. However, this tentative conclusion was quickly interpreted, by some at least, as a general rule that infants with these pathological signs were certainly cases of (...) abuse. Rather than focusing on inductive arguments, researchers today may be better off focusing on making a compelling inference to the best explanation. (shrink)

Background: A short version of the Posttraumatic Diagnostic Scale comprising only re-experiencing symptom items has been recently validated on Japanese adults. This short-version-PDS had good psychometric properties among Japanese adults with and without posttraumatic stress disorder. The aim of this study was to translate and culturally validate the short-version-PDS for the Brazilian sociolinguistic context.Methods: A translation of the short-version-PDS was performed based on established guidelines. We enrolled 53 patients with PTSD as a potential comorbidity. The translation and cross-cultural adaptation (...) of the short-version-PDS included forward and back-translation by a Japanese Brazilian researcher and a certified translator; synthesis was achieved by consensus, backward translation, pilot test, and finalization. Content validity coefficient was used to assess quality of adaptation. Internal consistency was calculated using Cronbach's alpha coefficient. Spearman correlations were between the new short-version-PDS and the Brazilian version of the posttraumatic Stress Disorder Checklist for DSM-5, and a receiver operating characteristic curve was used to determine the best cut-off values for the short-version-PDS.Results: The short-version-PDS was well accepted by all subjects, none of the questions were experienced as inappropriate, and all questions of the 3 items were judged important. Item 1 presented CVCt = 0.92; item 2 had a CVCt = 0.87 and item 3 had a CVCt = 0.95. The internal consistency of the final version as measured by Cronbach's alpha was 0.78. The short-version-PDS scale correlated positively with the DSM-5 scale with a Spearman rho of 0.64 (95%CI [0.4-0.8], p 31.0 with sensitivity and specificity are 86.4 and 93.5%, respectively.Conclusions: This Brazilian Portuguese version of the short-version-PDS had good psychometric properties among Brazilian adults with and without PTSD. Transferability and generalizability of the cut-off scores should be further analyzed. (shrink)

Background While integrating genomic sequencing into clinical care carries clear medical benefits, it also raises difficult ethical questions. Compared to traditional sequencing technologies, genomic sequencing and analysis is more likely to identify unsolicited findings (UF) and variants that cannot be classified as benign or disease-causing (variants of uncertain significance; VUS). UF and VUS pose new challenges for genetic health professionals (GHPs) who are obtaining informed consent for genomic sequencing from patients.Methods We conducted semi-structured interviews with 31 GHPs across Europe, Australia (...) and Canada to identify some of these challenges.Results Our results show that GHPs find it difficult to prepare patients to receive results because a vast amount of information is required to fully inform patients about VUS and UF. GHPs also struggle to engage patients – many of whom may be focused on ending their ‘diagnostic odyssey’ – in the informed consent process in a meaningful way. Thus, some questioned how ‘informed’ patients actually are when they agree to undergo clinical genomic sequencing.Conclusions These findings suggest a tension remains between sufficient information provision at the risk of overwhelming the patient and imparting less information at the risk of uninformed decision-making. We suggest that a shift away from ‘fully informed consent’ toward an approach aimed at realizing, as far as possible, the underlying goals that informed consent is meant to promote. (shrink)

Background While integrating genomic sequencing into clinical care carries clear medical benefits, it also raises difficult ethical questions. Compared to traditional sequencing technologies, genomic sequencing and analysis is more likely to identify unsolicited findings (UF) and variants that cannot be classified as benign or disease-causing (variants of uncertain significance; VUS). UF and VUS pose new challenges for genetic health professionals (GHPs) who are obtaining informed consent for genomic sequencing from patients.Methods We conducted semi-structured interviews with 31 GHPs across Europe, Australia (...) and Canada to identify some of these challenges.Results Our results show that GHPs find it difficult to prepare patients to receive results because a vast amount of information is required to fully inform patients about VUS and UF. GHPs also struggle to engage patients – many of whom may be focused on ending their ‘diagnostic odyssey’ – in the informed consent process in a meaningful way. Thus, some questioned how ‘informed’ patients actually are when they agree to undergo clinical genomic sequencing.Conclusions These findings suggest a tension remains between sufficient information provision at the risk of overwhelming the patient and imparting less information at the risk of uninformed decision-making. We suggest that a shift away from ‘fully informed consent’ toward an approach aimed at realizing, as far as possible, the underlying goals that informed consent is meant to promote. (shrink)

Transfer learning can improve the robustness of deep learning in the case of small samples. However, when the semantic difference between the source domain data and the target domain data is large, transfer learning easily introduces redundant features and leads to negative transfer. According the mechanism of the human brain focusing on effective features while ignoring redundant features in recognition tasks, a brain-like classification method based on adaptive feature matching dual-source domain heterogeneous transfer learning is proposed for the preoperative (...) aided diagnosis of lung granuloma and lung adenocarcinoma for patients with solitary pulmonary solid nodule in the case of small samples. The method includes two parts: (1) feature extraction and (2) feature classification. In the feature extraction part, first, By simulating the feature selection mechanism of the human brain in the process of drawing inferences about other cases from one instance, an adaptive selected-based dual-source domain feature matching network is proposed to determine the matching weight of each pair of feature maps and each pair of convolution layers between the two source networks and the target network, respectively. These two weights can, respectively, adaptive select the features in the source network that are conducive to the learning of the target task, and the destination of feature transfer to improve the robustness of the target network. Meanwhile, a target network based on diverse branch block is proposed, which made the target network have different receptive fields and complex paths to further improve the feature expression ability of the target network. Second, the convolution kernel of the target network is used as the feature extractor to extract features. In the feature classification part, an ensemble classifier based on sparse Bayesian extreme learning machine is proposed that can automatically decide how to combine the output of base classifiers to improve the classification performance. Finally, the experimental results (the AUCs were 0.9542 and 0.9356, respectively) on the data of two center data show that this method can provide a better diagnostic reference for doctors. (shrink)

The article is based on research conducted at the actual radiology department. It presents a range of descriptions and analyses of concrete operations performed by radiologists during their daily professional routine. After careful ethnographic observations, phenomenological analysis is employed with a view to examining the enactive cognition in the radiologist’s “life-world”. The paper uses both ethnography and phenomenology in order to reveal the essential regularities and sedimentations of everyday radiological processes, and the “everyday background” of certain scientific-cognitive operations. The (...) class='Hi'>method of research includes “enactive proofs”— observations and analysis of the externalization of a radiologist’s professional memory through the enaction of medical imaging and imageconsciousness. The findings of this research have much to offer to both philosophy and radiological praxis. While the observations strongly support the development of enactive phenomenology, critique of representationalism, primacy of inference in cognition, and shared intentions, they also provide insight into concrete operations in coping with radiology’s paraphernalia, habituality, the origin of mistakes, multilayered communication, and improving professional praxis. (shrink)

Next SectionObjectives To evaluate the adequacy of paediatric informed consent and its augmentation by a supplemental computer-based module in paediatric endoscopy. Methods The Consent-20 instrument was developed and piloted on 47 subjects. Subsequently, parents of 101 children undergoing first-time, diagnostic upper endoscopy performed under moderate IV sedation were prospectively and consecutively, blinded, randomised and enrolled into two groups that received either standard form-based informed consent or standard form-based informed consent plus a commercial (Emmi Solutions, Inc, Chicago, Il), sixth grade (...) level, interactive learning module (electronic assisted consent). Anonymously and electronically, the subjects' anxiety (State Trait Anxiety Inventory), satisfaction (Modified Group Health Association of America), number of questions asked, and attainment of informed consent were assessed (Consent-20). Statistics were calculated using t test, paired t test, and Mann Whitney tests. Results The ability to achieve informed consent, as measured by the new instrument, was 10% in the control form-based consent group and 33% in the electronic assisted consent group (p<0.0001). Electronically assisting form-based informed consent did not alter secondary outcome measures of subject satisfaction, anxiety or number of questions asked in a paediatric endoscopy unit. Conclusions This study demonstrates the limitations of form-based informed consent methods for paediatric endoscopy. It also shows that even when necessary information was repeated electronically in a comprehensive and standardised video, informed consent as measured by our instrument was incompletely achieved. The supplemental information did, however, significantly improve understanding in a manner that did not negatively impact workflow, subject anxiety or subject satisfaction. Additional study of informed consent is required. Clinical trial registration number ClinicalTrials.gov Identifier NCT00899392. (shrink)

Analysis of the adequacy of engineering design methods, as well as analysis of the utility of concepts of function often invoked in these methods, is a neglected topic in both philosophy of technology and in engineering proper. In this paper, I present an approach—dubbed an explanationist perspective—for assessing the adequacy of function-based design methods. Engineering design is often intertwined with explanation, for instance, in reverse engineering and subsequent redesign, knowledge base-assisted designing, and diagnostic reasoning. I argue that the presented (...) approach is useful for validating function-based design methods with respect to their explanatory elements and that it supports assessment of the explanatory and design utility of “function”, and the different conceptualizations thereof, as used in such engineering design methods. I deploy two key desiderata from the explanation literature to assess the viability of function-based design methods: explanatorily relevant difference-making factors and counterfactual understanding defined in terms of what-if-things-had-been-different questions. I explicate the approach and its merits in terms of two case studies drawn from the engineering functional modeling literature: reverse engineering and redesign and malfunction analysis. I close the paper by discussing ramifications of the presented approach for the philosophy of design and the philosophy of explanation. (shrink)

This research investigates how consumers’ ethical brand perceptions are affected by differentially valenced information. Drawing on literature from person-perception formation and using a sequential, mixed method design comprising qualitative interviews and two experiments with a national representative population sample, our findings show that only when consumers perceive their judgment of a brand’s ethicality to be pertinent, do they process information holistically and in line with the configural model of impression formation. In this case, negative information functions as a (...) class='Hi'>diagnostic cue to form an unethical brand perception, irrespective of other positive information at hand. However, in the case where processing relevance of the un/ethical information provided is low, brand perception formation is algebraic, in which case positive information can counterbalance and neutralize the detrimental impact of brand misbehavior. Our findings extend existing research on consumer perceived ethicality as well as consumer reactions to corporate social responsibility and sustainability initiatives, which has so far assumed the asymmetric impact of negative information on ethical perceptions and consumer attitudes to be prevalent. We derive a range of academic and managerial implications and present a number of important avenues for future research. (shrink)

Medical diagnosis has been traditionally recognized as a privileged field of application for so called probabilistic induction. Consequently, the Bayesian theorem, which mathematically formalizes this form of inference, has been seen as the most adequate tool for quantifying the uncertainty surrounding the diagnosis by providing probabilities of different diagnostic hypotheses, given symptomatic or laboratory data. On the other side, it has also been remarked that differential diagnosis rather works by exclusion, e.g. by modus tollens, i.e. deductively. By drawing on (...) a case history, this paper aims at clarifying some points on the issue. Namely: 1) Medical diagnosis does not represent, strictly speaking, a form of induction, but a type, of what in Peircean terms should be called ‘abduction’ (identifying a case as the token of a specific type); 2) in performing the single diagnostic steps, however, different inferential methods are used for both inductive and deductive nature: modus tollens, hypothetical-deductive method, abduction; 3) Bayes’ theorem is a probabilized form of abduction which uses mathematics in order to justify the degree of confidence which can be entertained on a hypothesis given the available evidence; 4) although theoretically irreconcilable, in practice, both the hypothetical- deductive method and the Bayesian one, are used in the same diagnosis with no serious compromise for its correctness; 5) Medical diagnosis, especially differential diagnosis, also uses a kind of “probabilistic modus tollens”, in that, signs (symptoms or laboratory data) are taken as strong evidence for a given hypothesis not to be true: the focus is not on hypothesis confirmation, but instead on its refutation [Pr (¬ H/E1, E2, …, En)]. Especially at the beginning of a complicated case, odds are between the hypothesis that is potentially being excluded and a vague “other”. This procedure has the advantage of providing a clue of what evidence to look for and to eventually reduce the set of candidate hypotheses if conclusive negative evidence is found. 6) Bayes’ theorem in the hypothesis-confirmation form can more faithfully, although idealistically, represent the medical diagnosis when the diagnostic itinerary has come to a reduced set of plausible hypotheses after a process of progressive elimination of candidate hypotheses; 7) Bayes’ theorem is however indispensable in the case of litigation in order to assess doctor’s responsibility for medical error by taking into account the weight of the evidence at his disposal. (shrink)

An increasing number of people seek medical attention for mild cognitive symptoms at older age, worried that they might develop Alzheimer’s disease. Some clinical practice guidelines suggest offering biomarker testing in such cases, using a brain scan or a lumbar puncture, to improve diagnostic certainty about Alzheimer’s disease and enable an earlier diagnosis. Critics, on the other hand, point out that there is no effective Alzheimer treatment available and argue that biomarker tests lack clinical validity. The debate on the (...) ethical desirability of biomarker testing is currently polarized; advocates and opponents tend to focus on their own line of arguments. In this paper, we show how the method of reflective equilibrium can be used to systematically weigh the relevant arguments on both sides of the debate to decide whether to offer Alzheimer biomarker testing. In the tradition of RE, we reflect upon these arguments in light of their coherence with other argumentative elements, including relevant facts, ethical principles, and theories on societal ideals or relevant concepts, such as autonomy. Our stance in the debate therefore rests upon previously set out in-depth arguments and reflects a wide societal perspective. (shrink)

In this article, on the basis of questionnaire data collected for other purposes, the Authors want to show the consequences of various methods of shortening of tests and what may result from such an action for diagnosticians, researchers and examined individuals. The research aim of the work is to show the best method of shortening of the scale of questionnaires. Will shortening of a questionnaire according to different statistical techniques bring the same results? Will the quality of shortened scales (...) be comparable? Is any of statistical techniques better for shortening of the scale of a questionnaire? The obtained results suggest a poorly controlable effect of the methods of questionnaire shortening. Moreover creating a short version on the basis of the results collected with the use of the full version leads to obtaining a tool with unknown diagnostic and psychometric properties. (shrink)

Se propone una reflexión sobre el método clínico y sus etapas, la relación médico-paciente y la presencia tecnológica en la Cardiología Pediátrica. La ecocardiografía transtorácica no puede sustituir el pensamiento médico, la anamnesis, ni el examen físico. Como medio diagnóstico realizado e interpretado por humanos, está sujeto a error, el cual se minimiza según la calidad de los datos clínicos aportados por el médico que lo solicita. El presente trabajo tiene como objetivo analizar los aspectos éticos del método clínico en (...) relación con la utilización de la ecocardiografía transtorácica en niños con cardiopatías congénitas. It is proposed a reflexion about the clinical method and its stages, the doctor-patient relation and the presence of technology in paediatric cardiology. The transthoracic echocardiography can4t substitute medical thought, neither the anamnesis nor the physical examination. As a diagnostic medium carried out and interpreted by humans, it is subject to error, which it is minimized according to the quality of the clinical data provided by the doctor who requests them. The present work has the objective to analyse the Ethical foundations of the clinical method in connection with the use of transthoracic echocardiography in children with congenital cardiopathies. (shrink)

There have been renewed calls to use phenomenology in psychiatry to improve knowledge about causation, diagnostics, and treatment of mental health conditions. A phenomenological approach aims to elucidate the subjective experiences of mental health, which its advocates claim have been largely neglected by current diagnostic frameworks in psychiatry (eg, DSM-5). The consequence of neglecting rich phenomenological information is a comparatively more constrained approach to theory development, empirical research, and care programmes. Although calls for more phenomenology in psychiatry have been (...) met with enthusiasm, there is still relatively little information on how to practically facilitate this integration. In this Personal View, we argue that phenomenological approaches need a shared semantic framework to drive their innovative potential, thus enabling consistent data capture, exchange, and interoperability with current mental health data and informatics approaches (eg, the Research Domain Criteria project). We show how an applied ontology of phenomenological psychopathology offers a suitable method to address these challenges. (shrink)

This book critically assesses the implications of modern medicine's claim to be a natural science. Medicine models its scientific and clinical self-understanding on an obsolete positivist conception of science, reality, and consciousness. In this view, the body is modeled as a biological machine, disease as breakdown of the machine, and therapy as physical measures to fix the machine. The problems besetting medical science and practice are rooted in the inadequacy of the positivist philosophical assumptions regarding the nature of science, reality (...) and consciousness To base the diagnostic practices and therapeutic regimes purely on knowledge of physical processes in the human body is, in view of this analysis, at best grossly inadequate, at worst thoroughly dehumanizing (Anton van Niekerk: Editorial Foreword). This means that medicine's clinical method cannot be transformed without transforming the underlying view of science, of reality, and of the human person. The book proposes a broader model of science which overcomes the outdated dichotomy between human and natural sciences. Science is viewed as an interdisciplinary exercise generating multiple perspectives. The insights of the human sciences are essential for scientific clinical medicine. Utilizing evolutionary biology and complexity theory, the author proposes an alternative understanding of reality and human consciousness as a basis for a transformed clinical method. Reality is a hierarchy of systems of increasing complexity. Different levels can be distinguished, namely material systems, living material systems, conscious living material systems and self-conscious living material systems. Each level represents a new manner of being which requires a different scientific discourse of understanding. Using this model of reality the author argues against understanding human consciousness as a byproduct of physical processes in the brain. The human person is a self-conscious, complex, psycho-somatic system, whose well-being is conditioned by much more than physical processes. (shrink)