Background: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians’ attitudes and practices regarding error discussions with colleagues.Methods: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables.Results: Responses were received from 338 participants . In all, 73% of (...) respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision , wanting colleagues to learn from the mistake and wanting to receive support . Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm , minor harm or major harm . Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion .Conclusions: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners. (shrink)

ICAP is a theory of active learning that differentiates students’ engagement based on their behaviors. ICAP postulates that Interactive engagement, demonstrated by co‐generative collaborative behaviors, is superior for learning to Constructive engagement, indicated by generative behaviors. Both kinds of engagement exceed the benefits of Active or Passive engagement, marked by manipulative and attentive behaviors, respectively. This paper discusses a 5‐year project that attempted to translate ICAP into a theory of instruction using five successive measures: (a) teachers’ understanding of ICAP after (...) completing an online module, (b) their success at designing lesson plans using different ICAP modes, (c) fidelity of teachers’ classroom implementation, (d) modes of students’ enacted behaviors, and (e) students’ learning outcomes. Although teachers had minimal success in designing Constructive and Interactive activities, students nevertheless learned significantly more in the context of Constructive than Active activities. We discuss reasons for teachers’ overall difficulty in designing and eliciting Interactive engagement. (shrink)

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)

Christopher Caudwell’s The Crisis in Physics is a stylish and readable analysis of the lines of connection between scientific theories and economic realities. Caudwell provides a trenchant critique of mechanism and positivism. In the words of J.B.S. Haldane, The Crisis in Physics offers a “quarry of ideas” for future philosophers: a wealth of insights and arguments that demands continuing critical reflection.

The history of Athenian relations with Sicily in the fifth century is beset with difficulties; and no part of it, perhaps, is more obscure than the story of what is commonly known as the First Sicilian Expedition, which set sail from Athens in the late summer of 427 under Laches, and was reinforced under Pythodorus, Sophocles and Eurymedon in the winter of 426.

'Philosophy arises through misconceptions of grammar', said Wittgenstein. Few people have believed him, and probably none, therefore, working in the area of the philosophy of mathematics. Yet his assertion is most evidently the case in the philosophy of Set Theory, as this paper demonstrates (see also Rodych 2000). The motivation for twentieth century Set Theory has rested on the belief that everything in Mathematics can be defined in terms of sets [Maddy 1994: 4]. But not only are there notable items (...) which cannot be so defined, including numbers and mereological sums, the very notion of a set, as formalized within this tradition, is based on a series of grammatical confusions. (shrink)

Background Informed consent confers upon participants the right to decline or accept participation in a study in equal measure. Consent declines can be used as a potential metric to assess the adequacy of the informed consent process. Limited literature is available on the reporting of consent declines in Clinical Research. We evaluated randomized controlled trials published in three high-impact factor journals for consent declines (four-year period) to assess the extent of exertion of autonomy by research participants. Methods CONSORT flow charts (...) in RCTs published in New England Journal of Medicine (NEJM), The Lancet and Journal of the American Medical Association (JAMA) between 2012 and 2015 were evaluated. The total and per journal proportion of RCTs reporting consent declines was calculated. Percentage of consent declines was also compared based on number of centers (single centric vs. multicentric) and type of setting (developed vs. developing). Between-groups analysis was done using Chi Square, Chi Square for trend and a Crude odds ratio [95% C.I] (cOR) were calculated. Results Only 3.7% (1103/29,825) of the published articles were RCTs. Of the 1103 RCTs, only 532 (48.2%) reported consent declines. JAMA had the highest RCTs reporting consent declines (171/267.64%), the Lancet [129,150/781,924, 16.5%] had the most participants declining consent. Difference was significant using Chi square for linear trend [ p < 0.00001]. Consent decline rate was higher in developed countries relative to developing countries [cOR(95% C.I): 2.27(2.23,2.32), p < 0.000001] and in single centric versus multicentric studies [cOR (95% C.I): 3.63(3.56,3.71), p < 0.0000001]. Conclusion Both authors and journal editors need to ensure better reporting of consent declines. (shrink)

A simple random walk model has been shown by Gaveauet al. to give rise to the Klein-Gordon equation under analytic continuation. This absolutely most probable path implies that the components of the Dirac wave function have a common phase; the influence of spin on the motion is neglected. There is a nonclassical path of relative maximum likelihood which satisfies the constraint that the probability density coincide with the quantum mechanical definition. In three space dimensions, and in the presence of electromagnetic (...) interaction, the Lagrangian for this optimal, nonclassical path coincides with the Lagrangian of the Dirac particle. The nonrelativistic, or diffusion, limit is shown to be a formal consequence of Einstein's dynamical equilibrium condition; the continuity equation reduces to the same diffusion equation derived from Schrödinger's equation. The relativistic, massless limit, which would describe a neutrino, is comparable (in the sense of analytic continuation) to a nonviscous liquid whose molecules possess internal degrees of freedom. (shrink)