Volume 20, Issue 5, June 2020, Page 38-40.

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)

Wisdom is a multi-component trait that is important for mental health and well-being. In this study, we sought to understand gender differences in relative strengths in wisdom. A total of 659 individuals aged 27–103 years completed surveys including the 3-Dimensional Wisdom Scale and the San Diego Wisdom Scale. Analyses assessed gender differences in wisdom and gender’s moderating effect on the relationship between wisdom and associated constructs including depression, loneliness, well-being, optimism, and resilience. Women scored higher on average on the 3D-WS (...) but not on the SD-WISE. Women scored higher on compassion-related domains and on SD-WISE Self-Reflection. Men scored higher on cognitive-related domains and on SD-WISE Emotion Regulation. There was no impact of gender on the relationships between wisdom and associated constructs. Women and men have different relative strengths in wisdom, likely driven by sociocultural and biological factors. Tailoring wisdom interventions to individuals based on their profiles is an important next step. (shrink)

This study investigates the relationship between intention to behave ethically and gender within the context of national culture. Using Reidenbach and Robin's measures of the ethical dimensions of justice and utilitarianism in a sample of business students from three different countries, we found that gender is significantly related to the respondents' intention to behave ethically. Women relied on both justice as well as utilitarianism when making moral decisions. By contrast, men relied only on justice, and did not rely on utilitarianism (...) when faced with the same ethical issues. Further, women's intention to behave was contextual, significantly affected by two national culture dimensions (uncertainty avoidance and individualism), whereas men's decisions were more universal, and not related to national culture dimensions. (shrink)

Objectives The objectives of the study are to understand the current practice of informed consent in medical research in public hospitals in Shanghai, and to share our views with other countries, especially developing countries. Methods In the study, 145 consent forms (CFs) of the selected research projects in eight public hospitals with ethics committees in Shanghai were audited, and the principle investigators (PIs) of these research projects and 40 student subjects who had participated in clinical drug tests were surveyed by (...) questionnaires. Results The CFs of medical researches in public hospitals with ethics committees in Shanghai were generally acceptable. However, there were some defects in the CFs. Although most of the surveyed PIs had correct recognition of informed consent, some processes of informed consent were not in accordance with generally accepted requirements. A large number of the PIs considered the greatest difficulty with informal consent was lack of correct recognition of subjects or legally authorised representatives on medical research. Discussion Informed consent in medical research should consider the research ethics, the background of potential subjects, the local resources and culture of medical research. In addition, special protection is needed for student subjects in informed consent as well as efforts for building and restoring the public's trust in biomedical research. Conclusion The informed consent in Shanghai's public hospitals with ethics committees was generally acceptable and the achievement of adequate informed consent is influenced by many factors. (shrink)

Given the recent ethics scandals in the United States, there has been a renewed focus on understanding the antecedents to ethical decision-making in the research literature. Since ethical norms and standards of behavior are not universally consistent, an individual’s choice of referent may exert a large influence on his/her ethical decision-making. This study used a social identity theory lens to empirically examine the relative influence of the macro- and micro-level variables of national culture and peers on an individual’s intention to (...) behave ethically. Our sample consisted of respondents from Germany, Italy, and Japan. The results indicated that both national culture and peers were found to act as significant referents in ethical decision-making dilemmas. Although peers exerted a much stronger influence on an individual’s ethical decision-making, the impact of peers varied depending on the national culture levels of individualism and power distance. (shrink)

The target article retains the traditional account of saccades as conjugate eye movements. However, recent single-unit recordings of premotor cells in the saccade pathway (excitatory burster neurons [EBNs]) found that they do not encode conjugate eye velocity, but rather, monocular eye velocity. These data argue against the traditional concept of saccades as inherently conjugate. Instead, they suggest a monocular mechanism in the sensorimotor transformation stage of saccade generation. This commentary will discuss the implications of these data for the saccade generation (...) model proposed in Findlay & Walker's target article. (shrink)

Evidence suggests divergent thinking is the cognitive basis of creative thoughts. Neuroimaging literature using resting-state functional connectivity has revealed network reorganizations during divergent thinking. Recent studies have revealed the changes of network organizations when performing creativity tasks, but such brain reconfigurations may be prolonged after task and be modulated by the trait of creativity. To investigate the dynamic reconfiguration, 40 young participants were recruited to perform consecutive Alternative Uses Tasks for divergent thinking and two resting-state scans were used for mapping (...) the brain reorganizations after AUT. We split participants into high- and low-creative groups based on creative achievement questionnaire and targeted on reconfigurations of the two brain networks: default-mode network and the network seeded at the left inferior frontal gyrus because the between-group difference of AUT-induced brain activation located at the left IFG. The changes of post-AUT RSFCs indicated the prolonged effect of divergent thinking. More specifically, the alterations of RSFCIFG−AG and RSFCIFG−IPL in the high-creative group had positive relationship with their AUT performances, but not found in the low-creative group. Furthermore, the RSFC changes of DMN did not present significant relationships with AUT performances. The findings not only confirmed the possibility of brain dynamic reconfiguration following divergent thinking, but also suggested the distinct IFGN reconfiguration between individuals with different creativity levels. (shrink)

Objectives The objective of this research was to develop ethics accreditation standards for hospitals. Research design Our research methods included a literature review, an expert focus group, the Delphi technique and a hospital survey. The entire process was separated into two stages: (1) the development of a draft of hospital ethics accreditation standards; and (2) conducting a nationwide hospital survey of the proposed standards. Results This study produced a tentative draft of hospital ethics accreditation standards comprised of six chapters and (...) 62 standards based on the expert focus group and Delphi technique. The six chapters are: Medical ethics policies, regulations and leadership; The establishment and operation of a medical ethics committee; The establishment and operation of research-related ethics committees; Medical ethics education; Organisational ethical climate; and Respect for patients' rights and establishment of good hospital-patient relationships. The hospital survey indicated that the concept of an organisational ethical climate was new to most hospital managers, most hospitals disliked the idea of having a separate hospital ethics accreditation system, and small hospitals were concerned about their ability to comply with all of the standards. Conclusions Regardless of whether hospital ethics accreditation can be a stand-alone accreditation or just part of existing hospital accreditation programmes, we hope this draft can serve as a good reference for future endeavours by hospital accreditation authorities. (shrink)

OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)

BackgroundBiobanks are considered to be key infrastructures for research development and have generated a lot of debate about their ethical, legal and social implications. While the focus has been on human genomic research, rapid advances in human microbiome research further complicate the debate.DiscussionWe draw on two cystic fibrosis biobanks in Toronto, Canada, to illustrate our points. The biobanks have been established to facilitate sample and data sharing for research into the link between disease progression and microbial dynamics in the lungs (...) of pediatric and adult patients. We begin by providing an overview of some of the ELSI associated with human microbiome research, particularly on the implications for the broader society. We then discuss ethical considerations regarding the identifiability of samples biobanked for human microbiome research, and examine the issue of return of results and incidental findings. We argue that, for the purposes of research ethics oversight, human microbiome research samples should be treated with the same privacy considerations as human tissues samples. We also suggest that returning individual microbiome-related findings could provide a powerful clinical tool for care management, but highlight the need for a more grounded understanding of contextual factors that may be unique to human microbiome research.ConclusionsWe revisit the ELSI of biobanking and consider the impact that human microbiome research might have. Our discussion focuses on identifiability of human microbiome research samples, and return of research results and incidental findings for clinical management. (shrink)

In The Pragmatics of Text Messaging: Making Meaning in Messages Michelle A. McSweeney seeks to explore the meaning to be found in the labyrinth of text messaging language, and offers explanations b...

The harmful impact of an adverse event ripples beyond injured patients and their families to affect physicians, nurses, and other health care staff that are involved. These “Second Victims” may experience intense feelings of anxiety, guilt, and fear. They may doubt their clinical competence or ability to continue working at all. Some go on to suffer post-traumatic stress disorder and depression.Medical institutions long ignored this problem, preferring to believe that adverse events, or “errors,” occur due to incompetence — the unfortunate (...) work of a few “bad” practitioners who deserve, if anything, a reprimand for their negligence. Study after study has rejected this attribution and shown that adverse events in health care stem primarily from systemic flaws, not “bad apples.” Devastating errors, in other words, can, do, and always will happen in the care of competent, well-trained, and caring practitioners. (shrink)

W niniejszym tekście, poświęconym definiowaniu m. in. słów i zwrotów frazeologicznych podczas nauczania języków, autorka opisuje lingwistyczną teorię Anny Wierzbickiej, dotyczącą Natural Semantic Metalanguage i w adaptacyjnej formie przenosi ją na płaszczyznę zajęć z języka obcego, gdzie przynosi ona namacalne wyniki. Podczas zajęć językowych wymaga się od uczących się poprawnego definiowania ogólnego, które jednak rzadko przekazywane jest w podręcznikach i na wykładach, mimo iż zdolność ta nie jest wcale oczywista, samo definiowanie zaś nie jest łatwym zadaniem. Przeciwnie - od studentek (...) i studentów języków obcych oczekuje się mentalnego uzdolnienia w tym kierunku, nie uwzględniając faktu, że wiele osób ma trudności z definiowaniem nawet w języku ojczystym. W artykule autorka chce pokazać, że po części zignorowana teoria Anny Wierzbickiej ze swoim punktem wyjściowym, jakim są primes, pozwala uświadomić uczącym się języka obcego, że istotę słowa, wyrażenia czy frazy można wyjaśnić w oparciu o sposób określenia znaczenia, przyjęty w NSM. Nie jest przy tym konieczne, ażeby znaczenia opisywać i określać poprzez primes. Ważne jest, aby w celu uniknięcia błędnego koła podczas objaśnień definicji nie koncentrować się na synonimach i antonimach. Jak takie i podobne objaśnienia mogą wyglądać, pokazane jest na przykładach kilku definicji, które wyjaśnione zostały w oparciu o sposób określenia znaczenia przyjęty w NSM. Autorka dyskutuje również opisy i warunki działania takiej metody. Na zakończenie przedstawione są propozycje w zakresie metodologii nauczania umiejętności definiowania podczas zajęć języka obcego. (shrink)

Access to legal information is fundamental to access to justice. Yet accessibility refers not only to making legal documents available to the public, but also rendering legal information comprehensible to them. A vexing problem in bringing legal information to the public is how to turn formal legal documents such as legislation and judgments, which are often highly technical, to easily navigable and comprehensible knowledge to those without legal education. In this study, we formulate a three-step approach for bringing legal knowledge (...) to laypersons, tackling the issues of navigability and comprehensibility. First, we translate selected sections of the law into snippets (called CLIC-pages), each being a small piece of article that focuses on explaining certain technical legal concept in layperson’s terms. Second, we construct a _Legal Question Bank_, which is a collection of legal questions whose answers can be found in the CLIC-pages. Third, we design an interactive _CLIC Recommender_. Given a user’s verbal description of a legal situation that requires a legal solution, CRec interprets the user’s input and shortlists questions from the question bank that are most likely relevant to the given legal situation and recommends their corresponding CLIC pages where relevant legal knowledge can be found. In this paper we focus on the technical aspects of creating an LQB. We show how large-scale pre-trained language models, such as GPT-3, can be used to generate legal questions. We compare machine-generated questions against human-composed questions and find that MGQs are more scalable, cost-effective, and more diversified, while HCQs are more precise. We also show a prototype of CRec and illustrate through an example how our 3-step approach effectively brings relevant legal knowledge to the public. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Remembering Lewis E. HahnGeorge C. H. Sun, President, John Howie, Professor Emeritus, Thomas Alexander, Professor and Director of Graduate Studies, Kenneth W. Stikkers, Professor and Chair, Randall Auxier, Professor, Robert Hahn, Professor, Joseph Wu, Professor Emeritus, Elizabeth R. Eames, Professor Emeritus, Martin Lu, Professor of Philosophy, George Kimball Plochmann, Professor Emeritus, Matt Sronkoski, Philosophy Graduate and Academic Adviser, Dave Clarke, Professor Emeritus, Eugenie Gatens-Robinson, Professor Emerita, Hans H. Rudnick, (...) Professor Emeritus, Stephen Bickham, Professor EmeritusPresident, and Don Mikula (bio)The following testimonials were offered on the occasion of a memorial gathering for Dr. Lewis E. Hahn held on February 19, 2005, and were compiled for presentation here by Sharon (Hahn) Crowell.A Tribute to Dr. Lewis E. Hahn (1908-2004) from a Global PerspectiveGeorge C. H. Sun President, Thomé H. Fang Institute, Inc., Mobile, AlabamaAmong the philosophical community in both the East and the West, no word of introduction is needed for our beloved Master, who was the recipient of numerous distinctions and honors, with titles that included "Man of the Year in Philosophy" and "Award of Lifetime Achievement." The very name "Lewis E. Hahn" itself already stands now for genuineness, dedication, and fulfillment.A great work is a dialogue with eternity; a great person is such a work. In less than thirty years he succeeded in developing Carbondale from what had been a small college town in the Midwest into the Mecca of American philosophy. His most important achievements were the Dewey Center and the Pepper Archives that he helped install at SIUC These, among other such institutions, will remain a unique contribution, a glory of American philosophy, and a monument in the history of human thought.For posterity Lewis E. Hahn will remain an object of wonder and amazement. How is it possible for one human being to have accomplished so much, so well, and in so short a span of time—less than one century—in breadth, depth, and diversity? Some one hundred years ago, by bridging the gap between the New World and the Old, William James was hailed as the great genius of international friendship among philosophical thinkers, but we now find a greater genius in Lewis E. Hahn, who succeeded in bringing together the peoples of East and West from at least four continents: Europe, Australia, America (both North and Latin America), and Asia. To my knowledge, few of his predecessors and contemporaries have been half so widely read and liberal-minded as he was, in view of the range and scope of the Library of Living Philosophers that he helped continue after the passing of its founder, Dr. Paul A. Schilpp.What type of man was Hahn, our younger generation will wonder? Only a pluralist approach can help us understand the true character of such a legendary pluralist-contextualist. In short, he was "a full personality." As I recall, while working on my dissertation with him in the 1970s, we had a brief discussion on Confucius, the sage of ancient China. "A full personality!" was his laconic assessment. Suddenly I realized, to quote the Analects: "The Master is talking about himself!" For, as the Buddhists put it, only a Buddha can understand a Buddha. Or, as William James put it, only one who has philosophy can appreciate philosophy. Many friends [End Page 1] of my generation admire him so much; Te Chen of Hong Kong calls him "a great Confucian in America." Those who regret the loss of many precious Confucian virtues in China today have now rediscovered them in the person of Lewis E. Hahn! If Nietzsche called Kant "a great Chinese in Königsberg," it is simply because he had not encountered our own Master.A paradigm of academic leadership, Dr. Hahn is simply irreplaceable—this is a tribute I personally heard in Carbondale in the late 1960s. It is not an exaggeration to say that he was a superb administrator, and he could have been the best Secretary of the State we ever had, for he possessed more in the way of philosophical wisdom than all his predecessors put together! As a great teacher, he was no less "serene, good, learned, wise, and ardent" than... (shrink)

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. (...) The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank. (shrink)

Fourteen healthy children (13.8±2.2 years, range 10 to 16; M:F=5:9) received 30 Hz intermittent theta burst transcranial magnetic stimulation (iTBS) with a stimulation intensity of 70% of resting motor threshold (RMT) with a total of 300 (iTBS300) pulses. All volunteers were free of neurologic, psychiatric and serious medical illnesses, not taking any neuropsychiatric medications, and did not have any contraindications to Transcranial Magnetic Stimulation. Changes in the mean amplitudes of motor-evoked potentials from baseline following iTBS were expressed as a ratio (...) and assessed from 1 to 10 minutes (BLOCK1) and 1 to 30 minutes (BLOCK2) using repeated-measures analysis of variance. All 14 subjects completed iTBS300 over the dominant primary motor cortex (M1) without any clinically reported adverse events. ITBS300 produced significant M1 facilitation (F5,65=3.165, p=0.01) at BLOCK1 and trend level M1 facilitation at BLOCK2 (F10,129=1.69, p=0.089). Although iTBS300 (stimulation duration of 92 seconds at 70% RMT) delivered over M1 in typically developed children was well-tolerated and produced on average significant facilitatory changes in cortical excitability, the post-iTBS300 neurophysiologic response was variable in our small sample. ITBS300-induced changes may represent a potential neuroplastic biomarker in healthy children and those with neuro-genetic or neuro-psychiatric disorders. However, a larger sample size is needed to address safety and concerns of response variability. (shrink)

The ordering tendency in binary f -Ti solid solution containing 3sp or 4sp simple-metal or 3d transition-metal solute is investigated systematically by the linear muffin-tin orbital method within the atomic sphere approximation . We demonstrated that the effective pairwise interaction energy in a solid solution is equal to half the solute-solute interaction energies and can be evaluated by a supercell total energy approach. The calculations of EPI energy both with and without volume relaxation of the supercells and local density of (...) states show that the EPI energies of Ti-SM and Ti-TM solutions are dominated by different factors. For Ti-SM solutions, the EPI energies are of large absolute values with a negative sign, indicating strong ordering tendency in these solutions. The volume relaxation does not alter the EPI energy substantially. The calculated LDOS shows that the ordering tendency in Ti-SM solutions may be related to the hybridization between the electrons of the SM atoms when they are close to each other. For most Ti-TM solutions, if calculated without relaxation, the absolute EPI energies are very small; however, if calculated with relaxation, they are of relatively large positive values, indicating a clustering tendency in these solutions. By combining the calculated EPI energy and Flinn's model for short-range order strengthening, the increase in critical shear stress ‰ sro due to SRO is estimated for Ti-SM alloys, and the results qualitatively agree with experiment. (shrink)

Neural markers, such as the mismatch negativity, have been used to examine the phonological underspecification of English feature contrasts using the Featurally Underspecified Lexicon model. However, neural indices have not been examined within the approximant phoneme class, even though there is evidence suggesting processing asymmetries between liquid and glide phonemes. The goal of this study was to determine whether glide phonemes elicit electrophysiological asymmetries related to [consonantal] underspecification when contrasted with liquid phonemes in adult English speakers. Specifically, /ɹɑ/ is categorized (...) as [+consonantal] while /wɑ/ is not specified [i.e., ]. Following the FUL framework, if /w/ is less specified than /ɹ/, the former phoneme should elicit a larger MMN response than the latter phoneme. Fifteen English-speaking adults were presented with two syllables, /ɹɑ/ and /wɑ/, in an event-related potential oddball paradigm in which both syllables served as the standard and deviant stimulus in opposite stimulus sets. Three types of analyses were used: traditional mean amplitude measurements; cluster-based permutation analyses; and event-related spectral perturbation analyses. The less specified /wɑ/ elicited a large MMN, while a much smaller MMN was elicited by the more specified /ɹɑ/. In the standard and deviant ERP waveforms, /wɑ/ elicited a significantly larger negative response than did /ɹɑ/. Theta activity elicited by /ɹɑ/ was significantly greater than that elicited by /wɑ/ in the 100–300 ms time window. Also, low gamma activation was significantly lower for /ɹɑ/ vs. /wɑ/ deviants over the left hemisphere, as compared to the right, in the 100–150 ms window. These outcomes suggest that the [consonantal] feature follows the underspecification predictions of FUL previously tested with the place of articulation and voicing features. Thus, this study provides new evidence for phonological underspecification. Moreover, as neural oscillation patterns have not previously been discussed in the underspecification literature, the ERSP analyses identified potential new indices of phonological underspecification. (shrink)

Geiger, M. Alexander Pfänders methodische Stellung.--Schwarz, P. Über die Oberste ontologische Kategorie.--Stavenhagen, K. Charismatische Persönlichkeitseinungen.--Celms, T. Lebensumgebung und Lebensprojektion.--Beck, M. Problem der Analogie zwischen seelischen und Dinglichen Qualitäten.--Spiegelberg, H. Sinn und recht der Begründung in der axiologischen und praktischen Philosophie.--Voigtländer, E. Bemerkungen zur Psychologie der Gesinnungen.--Löwenstein, K. Wunsch und wünschen.--Löw, F. Über die Definition.-- Specht, W. Die Grenzen der biologischen Erfassung der Persönlichkeit.--Heller, E. Über die Willenshandlung.