This article aims to describe underlying principles of paradigm shifts in clinical medicine by means of analysis of typical examples. Retrospectively, profound shifts of ruling paradigms can be shown in diverse fields such as outcome research, in the redefining of patient's and doctor's autonomies, in the challenges presented by consumer medicine and the free market economy. This has provoked controversy between doctors, patients and the community. The judgement on whether recent shifts in paradigms in medicine have improved the health (...) care delivered today is by no means uncontroversial. Aiming to demonstrate how shifts of paradigms in medicine occur and what consequences can result from such shifts we reflect on the works of Thomas S. Kuhn, the eminent philosopher of science. An analysis of his theories lends important insight into the observed shifts in paradigms. (shrink)

Background Researchers engaged in the study of the ethical, legal, and social implications (ELSI) of genetics and genomics are often publicly funded and intend their work to be in the public interest. These features of U.S. ELSI research create an imperative for these scholars to demonstrate the public utility of their work and the expectation that they engage in research that has potential to inform policy or practice outcomes. In support of the fulfillment of this “translational mandate,” the Center for (...) ELSI Resources and Analysis (CERA), funded by the National Human Genome Research Institute (NHGRI), aims to facilitate community-informed, ELSI research results synthesis and dissemination. However, little is known about how ELSI research scholars define the goals of translation and imagine the intended users of their research findings.Methodology We distributed a Qualtrics survey to ELSI scholars that aimed to determine: (1) researchers’ expectations for their research findings in relation to policy or practice outcomes, (2) the stakeholder groups researchers believe could benefit from their research findings, and (3) the methods researchers use to foster the uptake of their findings by those stakeholders.Results Most ELSI researchers surveyed thought there were stakeholders that could benefit from their research findings, including health care professionals, at-risk individuals, patients, and their family members, policy-makers, and researchers/scientists, and expected their research findings to inform the creation or revision of laws, policies, or practice guidelines. Most researchers planned to disseminate findings directly to relevant stakeholders, with fewer expecting dissemination support from research funders, universities, or other entities.Conclusion The broad range of research topics, disciplines, and set of potential end users represented in ELSI reseach complicate the work of a knowledge broker. Nonetheless, the CERA can play an important role in disseminating ELSI results to relevant stakeholders. Further research should explore outreach mechanisms. (shrink)

John Rawls's work has greatly contributed to rehabilitating equality as a basic social value, after decades of utilitarian hegemony,particularly in normative economics, but Rawls also emphasized that full equality of welfare is not an adequate goal either. This thesis was echoed in Dworkin's famous twin papers on equality, and it is now widely accepted that egalitarianism must be selective. The bulk of the debate on ‘Equality of What?’ thus deals with what variables ought to be submitted for selection and how (...) this selection ought to be carried out. (shrink)

As a new form of online reviews, Q&A reviews have been recently used by many e-commerce platforms to compensate for the weaknesses and problems related to trust and helpfulness found in traditional online reviews. This research documents what motivates people to share products or purchasing knowledge with others through Q&A reviews and why e-commerce platforms should place an emphasis on Q&A reviews. Importantly, our results provide evidence that, when receiving feedback, people are more likely willing to share knowledge with others (...) and will have a higher level of loyalty. We believe that this study contributes to knowledge sharing and the e-commerce literature, and also has practical implications. (shrink)

Flipped learning could improve the learning effectiveness of students. However, some studies have pointed out the limitations related to flipped classrooms because the content of the flipped course does not vary according to the needs of the students. On the other hand, adaptive teaching, which customizes the learning mode according to the individual needs of students, can make up for some of the shortcomings of flipped teaching. This study combines adaptive teaching with flipped teaching and applies it to face-to-face classroom (...) activities. The purpose of this research is to explore whether the implementation of flipping and adaptive learning in a computer programming course can improve the learning effectiveness of students. The experimental subjects of this study are the sophomore students in the Department of Information Management. The flipped classroom with adaptive instruction has been realized in the limited course time. This study uses questionnaires to collect pre- and post-test data on the “learning motivation” of students. The learning effectiveness was evaluated based on the students' previous programming course and the semester scores of this course. Research results show that the post-test “learning motivation” has improved overall compared with the pre-test, and the learning effect is significant. The results of this research not only prove the effectiveness of modern teaching theories in programming courses but also lay the foundation for future teaching design. (shrink)

In a series of ten preregistered experiments (N=2043), we investigate the effect of outcome valence on judgments of probability, negligence, and culpability – a phenomenon sometimes labelled moral (and legal) luck. We found that harmful outcomes, when contrasted with neutral outcomes, lead to increased perceived probability of harm ex post, and consequently to increased attribution of negligence and culpability. Rather than simply postulating a hindsight bias (as is common), we employ a variety of empirical means to demonstrate that the (...) outcome-driven asymmetry across perceived probabilities constitutes a systematic cognitive distortion. We then explore three distinct strategies to alleviate the hindsight bias and its downstream effects on mens rea and culpability ascriptions. Not all are successful, but at least some prove promising. They should, we argue, be taken into consideration in criminal jurisprudence, where distortions due to the hindsight bias are likely considerable and deeply disconcerting. (shrink)

Introduction; "One surely will be found one day to make an ontology with what I am telling you": the road to a post-Lacanian materialism -- Part One. Jacques Lacan: between the sacred and the secular -- 1. Conflicted matter: the challenge of secularizing materialism -- 2. Turning the sciences inside out: revisiting "Science and truth" -- 3. On deep history and psychoanalysis: phylogenetic time in Lacanian theory --Part Two. Alain Badiou: between form and matter -- 4. What matter(s) in ontology: (...) the Hebb-event and materialism split from within -- 5. Phantom of consistency: Kant troubles -- Part Three. Quentin Meillassoux: between faith and knowledge -- 6. The world before worlds: the ancestral and Badiou's anti-Kantian transcendentalism -- 7. Hume's revenge: a Dieu, Meillassoux? -- Postface: from critique to construction: toward a transcendental materialism. (shrink)

Principal Component Analysis is one of the data mining methods that can be used to analyze multidimensional datasets. The main objective of this method is a reduction of the number of studied variables with the mainte- nance of as much information as possible, uncovering the structure of the data, its visualization as well as classification of the objects within the space defined by the newly created components. PCA is very often used as a preliminary step in data preparation through the (...) creation of independent components for further analysis. We used the PCA method as a first step in analyzing data from IVF (in vitro fertilization). The next step and main purpose of the analysis was to create models that predict pregnancy. Therefore, 805 different types of IVF cy- cles were analyzed and pregnancy was correctly classified in 61-80% of cases for different analyzed groups in obtained models. (shrink)

Unethical conduct has reached crisis proportions in business :A1–A10, 2011) and on today’s college campuses :58–65, 2007). Despite the evidence that suggests that more than half of business students admit to dishonest practices, only about 5 % of business school deans surveyed believe that dishonesty is a problem at their schools :299–308, 2010). In addition, the AACSB which establishes standards for accredited business schools has resisted the urging of deans and business experts to require business schools to teach an ethics (...) class, and fewer than one-third of businesses schools now teach a business ethics course at the graduate or undergraduate levels. In this paper we briefly introduce the status of business ethics education and report the results of a survey of business students, deans of the top business schools, and business ethics subject matter experts about ten ethical outcomes. We then offer five specific recommendations to encourage business ethics faculty and decision makers to improve the teaching of business ethics. (shrink)

Outcome-adaptive randomization has been proposed as a corrective to certain ethical difficulties inherent in the traditional randomized clinical trial using fixed-ratio randomization. In particular, it has been suggested that OAR redresses the balance between individual and collective ethics in favour of the former. In this paper, I examine issues of welfare and autonomy arising in relation to OAR. A central issue in discussions of welfare in OAR is equipoise, and the moral status of OAR is crucially influenced by the (...) way in which this concept is construed. If OAR is based on a model of equipoise that demands strict indifference between competing interventions throughout the trial, such equipoise is disturbed by accruing data favouring one treatment over another; OAR seeks to redress this by weighting randomization to the seemingly superior treatment. However, this is a partial response, as patients continue to be allocated to the inferior therapy. Moreover, it rests upon considerations of aggregate harms and benefits, and does not therefore uphold individual ethics. Issues of fairness also arise, as early and late enrollees are randomized on a different basis. Fixed-ratio randomization represents a fuller and more consistent response to a loss of equipoise, as so construed. With regard to consent, the complexity of OAR poses challenges to adequate disclosure and comprehension. Additionally, OAR does not offer a remedy to the therapeutic misconception—participants’ tendency to attribute treatment allocation in an RCT to individual clinical judgments, rather than to scientific considerations—and, if anything, accentuates rather than alleviates this misconception. In relation to these issues, OAR fails to offer ethical advantages over fixed-ratio randomization. More broadly, the ethical basis of OAR can be seen to lie more in collective than in individual ethics, and overall it fares worse in this territory than fixed-ratio randomization. (shrink)

The objective of this study is to evaluate if use of a patient decision aid, when choosing between a repeat cesarean or a trial of labor after a cesarean, reduces medical liability exposure. The authors conclude that use of a PDA conferred liability protection when potential jurors were presented with a hypothetical malpractice claim against an obstetrician following a TOLAC.

Three centuries of history have made us take it for granted that mechanism and empiricism are natural allies. I want to suggest in this article that that alliance ought to surprise us a good deal more than it does, and that it arose out of contingent historical circumstance. This claim is perhaps best approached by considering initially a fundamental issue upon which the mechanists of the seventeenth century were themselves divided. In the “Proemial Discourse” to The Origin of Forms and (...) Qualities, According to the Corpuscular Philosophy, Robert Boyle confronted his readers with an issue which continues to confront modern interpreters of the history of the mechanical philosophy. Boyle stated that he intended to “write rather for the Corpuscularians in general, than any party of them.” What he knew and what modern commentators have since also realized is that the interprétation of the mechanical philosophy crucially depends on whether one chooses to take seriously the conflicts which existed among the seventeenth-century proponents of mechanism or whether one decides deliberately to ignore such conflicts of party. I propose in this article to examine the historical and philosophical consequences of viewing the mechanisms of the seventeenth-century natural philosophers from each of these standpoints. In pursuing this line of inquiry, I shall call attention to certain salient features of their thought which made it rationally justifiable for them either to write for corpuscularians in general or to write for a particular party, but rationally unjustifiable to do both. (shrink)

One of the important philosophical advantages stemming from study of the historical development of philosophical movements and traditions is the insight that comes from observing the logical out-working of a set of ideas over a period of time that far exceeds the lifetime of any individual thinker. An Aristotle or a Hegel may develop a philosophical mode of thought in an almost unbelievably comprehensive way, but no individual can grasp all the implications and ramifications of his philosophical vision, no matter (...) how monumental his powers may be. Many individuals, however, working over many years within the same framework of ideas can accomplish what no one of them alone could achieve. It is often said that philosophy is not an experimental science, and, in an obvious sense, this is true. But it is not entirely true. We can view the history of a tradition like Platonism, for example, or Augustinianism, as a vast experiment made by many thinkers with a set of ideas in which each thinker, building on what has gone before, seeks to develop further the basic premises of the position, proposing new logical alternatives, correcting errors, meeting objections, discovering further implications, and consolidating the results. In the case of a profound tradition, nothing less than this extended historical dialectic of ideas suffices to make plain what the basic position implies. Moreover, since climates of opinion change, the proponents of a given view will find that, in the course of time, new opponents appear, raising questions and posing problems that could not easily have been envisaged by the thinker who started the tradition. Sometimes these objections prove fatal and the tradition comes to an end; sometimes the objections are successfully overcome and the position finds new life and a more viable form of expression. The history of a tradition, therefore, is an indispensable resource for philosophical understanding. (shrink)

Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation instrument. (...) The aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers’ experiences and perceived importance of outcomes of Moral Case Deliberation. (shrink)

Background There has been little attention paid to research on the outcomes of clinical ethics support or critical reflection on what constitutes a good CES outcome. Understanding how CES users perceive the importance of CES outcomes can contribute to a better understanding, use of and normative reflection on CES outcomes. Objective To describe the perceptions of Dutch healthcare professionals on important outcomes of moral case deliberation, prior to MCD participation, and to compare results between respondents. Methods This mixed-methods study (...) used both the Euro-MCD instrument and semi-structured interviews. Healthcare professionals who were about to implement MCD were recruited from nursing homes, hospitals, psychiatry and mentally disabled care institutions. Results 331 healthcare professionals completed the Euro-MCD instrument, 13 healthcare professionals were interviewed. The outcomes perceived as most important were ‘more open communication’, ‘better mutual understanding’, ‘concrete actions’, ‘see the situation from different perspectives’, ‘consensus on how to manage the situation’ and ‘find more courses of action’. Interviewees also perceived improving quality of care, professionalism and the organization as important. Women, nurses, managers and professionals in mentally disabled care rated outcomes more highly than other respondents. Conclusions Dutch healthcare professionals perceived the MCD outcomes related to collaboration as most important. The empirical findings can contribute to shared ownership of MCD and a more specific use of MCD in different contexts. They can inform international comparative research on different CES types and contribute to normative discussions concerning CES outcomes. Future studies should reflect upon important MCD outcomes after having experienced MCD. (shrink)

Technological innovations, despite their several benefits, may have drawbacks, thus, they need a control mechanism or directional channel. Responsible innovation (RI) has gained popularity in technology-intensive countries as a way to regulate otherwise uncontrollable and radical technological innovations. However, existing RI research lacks a clear theoretical foundation and has not adequately addressed the commercial and performance aspects of innovative products and firms. The current research proposes an empirically testable model for RI by conducting a structured literature review, focusing on the (...) commercial aspect of innovative products and firms’ sustainability performance in the financial, social, and environmental dimensions. The study suggests a link between RI and the resource-based theory of the firm and proposes that RI can be seen as a distinctive competency developed through the firm’s resources and capabilities. The model would help enterprises achieve ethical and social acceptability and improve sustainability performance. Metadata examination of 98 articles yielded insights. The findings and future research directions of this study provide new insights for business strategy and policy. (shrink)

The paper describes how ethics consultation can be valuable to health professionals, patients and their families in understanding and evaluating ethical values and their consequences in a particular situation. Ethics consultation as it is practised at the university hospital of Freiburg is a special professional service offered by members of an academic institution.The practical approach and the goals are illustrated by a case study showing the difficulties of deciding about the limitation of intensive care medicine after heart surgery in the (...) setting of maximum treatment. Here, the ethics consultation was initiated by the relatives of the patient who wanted a decision to withhold further life-sustaining treatment.Following the experiences in Freiburg, it is concluded that clinical ethicists have to cover a variety of relevant fields of knowledge, need special analytical skills, and should have professional competence in counselling, including conflict mediation or crisis intervention. (shrink)