In this article, the insertion of a two-staged highly interesting question in an online, survey-based field experiment is shown to produce better survey completion rate (i.e., decreases completion refusal by 8%) and sample representativeness (increases the number of moderate answer patterns by 12%) than a typical (same) highly interesting question at the beginning of a survey only. Using nonparametric tests and subgroup probability analysis, measured effects include survey completion rates, response bias and reported demographic differences. In regards to sample representativeness, (...) the results also raise questions about the sensitivity of the conventional practice of comparing early to late respondent means scores as a method of investigating nonresponse bias in marketing research. Alternative approaches to measuring potential non-response bias are compared with the tradition of comparing early-wave verses late-wave mean respondent differences. The results indicate that the conventional mean test fails to identify differences in nonresponse bias; the scores of highly interested or opposed respondents in the first waves produce equivalent means to the scores of the less interested or opposed respondents in the latter wave between the surveys (e.g., 1's and 5's vs. 2's and 4's, both averaging to 3's) that are identifiable through kurtosis and probability analysis. (shrink)

In ‘Reification and Assent in Research Involving Those Who Lack Capacity’, Smajdor argues that adults with impaired capacity to grant informed consent (AWIC) are often excluded from participating in biomedical research because they cannot provide informed consent, leading to decreased chances AWIC will benefit from such research. Smajdor uses Honneth’s concept of reification to propose that securing assent (rather than consent) in cases involving AWIC offers patients moral recognition that is not tied to their capacities. Assent provides this recognition by (...) including the patient in a shared moral sphere, highlighting her agency and worth without reducing her to her incapacity or a thing-to-be-managed. Assent also avoids grounding in, or a reliance on, the future development of autonomy (pp.5–6).1 Our recent research on patient and caregiver perspectives of potential paediatric deep brain stimulation (pDBS) for refractory obsessive–compulsive disorder (OCD) and dystonia demonstrates that paediatric neurosurgery patients desire the kind of recognition Smajdor associates with assent, and their caregivers largely agree.2 3 Since (generally) paediatric patients in the USA are unable to grant informed consent, their caregivers must provide it instead. This raises the question of how to properly integrate paediatric patients into the DBS decision-making process. One dimension along which this is evident is that …. (shrink)

In ‘Patients, doctors and risk attitudes,’ Makins argues that, when physicians must decide for, or act on behalf of, their patients they should defer to patient risk attitudes for many of the same reasons they defer to patient values, although with a caveat: physicians should defer to the higher-order desires of patients when considering their risk attitudes. This modification of what Makins terms the ‘deference principle’ is primarily driven by potential counterexamples in which a patient has a first-order desire with (...) one risk attitude (either risk-seeking or averse) and a second-order desire that this risk attitude not be effective in guiding their choices.1 There are two reasons we might think people with obsessive–compulsive disorder (OCD) are particularly relevant patients for evaluating Makins’ proposal. Not only might their first-order risk attitudes be irrational, but many people with OCD also judge their own OCD behaviours to be excessive or unwarranted making them structurally similar to the counterexamples outlined above. Yet, I argue that recent research about risk and decision-making under uncertainty for those with OCD complicates Makins’ proposal by raising questions of whether and to what degree their risk attitudes are irrational such that they should not play a part in the surrogate decisions made by physicians. This places more …. (shrink)

Background Deep brain stimulation is approved for treating refractory obsessive-compulsive disorder in adults under the US Food and Drug Administration Humanitarian Device Exemption, and studies have shown its efficacy in reducing symptom severity and improving quality of life. While similar deep brain stimulation treatment is available for pediatric patients with dystonia, it is not yet available for pediatric patients with obsessive-compulsive disorder, although soon could be. The prospect of growing indications for pediatric deep brain stimulation raises several ethical concerns relating (...) to bodily integrity, the ability to offer informed assent, and the role pediatric patients play in the decision-making process. Objective The aim of this study is to solicit and assess the views of stakeholders (children, parents, clinicians) on pediatric assent, autonomy, and bodily integrity in the context of potential pediatric deep brain stimulation for obsessive-compulsive disorder. Methods Semi-structured interviews were conducted with pediatric obsessive-compulsive disorder patients ( n = 21), caregivers of pediatric obsessive-compulsive disorder patients aged 14–18 ( n = 19), and clinicians with experience treating refractory obsessive-compulsive disorder ( n = 25). Interviews were transcribed and coded in MAXQDA 2018 and 2020 software and processed for thematic content analysis to isolate and compare specific themes. Results A majority of respondents (74%, 48/65) across all three stakeholder groups voiced that the decision-making process should be collaborative and involve everyone (clinicians: 84% or 21/25, caregivers 71% or 15/21, and patients 63% or 12/19). We identified a split between respondents’ views on who should have the final say in the event of disagreement (38% or 25/65 favored the patient versus 35% or 23/65 favoring caregivers). A split between respondents also emerged concerning the maturity relevant for deep brain stimulation decision-making, with 45% (29/65) favoring developmental maturity (age/physiological development) and 45% (29/65) favoring decisional maturity (capacity to understand and weigh information). A majority of clinicians indicated that they would not move forward with deep brain stimulation without securing patient assent (80% or 20/25), with some stating the only exception is if patient quality of life was very poor and/or they lacked insight. Both caregivers and patients expressed a significant respect for the patient's right to bodily integrity, with 67% of caregivers (14/21) and 68% of patients (13/19) justifying patient involvement in decision-making specifically with reference to infringements of bodily integrity. Conclusion Our findings demonstrate that despite broad agreement across stakeholders that the decision-making process for pediatric deep brain stimulation for obsessive-compulsive disorder should be collaborative and somehow involve pediatric patients, there is disagreement about what this process entails and what factors determine patient involvement in the process. However, there is agreement that children have a right to bodily and brain integrity, which should only be infringed upon in rare circumstances. (shrink)

In “What are Humans Doing in the Loop?” Salloch and Eriksen (2024) argue for a collaborative decision-making approach to using machine learning-based AI decisional support systems in medicine, rece...

The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients’ views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts (...) to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and “normalcy” in the context of OCD. (shrink)

In The Conditions for Ethical Chemical Restraint, Crutchfield and Redinger (2024) propose ethical standards for the use of chemical restraints, which they consider normatively distinct from physica...

Political corruption imposes substantial costs on shareholders in the U.S. Yet, we understand little about the basic factors that exacerbate or mitigate the value consequences of political corruption. Using federal corruption convictions data, we find that firm-level economic rents and monitoring mechanisms moderate the negative relation between corruption and firm value. The value consequences of political corruption are exacerbated for firms operating in low-rent product markets and mitigated for firms subject to external monitoring by state governments or monitoring induced by (...) disclosure transparency. Our results should inform managers and policymakers of the tradeoffs imposed on firms operating in politically corrupt districts. (shrink)

Cognitive control refers to the regulation of mental activity to support flexible cognition across different domains. Cragg and Nation (2010) propose that the development of cognitive control in children parallels the development of language abilities, particularly inner speech. We suggest that children’s late development of cognitive control also mirrors their limited ability to revise misinterpretations of sentence meaning. Moreover, we argue that for certain tasks, a tradeoff between bottom-up (data-driven) and top-down (rule-based) thinking may actually benefit performance in both children (...) and adults. Specifically, we propose that a lack of cognitive control may promote important aspects of cognitive development, like language acquisition and creativity. (shrink)

In “Revive and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose”, Marshall, Derse, Weiner, and Joseph contend that patients who may appear to satisfy the standard criteria for...

Given the need for enforceable guardrails for artificial intelligence (AI) that protect the public and allow for innovation, the U.S. Government recently issued a Blueprint for an AI Bill of Rights which outlines five principles of safe AI design, use, and implementation. One in particular, the right to notice and explanation, requires accurately informing the public about the use of AI that impacts them in ways that are easy to understand. Yet, in the healthcare setting, it is unclear what goal (...) the right to notice and explanation serves, and the moral importance of patient-level disclosure. We propose three normative functions of this right: (1) to notify patients about their care, (2) to educate patients and promote trust, and (3) to meet standards for informed consent. Additional clarity is needed to guide practices that respect the right to notice and explanation of AI in healthcare while providing meaningful benefits to patients. (shrink)

First Published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

Rapid advancements in artificial intelligence and machine learning (AI/ML) in healthcare raise pressing questions about how much users should trust AI/ML systems, particularly for high stakes clinical decision-making. Ensuring that user trust is properly calibrated to a tool’s computational capacities and limitations has both practical and ethical implications, given that overtrust or undertrust can influence over-reliance or under-reliance on algorithmic tools, with significant implications for patient safety and health outcomes. It is, thus, important to better understand how variability in trust (...) criteria across stakeholders, settings, tools and use cases may influence approaches to using AI/ML tools in real settings. As part of a 5-year, multi-institutional Agency for Health Care Research and Quality-funded study, we identify trust criteria for a survival prediction algorithm intended to support clinical decision-making for left ventricular assist device therapy, using semistructured interviews (n=40) with patients and physicians, analysed via thematic analysis. Findings suggest that physicians and patients share similar empirical considerations for trust, which were primarilyepistemicin nature, focused on accuracy and validity of AI/ML estimates. Trust evaluations considered the nature, integrity and relevance of training data rather than the computational nature of algorithms themselves, suggesting a need to distinguish ‘source’ from ‘functional’ explainability. To a lesser extent, trust criteria were also relational (endorsement from others) and sometimes based on personal beliefs and experience. We discuss implications for promoting appropriate and responsible trust calibration for clinical decision-making use AI/ML. (shrink)

Introduction Deep brain stimulation (DBS) is approved under a humanitarian device exemption to manage treatment-resistant obsessive-compulsive disorder (TR-OCD) in adults. It is possible that DBS may be trialed or used clinically off-label in children and adolescents with TR-OCD in the future. DBS is already used to manage treatment-resistant childhood dystonia. Evidence suggests it is a safe and effective intervention for certain types of dystonia. Important questions remain unanswered about the use of DBS in children and adolescents with TR-OCD, including whether (...) mental health clinicians would refer pediatric patients for DBS, and who would be a good candidate for DBS.Objectives To explore mental health clinicians’ views on what clinical and psychosocial factors they would consider when determining which children with OCD would be good DBS candidates.Materials and Methods In depth, semi-structured interviews were conducted with n = 25 mental health clinicians who treat pediatric patients with OCD. The interviews were transcribed, coded, and analyzed using thematic content analysis. Three questions focused on key, clinical, and psychosocial factors for assessing candidacy were analyzed to explore respondent views on candidacy factors. Our analysis details nine overarching themes expressed by clinicians, namely the patient’s previous OCD treatment, OCD severity, motivation to commit to treatment, presence of comorbid conditions, family environment, education on DBS, quality of life, accessibility to treatment, and patient age and maturity.Conclusions Clinicians generally saw considering DBS treatment in youth as a last resort and only for very specific cases. DBS referral was predominantly viewed as acceptable for children with severe TR-OCD who have undertaken intensive, appropriate treatment without success, whose OCD has significantly reduced their quality of life, and who exhibit strong motivation to continue treatment given the right environment. Appropriate safeguards, eligibility criteria, and procedures should be discussed and identified before DBS for childhood TR-OCD becomes practice. (shrink)

Introduction, W G Runciman Social Evolution in Primates: The Role of Ecological Factors and Male Behaviour, Carel P van Schaik Determinants of Group Size in Primates: A General Model, R I M Dunbar Function and Intention in the Calls of Non-Human Primates, Dorothy L Cheney & Robert M Seyfarth Why Culture is Common, but Cultural Evolution is Rare, Robert Boyd & Peter J Richerson An Evolutionary and Chronological Framework for Human Social Behaviour, Robert A Foley Friendship and the Banker?s Paradox: (...) Other Pathways to the Evolution of Adaptations for Altruism, John Tooby & Leda Cosmides The Early Prehistory of Human Social Behaviour: Issues of Archaeological Inference and Cognitive Evolution, Steven Mithen The Emergence of Biologically Modern Populations in Europe: A Social and Cognitive ?Revolution??, Paul Mellars Responses to Environmental Novelty: Changes in Men?s Marriage Strategies in a Rural Kenyan Community, Monique Borgerhoff Mulder Genetic Language Impairment: Unruly Grammars, M Gopnik, J Dalalakis, S E Fukuda, S Fukuda & E Kehayia The Emergence of Cultures among Wild Chimpanzees, Christophe Boesch Terrestriality, Bipedalism and the Origin of Language, Leslie C Aiello Conclusions, John Maynard Smith. (shrink)

A repository of clinically associated Staphylococcus aureus (Sa) isolates is used to semi‐automatically generate a set of application ontologies for specific subfamilies of Sa‐related disease. Each such application ontology is compatible with the Infectious Disease Ontology (IDO) and uses resources from the Open Biomedical Ontology (OBO) Foundry. The set of application ontologies forms a lattice structure beneath the IDO‐Core and IDO‐extension reference ontologies. We show how this lattice can be used to define a strategy for the construction of a new (...) taxonomy of infectious disease incorporating genetic, molecular, and clinical data. We also outline how faceted browsing and query of annotated data is supported using a lattice application ontology. (shrink)

The embodied simulation of smiles involves motor activity that often changes the perceivers' own emotional experience (e.g., smiling can make us feel happy). Although Niedenthal et al. mention this possibility, the psychological processes by which embodiment changes emotions and their consequences for processing other emotions are not discussed in the target article's review. We argue that understanding the processes initiated by embodiment is important for a complete understanding of the effects of embodiment on emotion perception.

The issue of the theory-ladenness of observation has long troubled philosophers of science, largely because it seems to threaten the objectivity of science. However, the way in which prior beliefs influence the perception of data is in part an empirical issue that can be investigated by cognitive psychology. This point is illustrated through an experimental analogue of scientific data-interpretation tasks in which subjects judging the covariation between personality variables based their judgments on pure data, their theoretical intuitions about the variables, (...) or both data and prior theoretical beliefs. Results showed that the perceived magnitude of correlations was greatest when subjects relied solely on theoretical intuitions; that data-based judgments were drawn in the direction of those prior beliefs; but that exposure to data nonetheless moderated the strength of the prior theories. In addition, prior beliefs were found to influence judgments only after a brief priming interval, suggesting that subjects needed time to retrieve their theoretical intuitions from memory. These results suggest ways to investigate the processes mediating theory-laden observation, and, contrary to the fears of positivist philosophers, imply that the theory-ladenness of observation does not entail that theoretical beliefs are immune to data. (shrink)

In their paper, “Conversational Artificial Intelligence in Psychotherapy: A New Therapeutic Tool or Agent?” Sedlakova and Trachsel (2023) claim that therapeutic insights and therapeutic changes are...

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

This book offers 32 texts and case studies from across a wide range of business sectors around a managerial framework for Sustainable Business. The case studies are developed for and tested in executive education programmes at leading business schools. The book is based on the premise that the key for managing the sustainable business is finding the right balance over time between managing competitiveness and profitability AND managing the context of the business with its political, social and ecological risks and (...) opportunities. In that way, a sustainable business is highly responsive to the demands and challenges from both markets and societies and managers embrace the complexity, ambivalence and uncertainty that goes along with this approach. The book presents a framework that facilitates the adoption of best business practice. This framework leads executives through a systematic approach of strategic analysis and business planning in risk management, issues management, stakeholder management, sustainable business development and strategic differentiation, business model innovation and developing dynamic capabilities. The approach helps broaden the understanding of what sustainable performance means, by protecting business value against sustainability risks and creating business value from sustainability opportunities. (shrink)

ObjectiveCo-morbid insomnia and sleep apnea is a common and debilitating condition that is more difficult to treat compared to insomnia or sleep apnea-alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia is effective in patients with COMISA, however, those with more severe sleep apnea and evidence of greater objective sleep disturbance may be less responsive to CBTi. Polysomnographic sleep study data has been used to predict treatment response to CBTi in patients with insomnia-alone, but not in patients with COMISA. (...) We used randomized controlled trial data to investigate polysomnographic predictors of insomnia improvement following CBTi, versus control in participants with COMISA.MethodsOne hundred and forty five participants with insomnia and sleep apnea [apnea-hypopnea index ≥ 15] were randomized to CBTi or no-treatment control. Mixed models were used to investigate the effect of pre-treatment AHI, sleep duration, and other traditional, and novel [quantitative electroencephalography ] polysomnographic predictors of between-group changes in Insomnia Severity Index scores from pre-treatment to post-treatment.ResultsCompared to control, CBTi was associated with greater ISI improvement among participants with; higher AHI, less wake after sleep onset, and less N3 sleep. No quantitative electroencephalographic, or other traditional polysomnographic variables predicted between-group ISI change.DiscussionAmong participants with COMISA, higher OSA severity predicted a greater treatment-response to CBTi, versus control. People with COMISA should be treated with CBTi, which is effective even in the presence of severe OSA and objective sleep disturbance. (shrink)

Background Unit-based critical care nurse leaders (UBCCNL) play a role in exemplifying ethical leadership, addressing moral distress, and mitigating contributing factors to moral distress on their units. Despite several studies examining the experience of moral distress by bedside nurses, knowledge is limited regarding the UBCCNL’s experience. Research aim The aim of this study was to gain a deeper understanding of the lived experiences of Alabama UBCCNLs regarding how they experience, cope with, and address moral distress. Research design A qualitative descriptive (...) design and inductive thematic analysis guided the investigation. A screening and demographics questionnaire and a semi-structured interview protocol were the tools of data collection. Participant and research context Data were collected from 10 UBCCNLs from seven hospitals across the state of Alabama from February to July 2023. Ethical considerations This study was approved by the Institutional Review Board at the University of Alabama in Huntsville. Informed consent was obtained from participants prior to data collection. Findings UBCCNLs experience moral distress frequently due to a variety of systemic and organizational barriers. Feelings of powerlessness tended to precipitate moral distress among UBCCNLs. Despite moral distress resulting in increased advocacy and empathy, UBCCNLs may experience a variety of negative responses resulting from moral distress. UBCCNLs may utilize internal and external mechanisms to cope with and address moral distress. Conclusions The UBCCNL’s experience of moral distress is not dissimilar from bedside staff; albeit, moral distress does occur as a result of the responsibilities of leadership and the associated systemic barriers that UBCCNLs are privier to. When organizations allocate resources for addressing moral distress, they should be convenient to leaders and staff. The UBCCNL perspective should be considered in the development of future moral distress measurement tools and interventions. Future research exploring the relationship between empathy and moral distress among nurse leaders is needed. (shrink)

While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in (...) implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: train-the-trainer, local capacity-building, circuit-riding, and consolidated accountability. We note each model’s benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations. (shrink)

Mill's feminism has been attacked as being logically incoherent. The general verdict has been that Mill can easily be defended from the charge. However, both sides in the debate have ignored the fact that his feminism is part of a broader theory of liberal empiricism. Placing The Subjection of Women in this context re–opens the question of its logical credentials and reveals a basic weakness in Millian feminism.

We study the reverse mathematics of pigeonhole principles for finite powers of the ordinal $\omega$ . Four natural formulations are presented, and their relative strengths are compared. In the analysis of the pigeonhole principle for $\omega^{2}$ , we uncover two weak variants of Ramsey’s theorem for pairs.

Rooting, defined as a spectator’s demonstrative encouragement of a contestant’s effort, ideally has the morally positive aspects of benevolent concern and helpfulness but in practice strains against reasonable standards of conduct by being rude, excessively biased, exploitative, fanatical, and superstitious. Rooting may activate an atavistic, morally cogent sense of fighting for one’s group that is at odds with the universalism of civilized morality. The ‘merely play’ excuse can cut both ways, deflecting moral objections but also removing moral credit from rooting. (...) Although rooting is often not humane, humane rooting can occur and is supported by humane commentary by sports participants, broadcasters, and journalists. Humane rooting supports the premise of benevolence theories (Mengzi, Hutcheson) that morally ideal benevolence has a foothold in an innate general benevolence – seen in this area especially in benevolence toward efforts. Being partisan, excited, and demonstrative, rooters cannot perfectly embody ‘universal calm benevolence’, but they can consciously minimize the inhumane aspects of rooting and achieve a more fully prosocial satisfaction. (shrink)

The most powerful lesson learned from the 2013-2016 outbreak of Ebola in West Africa was that we do not learn our lessons. A common sentiment at the time was that Ebola served as a “wake-up call”—an alarm which signalled that an outbreak of that magnitude should never have occurred and that we are ill-prepared globally to prevent and respond to them when they do. Pledges were made that we must learn from the outbreak before we were faced with another. Nearly (...) five years later the world is in the grips of a pandemic of the severe acute respiratory syndrome coronavirus 2 that causes coronavirus disease 2019. It is therefore of no surprise that we are now yet again hearing that the COVID-19 pandemic serves as the “wake-up call” we need and that there are many lessons to be learned to better prepare us for future outbreaks. Will anything be different this time around? We argue that nothing will fundamentally change unless we truly understand and appreciate the nature of the lessons we should learn from these outbreaks. Our past failures must be understood as moral failures that offer moral lessons. Unless we appreciate that we have a defect in our collective moral attitude toward remediating the conditions that precipitate the emergence of outbreaks, we will never truly learn. (shrink)