BackgroundThe boundaries between health-related research and practice have become blurred as initiatives traditionally considered to be practice increasingly use the same methodology as research. Further, the application of different ethical requirements based on this distinction raises concerns because many initiatives commonly labelled as “non-research” are associated with risks to patients, participants, and other stakeholders, yet may not be subject to any ethical oversight. Accordingly, we sought to develop a tool to facilitate the systematic identification of risks to human participants (...) and determination of risk level across a broad range of projects and health-related contexts. This paper describes the development of the Public Health Ontario Risk Screening Tool.MethodDevelopment of the PHO Risk Screening Tool included: preparation of a draft risk tool ; expert appraisal; internal stakeholder validation; external validation; pilot testing and evalution of the draft tool; and revision after 1 year of testing.ResultsA risk screening tool was generated consisting of 20 items organized into five risk domains: Sensitivity; Participant Selection, Recruitment and Consent; Data/Sample Collection; Identifiability and Privacy Risk; and Commercial Interests. The PHO Risk Screening Tool is an electronic tool, designed to identify potential project-associated risks to participants and communities and to determine what level of ethics review is required, if any. The tool features an easy to use checklist format that generates a risk score associated with a suggested level of ethics review once all items have been completed. The final score is based on a threshold approach to ensure that the final score represents the highest level of risk identified in any of the domains of the tool.ConclusionsThe PHO Risk Screening Tool offers a practical solution to the problem of how to maintain accountability and appropriate risk oversight that transcends the boundaries of research and practice. We hope that the PHO Risk Screening Tool will prove useful in minimizing the problems of over and under protection across a wide range of disciplines and jurisdictions. (shrink)

BackgroundThe Patient Health Questionnaire-9 is the most well-known self-report measure to screen for depressive symptomatology, although discerning which is the factor structure that represents the best fit remains a challenge.ObjectiveThe aim of this study was to analyze the psychometric properties and factorial structure of the Spanish version of the PHQ-9 in a large sample of Ecuadorian college students.MethodsA total of 5,394 students from three Ecuadorian universities were surveyed using a computerized questionnaire within a 4-week assessment period. The PHQ-9 was tested (...) for factorial structure, reliability, and correlations with other mental health-related measures.ResultsThe hierarchical model that included a general factor and three nested factors had a better fit, and such a hierarchical structure remained invariant across sex and age. Total omega value was 0.90 for the total scale and hierarchical omega values were 0.68 for the general factor, as well as 0.34, 0.38, and 0.44 for the respective nested factors. Moreover, PHQ-9 scores were significantly higher among women, although effect sizes of comparison of those sex differences were very small. Finally, the PHQ-9 scores correlated with multiple mental health indicators.DiscussionThe Spanish version of the PHQ-9 showed good psychometric properties among Ecuadorian college students. The hierarchical structure showed the best fit for the data, including not only a dominant general factor, but also the somatic, cognitive/affective and concentration/motor subcomponents. In conclusion, the PHQ-9 tool seems to represent an easy-to-implement screening questionnaire to design preventive programs for those Ecuadorian college students at risk of developing depressive disorders. (shrink)

Empirical data can be an extremely powerful and influential tool in bioethical research. However, when researchers or policy makers look for answers to ethical questions by engaging with empirical research, there can be a tendency (conscious or unconscious) to shape, report, and use empirical research in a way that confirms their own preferred ethical conclusions. This skewing effect - what we call ‘normative bias’ - is often so subtle it falls short of clear misconduct and thus can be difficult (...) to call out. However, we argue that this subtle influence of bias has the potential to significantly influence debate and policy around highly sensitive ethical issues and must be guarded against. In this paper we share the lessons we have learned through a journey of self-reflection around the effect that normative bias can have when reporting on and referring to empirical data relating to ethical issues. We use a variety of papers from our area of the ethics of routine prenatal screening to illustrate these subtle but often powerfully distorting effects of bias. Our aim in doing so is not to criticise the work of others, as we recognise our own normative bias, but to improve awareness of this issue, remind the need for reflexivity to guard against our own biases, and introduce a new criterion - the idea of a ‘limitation prominence assessment’ - that can work as a practical way to evaluate the seriousness of the limitations of an empirical study and thus, the risks of the study being misread or misinterpreted through superficial reading. (shrink)

With the growing amount of clinical research, regulations and research ethics are becoming more stringent. This trend introduces a need for quality assurance measures for ensuring adherence to research ethics and human research protection beyond Institutional Review Board approval. Audits, one of the most effective tools for assessing quality assurance, are measures used to evaluate Good Clinical Practice and protocol compliance in clinical research. However, they are laborious, time consuming, and require expertise. Therefore, we developed a simple auditing process and (...) evaluated its feasibility and effectiveness. The screening audit was developed using a routine audit checklist based on the Severance Hospital’s Human Research Protection Program policies and procedures. The measure includes 20 questions, and results are summarized in five categories of audit findings. We analyzed 462 studies that were reviewed by the Severance Hospital Human Research Protection Center between 2013 and 2017. We retrospectively analyzed research characteristics, reply rate, audit findings, associated factors and post-screening audit compliance, etc. Investigator reply rates gradually increased, except for the first year. The studies were graded as “critical,” “major,” “minor,” and “not a finding”, based on findings and number of deficiencies. The auditors’ decisions showed fair agreement with weighted kappa values of 0.316, 0.339, and 0.373. Low-risk level studies, single center studies, and non-phase clinical research showed more prevalent frequencies of being “major” or “critical”. Inappropriateness of documents, failure to obtain informed consent, inappropriateness of informed consent process, and failure to protect participants’ personal information were associated with higher audit grade. We were able to observe critical GCP violations in the routine internal audit results of post-screening audit compliance checks in “non-responding” and “critical” studies upon applying the screening audit. Our screening audit is a simple and effective way to assess overall GCP compliance by institutions and to ensure medical ethics. The tool also provides useful selection criteria for conducting routine audits. (shrink)

Research on individuals at clinical high risk for psychological and physical disorders has grown exponentially in recent years, with a variety of new screening tools and early intervention techniques being implemented. One recent example is Attenuated Psychosis Syndrome, a diagnosis for individuals who are at clinical high risk for psychosis, which was recently included in Section III of the Diagnostic and Statistical Manual of Mental Disorders. Given the focus on prevention at early stages, at-risk individuals will (...) continue to be a topic of significance not only in psychosis research but also in other illnesses. This document provides a comprehensive summary of the ethical dilemmas that clinicians or researchers may encounter in this domain, and possible actions consistent with the current Canadian Code of Ethics for Psychologists. We use clinical high risk for psychosis and the Canadian Code of Ethics for Psychologists as a way to illuminate these ethical issues; however, application to other jurisdictions and disciplines, as well as other high-risk populations, is also of relevance. (shrink)

In prevention and health promotion interventions, screening methods and risk profile assessments are often used as tools for establishing the interventions’ effectiveness, for the selection and determination of the health status of participants. The role these instruments fulfil in the creation of effectiveness and the effects these instruments have themselves remain unexplored. In this paper, we have analysed the role screening methods and risk profile assessments fulfil as part of prevention and health promotion programmes in the (...) selection, enrolment and participation of participants. Our analysis showed, that screening methods and health risk assessments create effects as they objectify health risks and/or the health status of individuals, i.e., they select the individuals ‘at risk’ and indicate the lifestyle modifications these people are required to make in order to improve their health. Yet, these instruments also reduce the group of participants thereby decreasing the possible effect of interventions, as they provide the legitimisation for people to make choices to whether they enrol or not and what lifestyle changes they incorporate into their lives. In other words, they present a space of interaction, in which agency is distributed across the practice nurses, the participants and the instruments. Decisions were not just made upon the projection of the outcomes of these instruments; decisions that were made by both the patients and practice nurses were the resultant of their opinions on these outcomes that were formed in interaction with the instruments. (shrink)

In the summer of 1914, Archduke Franz Ferdinand was assassinated in Sarajevo, an event which led to the horror of World War I and which many historians suggest marked the beginning of the twentieth century. In 1992, Sarajevo again lurched into prominence as the focal point of one of the century’s bloodiest civil wars. Yet Sarajevo at one point epitomized the dreams of the Enlightenment, a city where Christians, Jews, and Muslims peacefully coexisted. In the midst of Sarajevo’s recent decline (...) into chaos and destruction, Susan Sontag decided to produce Act I of Waiting for Godot, which, despite ever-looming danger, played to packed houses. Why? Why did this city of hope lie crushed at the end of the twentieth century? Why did Sontag stage an artistic production in the middle of such overwhelming tragedy? Why Waiting for Godot ? And, most important, why the appreciative, silent tears of audience members who risked their lives to attend a play in the middle of a war?These are the questions that guide David Toole’s theological reflections in Waiting for Godot in Sarajevo, where he seeks to come to terms with what it means to live a life of dignity in a world of undeniable suffering. Toole skillfully weaves together Friedrich Nietzsche’s views on nihilism with Michel Foucault’s analysis of power to produce a metaphysics of tragedy, or a “politics of dying.” Such politics are then used to shed new theological light on the Christian apocalypse and what it means to be alive at the end of the twentieth century. In making his argument, Toole draws innovative connections between such diverse figures as John Milbank, Alasdair MacIntyre, Euripides, John Howard Yoder, and Norman Maclean (author of A River Runs Through It and Young Men and Fire ), all the while using Beckett’s play as a compass for his direction. The end result is a fascinating, eminently readable, unexpectedly adventurous theological inquiry into the meaning of life. (shrink)

There are widely held premises that suicide is almost exclusively the result of mental illness and there is “strong evidence for successfully detecting and managing suicidality in healthcare”. In this context, ‘zero-suicide’ policies have emerged, and suicide risk assessment tools have become a normative component of psychiatric practice. This essay discusses how suicide evolved from a moral to a medical problem and how, in an effort to reduce suicide, a paternalistic healthcare response emerged to predict those at high (...) class='Hi'>risk. The evidence for the premises is critiqued and shown to be problematic; and it is found that strong paternalistic interventions are being used more often than acknowledged. Using a Principles approach, the ethics of overriding autonomy in suicide prevention is considered. Ethical concerns are identified with the current approach which are potentially amplified by the use of these risk assessments. Furthermore, it is identified that the widespread use of risk assessments in health settings is equivalent to screening without regard to the ethical principles of screening. The essay concludes that this is unethical; that we should abandon the use of standardized suicide risk assessments and ‘zero-suicide’ policy; and that this may improve outcomes. (shrink)

The recent financial crises indicated the need to reinforce corporate governance mechanisms in emerging and developing market economies. Corporate governance refers to all the factors that affect firm processes. Firms must avoid debt financing instruments and adopt financing instruments that allow for “risk-sharing” rather than “risk-shifting” because all recent financial crises were, in essence, debt crises. The primary objective of this paper is to examine the principles of risk-sharing promoted by Islamic finance and study their implications for (...) corporate governance. The secondary objective of this paper is to propose a pricing model for a new risk-sharing financial instrument that was recently discussed by Zarka and Al-Suhaibani. We study the implications of this new instrument as a powerful tool for corporate governance in the case of Islamic markets. We explain the possible contribution of IPS to agency cost reduction, Sharia screening costs and ethical corporate governance. (shrink)

Noninvasive prenatal screening using cell-free DNA, which analyzes placental DNA circulating in maternal blood to provide information about fetal chromosomal disorders early in pregnancy and without risk to the fetus, has been hailed as a potential “paradigm shift” in prenatal genetic screening. Commercial provision of cell-free DNA screening has contributed to a rapid expansion of the tests included in the screening panels. The tests can include screening for sex chromosome anomalies, rare subchromosomal microdeletions and (...) aneuploidies, and most recently, the entire fetal genome. The benefits of this screening tool are generally framed, by both providers and commercial laboratories, as enhancing reproductive autonomy and choice by providing an earlier, simpler, and more accurate screening while potentially reducing the need for invasive follow-up testing. The majority of the literature has explored these issues empirically or conceptually from a European or North American vantage point, one that assumes normative priorities such as individual reproductive autonomy and the clinical availability of maternal health care or prenatal screening programs within which cell-free DNA screening is offered. While its implementation has raised both challenges and opportunities, very little is known about real-world experiences and the implications of the rapid introduction of cell-free DNA screening outside of North America and Europe, especially in low- and middle-income countries. To begin addressing this gap in knowledge, we organized a four-day international workshop to explore the ethical, legal, social, economic, clinical, and practical implications of the global expansion of cell-free DNA screening. We describe eight key insights that arose from the workshop. (shrink)

ABSTRACTElder abuse is a serious and under-detected problem. Law reform agencies and legal profession regulatory authorities have called for action to ensure that lawyers meet their ethical obligations to older clients, including identifying and acting on risk factors for abuse. Screening tools to detect situations of elder abuse exist, but they are targeted mainly at health and social care practitioners. Drawing on international literature, this article identifies and discusses screening tools that could be adapted for use by (...) legal professionals. Three general categories of screening are relevant for lawyers who serve older clients: elder abuse screening tools that cover all domains of abuse or target specific behaviours, such as financial exploitation; screening for decision-making capacity, especially taking account of the impact of abuse or neglect on capacity; and screening to probe the suitability of a person to act in a formal decision-making role for an older person. The article emphas... (shrink)

Substantial medical evidence shows that about half of ovarian cancers originate in the fallopian tube. Some medical organizations and clinical articles have suggested opportunistic salpingectomy to reduce the risk of ovarian cancer in patients at average risk of developing it. This entails removing the fallopian tubes at the same time as another procedure that would occur anyway. The authors argue that the principles of totality and double effect can justify such salpingectomies, even though there is a low incidence (...) of ovarian cancer. Since screening tools for ovarian cancer are ineffective and treatment options are poor, the good effect of reducing the risk of death from this type of ovarian cancer can be proportionate to the bad effects of the minor increase in surgical risk over the other procedure, the unintended side effect of infertility, and the removal of normally functioning tissue. The authors conclude that it is within the purview of a patient and physician to determine whether the benefits are proportionate to the risks in a particular case. (shrink)

COVID-19 pandemic-related perceived risk of infection, illness fears, acute stress, emotional anxiety, exhaustion, and fatigue, psychological trauma and depressive symptoms, and sustained psychological distress can cause smartphone addiction risk and lead to technology-related cognitive, emotional, and behavioral disorders, thus impacting psychological well-being. Behavioral addiction of smartphone users can result in anxiety symptom severity, psychiatric symptoms, and depressive stress. We carried out a quantitative literature review of the Web of Science, Scopus, and ProQuest throughout June 2022, with search terms (...) including “smartphone addiction + COVID-19” + “stress,” “anxiety,” “depression,” “psychological distress,” “screen time,” and “fear.” As we analyzed only articles published between 2020 and 2022, 288 papers met the eligibility criteria. By excluding sources with similar titles, having unclear findings or unsupported by replication, or displaying inconsistent content, we selected 64, mainly empirical, sources. We used layout algorithms and bibliometric mapping as data visualization tools. Assessing the Methodological Quality of Systematic Reviews, a systematic review and literature review software, Mixed Methods Appraisal Tool, and Systematic Review Data Repository were employed as methodological quality assessment tools. As limitations, we analyzed only articles published between 2020 and 2022 in scholarly outlets indexed in the Web of Science, Scopus, and ProQuest databases. The scope of our study also does not advance the inspection of sources covering vulnerable individuals suffering from certain diseases or specific generations. Subsequent analyses should develop on smartphone use and addiction among children and adolescents. Future research should thus investigate problematic smartphone use and addiction across generations Z and Alpha. Attention should be directed to their personality traits and psychopathological symptoms. (shrink)

Impairment of spatial memory, including an inability to recall previous locations and navigate the world, is often one of the first signs of functional disability on the road to cognitive impairment. While there are many screening and diagnostic tools which attempt to measure spatial memory ability, they are often not representative of real-life situations and can therefore lack applicability. One potential solution to this problem involves the use of virtual reality, which immerses individuals in a virtually-simulated environment, allowing for (...) scenarios more representative of real-life without any of the associated risks. Here, we review the evidence surrounding the use of VR for the screening and diagnosis of spatial memory impairments, including potential limitations and how it compares to standard neuropsychological tests. We will also discuss the evidence regarding the potential use of VR in the rehabilitation of spatial memory deficits, which has not been well studied, but which could be game-changing if proven successful. (shrink)

Background and aim Child and adolescent forensic psychiatry is fraught with complex medical, legal, and social tensions. The ethical challenges this entails for inhospital treatment have hardly been investigated, and specific support for health care professionals is lacking. This study identifies ethical issues and problems in this area and develops a tool for early detection and intervention of ethical problems in clinical practice. Methods A systematic literature search and an observational study in adolescent forensics at the University Psychiatric Clinics (...) Basel are conducted. The observation data are evaluated using a qualitative content analysis. The instrument is developed based on the results using a new method. Results In the literature search, 14 valid publications were identified that mainly address ethical conflicts in legal psychiatry, such as professional role conflicts, ethical problems in diagnostics and assessment, or confidentiality issues. Empirical or empirical–normative studies are missing. In the observational study, 24 ethical issues and specific conflicts were identified. Ethical questions about moral competencies of the adolescents, the quality of treatment, the handling of rules and sanctions, and freedom and privacy are particularly common. The Instrument for Early Detection and Intervention of Ethical Problems (FIEP) contains the four core elements risk factors, indicators, intervention planning and decision-making. Conclusions Inhospital treatment in forensic child and adolescent psychiatry reveals a broad spectrum of ethical issues with specific ethical problems, which are hardly investigated in literature so far. The FIEP instrument developed here supports health care practitioners in recognizing ethical problems at an early stage and addressing them efficiently. (shrink)

Violence risk assessment tools are increasingly used within criminal justice and forensic psychiatry, however there is little relevant, reliable and unbiased data regarding their predictive accuracy. We argue that such data are needed to (i) prevent excessive reliance on risk assessment scores, (ii) allow matching of different risk assessment tools to different contexts of application, (iii) protect against problematic forms of discrimination and stigmatisation, and (iv) ensure that contentious demographic variables are not prematurely removed from risk (...) assessment tools. (shrink)

The clinical trial is the major investigational tool of clinical medicine. Two recent reports highlight the fact that the most often quoted mechanisms for the protection of research subjects, viz., research ethics board review and eligibility criteria, are insufficient to achieve this end. In this paper, we argue that the prime mechanism for the protection of persons in clinical trials should be the clinical judgement of the physician-investigator. The clinical investigator has a duty to protect subjects from both harm (...) and undue risk. It is argued that the clinical investigator has a duty to screen for, and exclude, potential research subjects who may be unduly vulnerable to the risks of a particular clinical trial. In order to fulfill this obligation, the investigator should personally screen each potential research subject at the time of accrual. In larger trials in which this is not feasible, this task could be delegated to another appropriately qualified health care professional, with the principal investigator retaining personal responsibility. To reinforce and make explicit this legal and moral duty, we propose that the investigator sign a statement, appended to each subject's consent form, to attest that this duty has been responsibly discharged. (shrink)

Jeff Nisker describes his personal experience of a diagnosis of advanced prostate cancer and the kindnesses he received from friendly doctors. He claims that this narrative account supports the promotion of Prostate Specific Antigen screening for asymptomatic men and impugns statisticians, mistakenly thinking that their opposition to PSA screening derives from concerns about financial cost. The account inadvertently demonstrates the danger of over-reliance on a single ethical tool for critical analysis. In the first part of this response, (...) we describe the statistical evidence. The most reliable Cochrane meta-analyses have not shown that PSA screening saves lives overall. Moreover, the high false positive rate of PSA screening leads to overinvestigation which results in unnecessary anxiety and increased cases of unnecessary sepsis, urinary incontinence and sexual dysfunction. Then we describe how narrative ethics alone is an insufficient tool to make claims about policies, such as PSA screening, which have hidden harms. Although Nisker’s story-telling is compelling and evokes emotions, narrative ethics of this sort have an inherent bias against people who would be harmed by the counterfactual. Particular care must be taken to look for and consider those untellable stories. Ethicists who only consider narratives which are readily at hand risk harming those who are voiceless or protected by the status quo. PSA screening is the wrong tool to reduce prostate cancer deaths and narrative ethics is the wrong tool to appraise this policy. It is vital that the correct theoretical tools are applied to the medical and ethical questions under scrutiny. (shrink)

Publication date: 24 January 2019 Source: Author: Timurlenk Chekovik, Jugoslav Achkoski The control of migrants in Europe has become increasingly challenging, marked by a number of illegal border-crossing. It revealed a crisis without equivalent since World War II. The European borders are now one of the most affected by migrants from Asia and Africa. Border police is the most responsible for the first interview with the asylum seeker. In terms of basic contribution to the asylum procedure, good cooperation between the (...) border police and the services of asylum is of primary importance. There is a need of risk assessment. While the risk assessment is made there can be a violation of the humanitarian aspect of conducting regular border check. By determining the race and color of migrants, screening made on the border crossing can put legality of the border police actions in question. The Humanitarian efforts with border management, cooperation between the government services and use of appropriate methodology are an important segment handling migrant crisis. One of the known methodologies is Analysis of Competitive Hypotheses used to better assess the choice of a suitable place for migrants and their acceptance or readmission. Тhe procedure for vulnerable categories of citizens can jeopardize the legality and the manner of dealing with illegal migrants and this arises from the legal and physical protection of persons seeking asylum. The `politics of pity' changes into psychological cases to be governed by risk technologies within a `politics of risk', the humanitarian and security interventions are shown to be in no way mutually exclusive. (shrink)

The purpose of the present study was to test the measurement invariance of the baby pediatric symptom checklist across gender and age as a means to provide for valid comparisons in point estimates across groups. A secondary goal involved confirming the earlier identified factor structure and re-examining the presence of differentially item functioning in the BPSC across grouping variables. Participants were 601 children aged below 1 year and 1 year to 12 months. Data were collected as part of the National (...) Health Interview Survey in 2020. Results related to gender indicated satisfying all five levels of measurement and structural invariance. When testing measurement invariance across age groups, a few modifications were necessary. Specifically, partial metric invariance was satisfied after freeing slope estimates of items 1 and 2, partial scalar after freeing intercept terms of items 6 and 10, and partial residual invariance through freeing error terms of items 2 and 12. These non-invariant estimates, however, provide support for partial invariance and do not invalidate the comparison of latent means. The BPSC can be used for the valid assessment of social–emotional skills in infants up to the age of 18 months. (shrink)

The quality and authenticity of images is essential for data presentation, especially in the life sciences. Questionable images may often be a first indicator for questionable results, too. Therefore, a tool that uses mathematical methods to detect suspicious images in large image archives can be a helpful instrument to improve quality assurance in publications. As a first step towards a systematic screening tool, especially for journal editors and other staff members who are responsible for quality assurance, such (...) as laboratory supervisors, we propose a basic classification of image manipulation. Based on this classification, we developed and explored some simple algorithms to detect copied areas in images. Using an artificial image and two examples of previously published modified images, we apply quantitative methods such as pixel-wise comparison, a nearest neighbor and a variance algorithm to detect copied-and-pasted areas or duplicated images. We show that our algorithms are able to detect some simple types of image alteration, such as copying and pasting background areas. The variance algorithm detects not only identical, but also very similar areas that differ only by brightness. Further types could, in principle, be implemented in a standardized scanning routine. We detected the copied areas in a proven case of image manipulation in Germany and showed the similarity of two images in a retracted paper from the Kato labs, which has been widely discussed on sites such as pubpeer and retraction watch. (shrink)

This paper investigates the use of metrics to recruit professors for academic positions. We analyzed confidential reports with candidate evaluations in economics, sociology, physics, and informatics at the University of Oslo between 2000 and 2017. These unique data enabled us to explore how metrics were applied in these evaluations in relation to other assessment criteria. Despite being important evaluation criteria, metrics were seldom the most salient criteria in candidate evaluations. Moreover, metrics were applied chiefly as a screening tool (...) to decrease the number of eligible candidates and not as a replacement for peer review. Contrary to the literature suggesting an escalation of metrics, we foremost detected stable assessment practices with only a modestly increased reliance on metrics. In addition, the use of metrics proved strongly dependent on disciplines where the disciplines applied metrics corresponding to their evaluation cultures. These robust evaluation practices provide an empirical example of how core university processes are chiefly characterized by path-dependency mechanisms, and only moderately by isomorphism. Additionally, the disciplinary-dependent spread of metrics offers a theoretical illustration of how travelling standards such as metrics are not only diffused but rather translated to fit the local context, resulting in heterogeneity and context-dependent spread. (shrink)

Automatic screening tools such as plagiarism scanners play an increasing role in journals’ efforts to detect and prevent violations of research integrity. More than just neutral technological means, these tools constitute normatively charged instruments for governance. Employing the analytical concept of the digital imaginary, this contribution investigates the normative concepts that play a role in journals’ use of automatic screening. Using survey data of journal editors, as well as guidance documents by academic publishers and the Committee of Publication (...) Ethics, it traces how editors normatively situate their (non-)use of automatic screening tools in two opposing imaginaries of academic publishing: One that portrays academic publishing as a small and safe community, and one that sees it as a vast and dangerous space. These imaginaries reflect the social and epistemic characteristics and publication cultures in different academic fields, and both entail different modes of control. Additionally, they are shaped by a focus on plagiarism screening as a specific form of automatic screening that critically hinges on the issue of size of the publishing space, which exemplifies the mutual constitution of a specific problem, an imaginary where this problem becomes meaningful, and the availability of a tool that targets this problem. (shrink)

Generalized anxiety disorder can cause significant socioeconomic burden and daily life dysfunction; hence, therapeutic intervention through early detection is important. This study was the final stage of a 3-year anxiety screening tool development project that evaluated the psychometric properties and diagnostic screening utility of the Mental Health Screening Tool for Anxiety Disorders, which measures GAD. A total of 527 Koreans completed online and offline versions of the MHS: A, Beck Anxiety Inventory, Generalized Anxiety Disorder-7, and (...) Penn State Worry Questionnaire. The participants had an average age of 38.6 years and included 340 females. Participants were also administered the Mini-International Neuropsychiatric Interview. Internal consistency, convergent/criterion validity, item characteristics, and test information were assessed based on the item response theory, and a factor analysis and cut-off score analyses were conducted. The MHS: A had good internal consistency and good convergent validity with other anxiety scales. The two versions of the MHS: A were nearly identical. It had a one-factor structure and showed better diagnostic accuracy for GAD detection than the GAD-7 and BAI. The IRT analysis indicated that the MHS: A was most informative as a screening tool for GAD. The MHS: A can serve as a clinically useful screening tool for GAD in Korea. Furthermore, it can be administered both online and offline and can be flexibly used as a brief mental health screener, especially with the current rise in telehealth. (shrink)

Recently, two prescription drugs have become salient to breast cancer prevention. With the advent of these drugs, referred to as “chemoprevention,” a mandate has emerged to classify certain women as high risk for breast cancer to determine a group of legitimate users of the drugs. This article examines the development and standardization of the model used to create such a group of high-risk women. The author argues that while the model remains uncertain and controversial, it has become the (...) standard tool for the many jobs associated with legitimizing chemoprevention use in the United States. It has become the assumed standard—shaping practices, identities, and definitions—through its organizational embeddedness in the multiple practices and public images of chemoprevention despite its uncertainty and widespread critique. (shrink)

In “Risk Based Passenger Screening in Aviation Security: Implications and Variants of a New Paradigm”, Sebastian Weydner-Volkmann describes the current paradigm shift from ‘traditional’ forms of screening to ‘risk based passenger screening’ (RBS) in aviation security. This paradigm shift is put in the context of the wider historical development of risk management approaches. Through a discussion of Michel Foucault, Herfried Münkler and Ulrich Beck, Weydner-Volkmann analyses the shortcomings of such approaches in public security policies, (...) which become especially evident in the aviation security context. As he shows, the turn towards methods of RBS can be seen as an attempt to address a trade-off ‘trilemma’ between the effective provision of security, the implied costs for industry and passengers, and the ethical, legal and societal implications of the screening procedures. In order to analyse foreseeable outcomes of embracing RBS, he differentiates three prototypical variants of the new paradigm on the basis of their main referent and rationale. For each variant, he then subsequently assesses the implications for the ‘trilemma’, after having unveiled the criteria of analysis that will necessarily have to be followed within a serious appraisal of RBS methods. (shrink)

Myocardial disarray is the screening tool for HCM (hypertrophy cardiomyopathy). It is also found in hypertension, congenital heart disease, corpulmonale, etc. Many patients died from heart failure due to myocardial disarray. The risk of premature death may be determined by the degree of myocyte disarray. This article reviews the anatomical explanation of myocardial disarray. It also discusses the pathogenesis of the myocardial disorganization that causes heart failure. How to measure myocardial disarray has also been assessed. Therefore, early (...) detection of myocardial disarray is advised to prevent heart failure. (shrink)

In this text, our question is what is the current regulatory trend in countries that are not considered central in the development of artificial intelligence, such as Brazil: a preventive approach, or an experimental approach? We will analyze the bills (PL) that are being processed in legislative houses at the state level, and at the federal level, highlighting some elements, such as: Delimitation of the object (conceptualization), fundamental principles, ethical guidelines, relationship with human work, human supervision, and guidelines for public (...) authorities. Based on these elements, we identified how the issues that drive the contemporary debate on AI have been addressed in these legislative initiatives. The results indicate that the strongest national regulation proposal mentions risks, rights, governance, economic agents; these mentions dialogue with the concerns discussed by researchers around the world, regarding the mitigation and prevention of risks, regarding the preservation of individual and collective rights, the role of the State as a regulator and supervisor, and, as was to be expected, the maintenance of economic policies that possibly tend to protect the market; proposes that the foundations of the development, implementation and use of AI have values consistent with ‘human centered AI’ (Bingley et al. 2023), but also points to the neoliberal matrix; introduces human supervision as an effective element in the AI systems cycle; the trend that we can observe in Brazil is the configuration of a regulation that harmonizes articles that favor the preventive approach, with the presence of articles that favor the experimentation approach. (shrink)

Newborn screening has evolved to include an increasingly complex spectrum of diseases, raising concerns that screening should be optional and require parental consent. Early detection of disorders like PKU and MCAD is essential to prevent serious disability and death in affected children. These are examples of high benefit-risk ratio disorders because of the irrefutable health benefits of early detection, coupled with the low risks of treatment. The dire consequences of not diagnosing an infant with a treatable disorder (...) because of parental refusal to screen are wholly unacceptable. Thus, we believe that newborn screening for disorders with high benefit-risk ratios should continue to be mandatory. (shrink)

The ability to determine genetic predisposition to cancer represents an opportunity to expand cancer control efforts in a manner that was previously unimaginable. This possibility also forces individual patients, families, health care professionals, and society to confront difficult questions about genetic knowledge. Although genetic testing or screening for cancer risk may hold promise of cancer control benefits, this prospect also raises significant ethical and legal concerns that must inform and shape policy decisions. In “Cancer Genetic Susceptibility Testing,” Benjamin (...) Wilfond and the Cancer Genetic Screening Consortium present a status report and an ambitious agenda for future examination of ethical and policy issues in this embryonic field. The paper provides a provocative and timely discussion of some extremely vexing issues, but it also misses on several critical points. (shrink)

Risk communication has been generally categorized as a warning act, which is performed in order to prevent or minimize risk. On the other side, risk analysis has also underscored the role played by information in reducing uncertainty about risk. In both approaches the safety aspects related to the protection of the right to health are on focus. However, it seems that there are cases where a risk cannot possibly be avoided or uncertainty reduced, this is (...) for instance valid for the declaration of side effects associated with pharmaceutical products or when a decision about drug approval or retirement must be delivered on the available evidence. In these cases, risk communication seems to accomplish other tasks than preventing risk or reducing uncertainty. The present paper analyzes the legal instruments which have been developed in order to control and manage the risks related to drugs – such as the notion of “development risk” or “residual risk” – and relates them to different kinds of uncertainty. These are conceptualized as epistemic, ecological, metric, ethical, and stochastic, depending on their nature. By referring to this taxonomy, different functions of pharmaceutical risk communication are identified and connected with the legal tools of uncertainty management. The purpose is to distinguish the different functions of risk communication and make explicit their different legal nature and implications. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:It's Not Always Just a RashAdam BossertI looked at the emergency department track board and saw a patient waiting for a provider who was "roomed" in a hallway stretcher with a chief complaint of a rash. I briefly considered his ultimate disposition, "He's probably fine. He can't be that sick if he was triaged as safe for the hallway." I was tired and close to the end of an (...) overnight shift and thought he would be a quick turnaround, likely discharged, since rashes are typically benign. I walked over to his stretcher after a quick chart biopsy that highlighted his mildly increased heart [End Page 24] rate on arrival as well as his history of polysubstance use and homelessness."Hey doc, I don't feel so good.""I'm sorry to hear that. What's specifically bothering you?""I am itching all over with these bumps. My skin is red, and I also think I'm withdrawing since I have body aches and chills."The interview continued.I discovered his last heroin use was approximately eight hours prior to arrival. I thought he was an ideal candidate for buprenorphine since he was actively withdrawing. I was recently licensed to prescribe this medication and excited to use my license for the first time. He declined the suggestion, however, preferring methadone instead. Buprenorphine can precipitate withdrawal if not given long enough after opioid use or if an incorrect dose is given; thus, many patients are hesitant to take it. He also stated he was predominantly here for his rash and did not want rehabilitation placement. I ordered our initiation methadone dose as well as a screening COVID-19 test and a urine drug screen test, which are both needed for rehabilitation placement in case he changed his mind.His rash was highly suspicious for scabies. He was covered with red bumps that spared only his face, some in linear distributions, and was actively scratching his arms and legs during the interview. I prefer oral ivermectin over topical permethrin for the homeless population simply for ease of administration, lower cost, and increased compliance. He received ivermectin for his scabies and knew he could return to the emergency department for a repeat dose if he was unable to fill a prescription.What happened next is, in my experience, an all-too-common scenario.The patient told me that the methadone is "doing nothing." I explained he could no longer take buprenorphine since he already received methadone, which only made him more frustrated. Unfortunately, I am restricted with the amount of methadone I can give in the emergency department, largely due to the drug's long half-life, and thus I was unable to give him more, let alone attempt titrating to his tolerance.Opioid withdrawal is not a life-threatening diagnosis; these patients are not typically admitted to the hospital. The management consists of initiating either methadone or buprenorphine, symptomatic treatment and then outpatient referral or rehabilitation placement. I explained the options to him, and he requested to be discharged since he was deferring rehabilitation. He was discharged. I was able to treat his rash but his chronic illness, opioid use disorder, was not controlled.I discharge a patient in opioid withdrawal or who has opioid use disorder almost every day, and I think most emergency medicine physicians would echo that statement. The disposition is not wrong from the perspective of the individual physician, but it feels like the system has failed these patients when I think of the frequency that they return and their baffling risk of overdose. The latter can be reduced by giving patients Narcan, the drug to reverse opioid overdose, upon discharge but this is just placing a bandage over the problem and not all emergency departments can fund this risk-reduction tool.I saw my patient's COVID-19 result return as I wrapped up my shift. It was positive. And, of course, he was in our department's hallway the whole time, only intermittently using his mask. I suddenly realized that while yes, he was withdrawing, he also may have had a symptomatic COVID-19 infection! I quickly reopened his chart, only to... (shrink)

The focus of this chapter will be on the epistemic and normative questions at issue in debates about cancer screening, with a special focus on mammography as a case study. Such questions include: How do we know who needs to be screened? What are the benefits and harms of cancer screening, and what is the quality of evidence for each? How ought we to measure and compare these benefits and harms? What are the sources of uncertainty about our (...) estimates of benefit and harm? Why are such issues so contested? What are the major drivers of dissent and consensus on the data and their interpretation? How, if at all, do values play a role in debates surrounding mammography screening? In sum: In what ways does inductive risk, broadly conceived, 1 come into play in the science behind cancer screening, and mammography screening in particular? (shrink)

Although risk and uncertainty are inevitable aspects of the sustainability problem, they are often neglected in the sustainability discourse, especially in the economic analysis of sustainable development. We argue that this deprives the sustainability discourse of interesting connections to risk management. We show that defining sustainability as the obligation to limit the risk of harming future individuals provides a framework in which tools from risk management, like mean-variance analysis, can be employed to analyze planning decisions and (...) to calculate a risk-minimizing policy mix. Furthermore, we discuss whether such a notion of sustainability can be an ethically tenable sustainability concept and how a positive probability of harming future individuals might be defended. (shrink)

The purpose of this study was to examine the role of personality traits on academic performance. Furthermore, this study also aims at exploring the effects of virtual experience and emotional intelligence between personality traits and academic performance of the students. The findings imply that personality traits are the strong predictors of better academic performance. However, several personality traits do not have a positive impact on the academic performance. The study further suggests that students who have emotional abilities and virtual experience (...) are more likely to perform well in their academics. The population of this research consists of students in various colleges and universities in developing regions. Thus, the sample consists of bachelor's and master's students. Existing scales are adopted with minor changes to make it more suitable and understandable within the study context. A total of 319 questionnaires were distributed. Among these 365 questionnaires, 234 questionnaires were received and further used for the purpose of data analysis. This shows an encouraging response from the targeted sample. Education and productivity of the students are influenced by their personality as well as their emotional intelligence abilities. The findings imply that being extrovert is a strong predictor of student achievement and should be prioritized in intervention strategies. This personality feature is responsible for performance in addition to virtual learning experience. Despite its low overall relative value, agreeableness is a significant driver of student achievement. Along with ability and aptitude assessments, personality evaluations might be utilized as a secondary screening tool to identify adolescents at risk of underperformance and academic performance failure. Therefore, learning emotional skills would be beneficial to cope the modern challenges of the competitive educational environment. Virtual experience and being emotionally sound can help students to learn quickly and to be more adaptive into the new world of digitalization. The conclusions of the current study have significant consequences for educators and policymakers. They must accept that boosting emotional intelligence levels through teaching or training is a significant objective of contemporary education. The emotional intelligence abilities of the students related to culture may be shown in a variety of ways, from expectations toward students to interpersonal interactions with students, and from teaching techniques to evaluation methods. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“What Is Actually Being Measured?”: Causality and Underlying Scientific Thinking Process in the Assessment of DepressionGreta Kaluzeviciute-Moreton, PhD (bio)Depression is a complex mental health phenomenon due to its multifaceted nature. For one, depression is thought to have a significant genetic component, with studies suggesting that heritability is a significant factor in the development of the disorder (Sullivan, Neale, Kendler, 2000). In clinical psychology, environmental factors such as childhood trauma, (...) chronic stress, social isolation and negative life events (e.g., the loss of a loved one) have been documented as significant risk factors for the development of depression or as trigger events for depressive episodes (Fu & Parahoo, 2009; Kendler, Kuhn, & Prescott, 2004; Neitzke, 2016). Despite this, causal theories of mental health conditions are often tricky and/or scarcely reflected in both diagnostic and rating scales. For instance, the Diagnostic and Statistical Manual of Mental Disorders classifies mental health disorders primarily based on observable symptoms and behaviors, rather than on the underlying psychological and neurobiological processes that may contribute to these symptoms (Kendler, 2006).Similarly, rating scales for depression are typically designed to assess the severity of symptoms, rather than their underlying causes, that is, most rating scales are used as screening tools to identify individuals who may require further evaluation and treatment. Some rating scales may include items related to causal factors, such as the Beck Depression Inventory-II (BDI-II) includes an item that asks about “loss of interest in sex,” which could be related to either biological or psychological factors. Several rating scales include items assessing risk factors for depression, such as family history of depression or personal history of trauma. This may be indicative of both genetic and environmental risk factors, such as the Patient Health [End Page 255] Questionnaire-9, includes an item that asks about family history of depression. However, while risk and causal factors are related, they are distinct in the assessment of depression. Risk factors refer to factors that increase the likelihood of developing depression, while causal factors refer to factors that directly contribute to the development of the condition. The presence of a risk factor does not necessarily mean that an individual will develop depression (Peterson & Seligman, 1984). However, the two are frequently blurred and equated in psychotherapy research (Westen & Bradley, 2005).As such, the historical issues of rating and diagnostic scales, aptly depicted by the Le Moigne (2023) as full of “composite, if not contradictory, heritage, weaving together the classificatory and discontinuous tradition of psychiatry, on the one hand, and the psychometric and continuous tradition of psychology, on the other” (p. XX ), suffer from an epistemological oversight when it comes to the assessment of causal factors in complex mental health conditions, such as depression. In turn, this contributes to a wider psychometric issue: what is actually being measured? Le Moigne’s detailed overview predominantly focuses on “superficial” symptomatology of depression (which contributed to two distinct forms of evaluation: hetero- and self-evaluation), and its subsequent impact on the classification and taxonomy of depression throughout history. However, the overarching conceptualization of depression (including a more detailed consideration of causal factors and their assessment) and the usefulness of rating scales in applied research (such as psychotherapy) remain in the background.The question of “what is actually being measured” is obviously not new in psychometrics. However, it is important to continuously revisit this issue, given that rating scales (such as the BDI) are considered to be universally applicable “evidence-based” tools (Rogers, Adler, Bungay, & Wilson, 2005) as well as a common and well-accepted form of scientific thinking in psychotherapy research (Kaluzeviciute & Willemsen, 2020). From an epistemological point of view, a scientific thinking style entails not only cognitive operations common to methodology, but also practices of generating, sharing, assimilating and transforming knowledge(Hacking, 2012).Therefore, it is important to acknowledge that any scientific tool, including rating scales, encompasses not just what but also how researchers find out about their studied phenomena (i.e., a scientific thinking style conveys a performative quality) (Kaluzeviciute & Willemsen, 2020). As identified by Le Moigne (2023), taxonomy leads toward a category-based logic in that it considers the examined phenomenon to be shared by only a... (shrink)