Purpose While online classes have enabled many universities to carry out their regular academic activities, they have also given rise to new and unanticipated ethical concerns. We focus on the “dark side” of online class settings and attempt to illuminate the ethical problems associated with them. The purpose of this study is to investigate the affordances stemming from the technology-user interaction that can result in negative outcomes. We also attempt to understand the context in which these deleterious affordances are actualized. (...) Design/methodology/approach We obtain the data from narratives written by students at a top private university in Bangladesh about their experiences of online classes and exams and from focus group discussions with them. We use the lens of affordance theory to identify the abilities that goal-oriented actors – primarily students – obtain from the technology-user interactions, which result in negative outcomes. We also attempt to understand the contextual actualization of those affordances through the lens of Routine Activity Theory (RAT). Findings We find three deleterious affordances and three associated deviant outcomes. Non-monitorability which results in academic dishonesty, disguiseability which results in cyber-truancy, and intrudeability which results in embarrassment and harassment. Our findings reveal a deeper underlying problem with the existing educational approach in the universities of Bangladesh and suggest that there is a need to introduce more modern teaching techniques focused on issues such as student engagement and interactive learning. Originality/value To the best of our knowledge, this is the first paper that combines affordance theory with RAT to identify unethical practices observed in online class settings in the context of a least developed country like Bangladesh and to examine the environmental components that give rise to the pre-conditions for the unethical practices to surface. (shrink)

Malpractice issues in psychotherapy and psychological treatments refer to the unethical behavior of a psychologist or psychotherapist toward the patient. The current study reviewed complaints directed at psychologists and psychotherapists in Sweden with regard to possible incidents of malpractice. Eligible cases were retrieved from a database managed by the Health and Social Care Inspectorate [Inspektionen för vård och omsorg (IVO)], an administrative authority responsible for the safety and quality of healthcare and social services delivery. These cases were analyzed using thematic (...) analysis. In total, 33 complaints matched the keywords proposed by IVO, and were scrutinized in detail. The cases primarily involved psychiatric care by a psychologist in outpatient settings, although many cases comprised multiple healthcare providers responsible for the patient’s care, or targeted the healthcare unit as a whole. The results demonstrated that different forms of malpractice occur, and can be classified in two general themes, Incorrect administration and implementation and Attitude and behavior, which involve organizational aspects as well as examples of malpractice and unethical behavior. Implications for clinical practice and future research include further training in ethics and malpractice, video recording or auditing sessions, routine outcome monitoring, and providing patients with information on how to file complaints. (shrink)

For the successful achievement of evidence-based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a re-clarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to (...) review outcome measures for use in routine care settings. Central features include the user-centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence-based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care. (shrink)

(2011). The Children's Oncology Group Routinely Applies “Lack of Efficacy” Interim Monitoring to Its Randomized Clinical Trials. The American Journal of Bioethics: Vol. 11, No. 3, pp. 18-19.

BackgroundPublication and outcome reporting bias is often caused by researchers selectively choosing which scientific results and outcomes to publish. This behaviour is ethically significant as it distorts the literature used for future scientific or clinical decision-making. This study investigates the practicalities of using ethics applications submitted to a UK National Health Service research ethics committee to monitor both types of reporting bias.MethodsAs part of an internal audit we accessed research ethics database records for studies submitting an end of study (...) declaration to the Hampshire A research ethics committee between 1st January 2010 and 31st December 2011. A literature search was used to establish the publication status of studies. Primary and secondary outcomes stated in application forms were compared with outcomes reported in publications.ResultsOut of 116 studies the literature search identified 57 publications for 37 studies giving a publication rate of 32 %. Original Research Ethics Committee applications could be obtained for 28 of the published studies. Outcome inconsistencies were found in 16 of the published studies.ConclusionsThis study showed that the problem of publication and outcome reporting bias is still significant in the UK. The method described here demonstrates that UK NHS research ethics committees are in a good position to detect such bias due to their unique access to original research protocols. Data gathered in this way could be used by the Health Research Authority to encourage higher levels of transparency in UK research. (shrink)

This qualitative cross-sectional survey, undertaken in the antenatal booking clinics of a hospital in central London, explores pregnant women’s responses to routine HIV testing, examines their reasons for declining or accepting the test, and assesses how far their responses fulfil standard criteria for informed consent. Of the 32 women interviewed, only 10 participants were prepared for HIV testing at their booking interview. None of the women viewed themselves as being particularly at risk for HIV infection. The minority of the (...) participants who declined testing differed from those who accepted, by interpreting test acceptance as risky behaviour, privileging the negative outcomes of HIV positivity and expressing an inability to cope with these, should they occur. Troublingly, only a minority of women had a broad understanding of the rationale for the test, and none fulfilled the standard criteria for informed consent. This study suggests that, although routine screening combined with professional recommendation may be successful in increasing uptake, this may be at the cost of eroding informed consent. Protecting third parties from a preventable disease may outweigh the moral duty of respecting autonomy, enshrined in Western bioethical tradition. Nevertheless, such a policy should be made transparent, debated in the public domain and negotiated with women seeking antenatal care. (shrink)

Active monitoring of research with human subjects is no longer reserved for especially complex research or investigating research alleged to be problematic. Rather, many human research subjects’ protection programmes now engage in routine monitoring. Although limited data concerning such monitoring are available, the Association for the Accreditation of Human Research Protection Programs , reports that in 2011 its accredited organisations conducted many routine audits .1 While accredited organisations currently represent a small subset of human subjects’ (...) research programmes, these data are consistent with AAHRP's standard : ‘The Organization measures and improves, when necessary, compliance with organizational policies and procedures and applicable laws, regulations, codes, and guidance. The Organization also measures and improves, when necessary, the quality, effectiveness, and efficiency of the Human Research Protection Program.’2In this issue of Journal of Medical Ethics …. (shrink)

The challenges of dealing with disclosure of HIV status cause frustration to health care providers and counselors. This frustration follows from the already known high risk to the third party on one hand and our ethical obligation to “respect persons” in terms of privacy and confidentiality on the other side. Given the stubbornly low rates of voluntary disclosure (partner notification) among couples, however, it is quite tempting to suggest a paradigm of routine third party disclosure to identifiable sexual partners (...) by health care providers. This might be the lesser of the two evils and might give better public health outcomes in the fight against HIV/AIDS in Sub-Saharan Africa. (shrink)

The rise of digital and interconnected technology within the workplace, including programs that facilitate monitoring and surveillance of employees is unstoppable. The COVID-19-induced lockdowns and the resulting increase in home office adoption even increased this trend. Apart from major benefits that may come along with such information and communication technologies (e.g., productivity increases, better resource planning, and increased worker safety), they also enable comprehensive Electronic Performance Monitoring (EPM) which may also have negative effects (e.g., increased stress and a (...) reduction in job satisfaction). This conceptual article investigates EPM to better understand the development, adoption, and impact of EPM systems in organizations. The EPM literature published since the 1980s constitutes the basis for this conceptual article. We present a framework which is intended to serve as foundation for future studies. Moreover, we reviewed more than three decades of empirical EPM research and identified six major outcomes that are influenced by the use of an EPM system, as well as a large number of moderator variables. Based on our conceptual analyses and the resulting insights, which also include privacy, ethical, and cultural considerations, we discuss future research opportunities where we also refer to design implications for EPM systems. (shrink)

In recent years, to protect the rights and welfare of human subjects, institutions in the USA have begun to set up programmes to monitor ongoing medical research. These programmes provide routine, onsite oversight, and thus go beyond existing oversight such as investigating suspected misconduct or reviewing paperwork provided by investigators. However, because of a lack of guidelines and evidence, institutions have had little guidance in setting up their programmes. To help institutions make the right choices, we used interviews and (...) document analysis to study how and why 11 US institutions have set up their monitoring programmes. Although these programmes varied considerably, we were able to distinguish two general types. ‘Compliance’ programmes on the one hand were part of the institutional review board office and set up to ensure compliance with regulations. Investigators’ participation was mandatory. Monitors focused on documentation. Investigators could be disciplined, and could be obliged to take corrective actions. ‘Quality-improvement’ programmes on the other hand were part of a separate office. Investigators requested to be monitored. Monitors focused more on actual research conduct. Investigators and other parties received feedback on how to improve the research process. Although both types of programmes have their drawbacks and advantages, we argue that if institutions want to set up monitoring programmes, quality improvement is the better choice: it can help foster an atmosphere of trust between investigators and the institutional review board, and can help raise the standards for the protection of human subjects. (shrink)

The medial prefrontal cortex (mPFC) has been the subject of intense interest as a locus of cognitive control. Several computational models have been proposed to account for a range of effects, including error detection, conflict monitoring, error likelihood prediction, and numerous other effects observed with single-unit neurophysiology, fMRI, and lesion studies. Here, we review the state of computational models of cognitive control and offer a new theoretical synthesis of the mPFC as signaling response–outcome predictions. This new synthesis has (...) two interacting components. The first component learns to predict the various possible outcomes of a planned action, and the second component detects discrepancies between the actual and intended responses; the detected discrepancies in turn update the outcome predictions. This single construct is consistent with a wide array of performance monitoring effects in mPFC and suggests a unifying account of the cognitive role of medial PFC in performance monitoring. (shrink)

Self-esteem, self-monitoring, and temperamental traits are important factors that influence human behavior. The purpose of the present study was to compare groups involved in humanitarian (n= 61), political (n= 68), and religious (n= 54) activities in terms of intergroup differences in self-esteem, self-monitoring, and temperamental traits. There are two research questions that we sought to address: “What are the relationships between self-esteem, self-monitoring, and temperamental traits among those involved in social, religious, and humanitarian aid activities?” and “Do (...) temperamental traits affect self-esteem and self-monitoring among volunteers?” The study was conducted in Poland among adults aged 18 years and older, during meetings of six selected non-profit organizations, consisting of two organizations each in the humanitarian, political, and religious areas. The study used the Polish versions of the Rosenberg Self-esteem Scale, Snyders’ Self-Monitoring Scale, and the EAS Temperament Questionnaire. Volunteers of humanitarian organizations had the lowest self-esteem among all the examined groups. Politicians turned out to be more pragmatic than those involved in religious activities and humanitarian aid. Between the three examined groups, there were statistically significant differences in temperamental activity; the most active are those politically involved, followed by participants involved in humanitarian aid and religious activities. Moreover, volunteers involved in humanitarian aid reported a higher level of temperamental fear than those involved in political and religious activities. Furthermore, there were group differences in their reasons for social involvement. We discuss the potential sources of differences and consequences of outcomes for human resource practice in non-profit organizations. (shrink)

If definitive evidence concerning treatment effectiveness becomes available from an ongoing randomized clinical trial, then the trial could be stopped early, with the public release of results benefiting current and future patients. However, stopping an ongoing trial based on accruing outcome data requires methodological rigor to preserve validity of the trial conclusions. This has led to the use of formal interim monitoring procedures, which include inefficacy monitoring that will stop a trial early when the experimental treatment appears (...) not to be working. For participants, inefficacy monitoring is especially important as it ensures that they are not being treated worse than if they had not enrolled on the trial. We discuss the importance of reporting with trial results the formal interim inefficacy monitoring guidelines that were utilized, and, if none were used, the reasons for their absence. A survey of two leading medical journals suggests that this is not current practice. (shrink)

Multiple studies show that periodic reanalysis of genomic test results held by clinical laboratories delivers significant increases in overall diagnostic yield. However, while there is a widespread consensus that implementing routine reanalysis procedures is highly desirable, there is an equally widespread understanding that routine reanalysis of individual patient results is not presently feasible to perform for all patients. Instead, researchers, geneticists and ethicists are beginning to turn their attention to one part of reanalysis—reinterpretation of previously classified variants—as a (...) means of achieving similar ends to large-scale individual reanalysis but in a more sustainable manner. This has led some to ask whether the responsible implementation of genomics in healthcare requires that diagnostic laboratories routinely reinterpret their genomic variant classifications and reissue patient reports in the case of materially relevant changes. In this paper, we set out the nature and scope of any such obligation, and analyse some of the main ethical considerations pertaining to a putative duty to reinterpret. We discern and assess three potential outcomes of reinterpretation—upgrades, downgrades and regrades—in light of ongoing duties of care, systemic error risks and diagnostic equity. We argue against the existence of any general duty to reinterpret genomic variant classifications, yet we contend that a suitably restricted duty to reinterpret ought to be recognised, and that the responsible implementation of genomics into healthcare must take this into account. (shrink)

The definition of what constitutes minimal monitoring rests not so much on a scientific analysis of physiologic variables and their specificity, sensitivity, and predictiveness, but more on a usage pattern in a given community or country. In the United States, the minimal monitoring standards accepted in the majority of institutions and used for routine anesthesia care of patients not classified as high risk include (1) the alert anesthesiologist or nurse anesthetist observer, (2) an electrocardiogram, (3) a blood (...) pressure measuring device, and (4) an oxygen analyzer in the breathing circuit. To this basic cluster of monitors can be added a finger plethysmograph, a neuromuscular junction monitor, a temperature probe, and an esophageal/precordial stethoscope which are used in many communities. In the near future we expect to see a capnograph and a pulse oximeter added to this list, and later on the automated anesthesia record. (shrink)

Humans routinely make inferences about both the contents and the workings of other minds based on observed actions. People consider what others want or know, but also how intelligent, rational, or attentive they might be. Here, we introduce a new methodology for quantitatively studying the mechanisms people use to attribute intelligence to others based on their behavior. We focus on two key judgments previously proposed in the literature: judgments based on observed outcomes (you're smart if you won the game) and (...) judgments based on evaluating the quality of an agent's planning that led to their outcomes (you're smart if you made the right choice, even if you didn't succeed). We present a novel task, the maze search task (MST), in which participants rate the intelligence of agents searching a maze for a hidden goal. We model outcome‐based attributions based on the observed utility of the agent upon achieving a goal, with higher utilities indicating higher intelligence, and model planning‐based attributions by measuring the proximity of the observed actions to an ideal planner, such that agents who produce closer approximations of optimal plans are seen as more intelligent. We examine human attributions of intelligence in three experiments that use MST and find that participants used both outcome and planning as indicators of intelligence. However, observing the outcome was not necessary, and participants still made planning‐based attributions of intelligence when the outcome was not observed. We also found that the weights individuals placed on plans and on outcome correlated with an individual's ability to engage in cognitive reflection. Our results suggest that people attribute intelligence based on plans given sufficient context and cognitive resources and rely on the outcome when computational resources or context are limited. (shrink)

High degrees of uncertainty and a lack of effective therapeutic treatments have characterized the COVID-19 pandemic and the provision of drug products outside research settings has been controversial. International guidelines for providing patients with experimental interventions to treat infectious diseases outside of clinical trials exist but it is unclear if or how they should apply in settings where clinical trials and research are strongly regulated. We propose the Professional Oversight of Emergency-Use Interventions and Monitoring System as an alternative pathway (...) based on guidance developed for the ethical provision of experimental interventions to treat COVID-19 in Singapore. We support our proposal with justifications that establish moral duties for physicians to record outcomes data and for institutions to establish monitoring systems for reporting information on safety and effectiveness to the relevant authorities. Institutions also have a duty to support generation of evidence for what constitutes good clinical practice and so should ensure the unproven intervention is made the subject of research studies that can contribute to generalizable knowledge as soon as practical and that physicians remain committed to supporting learning health systems. We outline key differences between POEIMS and other pathways for the provision of experimental interventions in public health emergencies. (shrink)

BackgroundThe aim of this study was to investigate the effectiveness of psychotherapeutic interventions for clinically referred adolescents, as well as to examine whether sociodemographic, clinical, or treatment-related variables and patients’ role expectations predict treatment outcome or are possible predictors of treatment dropout.MethodThe study comprised 58 adolescents suffering from diverse psychiatric disorders referred to psychotherapeutic interventions conducted in outpatient care. The outcome measures, The Beck Depression Inventory, and the Clinical Outcomes in Routine Evaluation – Outcome Measure were (...) filled in at baseline and at 3-, 6-, and 12-month follow-ups. Possible predictors were assessed at baseline.ResultsThe results indicate that the mean level of symptoms and psychological distress decreased during the treatment, most reduction occurring in the first 6 months. The frequency of treatment sessions was the strongest predictor of good outcome. Adolescents with a higher level of externalizing problems or lower level of expectations for their own active role in treatment seem to have a higher risk of dropping out.ConclusionOffering intensive treatment for a shorter period might be the most efficient way to gain symptom reduction and decrease psychological distress in psychotherapeutic interventions with adolescents. Being aware of externalizing behavior and increasing the adolescents’ own agency during the assessment could strengthen commitment and result in the adolescent benefiting more from treatment. (shrink)

IntroductionDuring the COVID-19 pandemic, healthcare workers in Italy have been exposed to an unprecedented pressure and traumatic events. However, no direct comparison with the general population is available so far. The aim of this study is to detail mental health outcomes in healthcare workers compared to the general population.Methods24050 respondents completed an on-line questionnaire during the contagion peak, 21342 general population, 1295 second-line healthcare workers, and 1411 front-line healthcare workers. Depressive, anxious, post-traumatic symptoms and insomnia were assessed. Specific COVID-19 related (...) potential risk factors were also considered in healthcare workers.ResultsDepressive symptoms were more frequent in the general population and front-line healthcare workers compared to the second-line healthcare workers groups. Anxiety symptoms showed a prevalence of 21.25% in the general population, 18.05% for second-line healthcare workers, and 20.55% for front-line healthcare workers. Insomnia showed a prevalence of 7.82, 6.58, and 9.92% for the general population, second-line healthcare workers, and front-line healthcare workers, respectively. Compared to the general population, front-line healthcare workers had higher odds of endorsing total trauma-related symptoms. Both second-line healthcare workers and front-line healthcare workers had higher odds of endorsing core post-traumatic symptoms compared to the general population, while second-line healthcare workers had lower odds of endorsing negative affect and dissociative symptoms. Higher total traumatic symptom score was associated with being a front-line healthcare worker, having a colleague infected, hospitalized, or deceased, being a nurse, female gender, and younger age.ConclusionThis study suggests a significant psychological impact of the COVID-19 pandemic on the Italian general population and healthcare workers. Front-line healthcare workers represent a specific at-risk population for post-traumatic symptoms. These findings underline the importance of monitoring and intervention strategies. (shrink)

PurposeContinuous patient-reported outcomes to identify and address patients’ needs represent an important addition to current routine care. The aim of this study was to identify and determine important dimensions of health-related quality of life in routine oncological care.MethodsIn a cross-sectional qualitative study, interviews and focus groups were carried out and recorded. The interviewees were asked for their evaluation on HrQoL in general and specifically regarding cancer treatment. The material was transcribed and analyzed using qualitative content analysis based on (...) Mayring. The results were reviewed in an expert discussion.ResultsInterviews with patients and clinicians, as well as five focus groups with clinicians were conducted. Initially, nine deductive and two inductive categories on HrQoL were built. Four categories were excluded following the qualitative content analysis because they were hardly or not at all mentioned by participants. Following on from the analysis of the expert discussion, one dimension was added, and two further categories were excluded. The resulting system consisted of six dimensions: emotional health, physical ailments, autonomy, social functionality, dignity, and resources.ConclusionThe identified dimensions of HrQoL in routine oncological care were found to differ from those used in existing HrQoL measurements for patients. Further research is needed to test and evaluate the presented structure in a larger sample of cancer patients to further assess its psychometric properties. (shrink)

The Medication Event Monitoring System (MEMS) is a relatively new device designed to overcome some of the disadvantages of traditional adherence-measuring techniques. MEMS has also been found useful in tracking adherence behaviour without the need to visit patients frequently. In this study each patient was given a pre-filled, labelled MEMS bottle and cap. Patients were monitored for 24 weeks. For patients specifically studied, there were periods when drug levels may have been low and some exhibited erratic medication-taking behaviour. It (...) is concluded that MEMS can measure adherence behaviour objectively, and so might be used to improve prescribing decisions, identify drug wastage and improve carer support. Further research is needed before the routine use of electronic medication monitoring can be recommended. (shrink)

This paper is based on ethnographic research of data practices in a public health project called Weather Health and Air Pollution. I examine two different kinds of practices that make air pollution data, focusing on how they relate to particular modes of sensing and articulating air pollution. I begin by describing the interstitial spaces involved in making measurements of air pollution at monitoring sites and in the running of a computer simulation. Specifically, I attend to a shared dimension of (...) these practices, the checking of a numerical reading for error. Checking a measurement for error is routine practice and a fundamental component of making data, yet these are also moments of interpretation, where the form and meaning of numbers are ambiguous. Through two case studies of modelling and monitoring data practices, I show that making a ‘good’ measurement requires developing a feeling for the instrument–air pollution interaction in terms of the intended functionality of the measurements made. These affective dimensions of practice are useful analytically, making explicit the interaction of standardised ways of knowing and embodied skill in stabilising data. I suggest that environmental data practices can be studied through researchers’ materialisation of error, which complicate normative accounts of Big Data and highlight the non-linear and entangled relations that are at work in the making of stable, accurate data. (shrink)

Patient self-management of disease is increasingly supported by technologies that can monitor a wide range of behavioural and biomedical parameters. Incorporated into everyday devices such as cell phones and clothes, these technologies become integral to the psychosocial aspects of everyday life. Many technologies are likely to be marketed directly to families with ill members, and families may enlist the support of clinicians in shaping use. Current ethical frameworks are mainly conceptualised from the perspective of caregivers, researchers, developers and regulators in (...) order to ensure the ethics of their own practices. This paper focuses on families as autonomous decision-makers outside the regulated context of healthcare. We discuss some morally relevant issues facing families in their decisions to monitor the health-related behaviours of loved ones. An example – remote parental monitoring of adolescent blood glucose – is presented and discussed through the lens of two contrasting accounts of ethics; one reflecting the predominant focus on health outcomes within the health technology assessment (HTA) framework and the other that attends to the broader sociocultural contexts shaping technologies and their implications. Issues discussed include the focus of assessments, informed consent and child assent, and family co-creation of system characteristics and implications. The parents’ decisions to remotely monitor their child has relational implications that are likely to influence conflict levels and thus also health outcomes. Current efforts to better integrate outcome assessments with social and ethical assessments are particularly relevant for informed decision-making about health monitoring technologies in families. (shrink)

By addressing social issues, rather than maximizing profits, social enterprises are said to contribute to the well-being of societies. In this paper, we test whether social enterprises fulfil this expectation. The paper applies regression analysis to a unique dataset obtained by merging survey data from the Global Entrepreneurship Monitor with official statistics on social enterprises in Luxembourg. Results suggest that social enterprises contribute to subjective well-being, which is an encompassing measure of people’s satisfaction with their own life. We find that (...) when the share of social enterprises in a city increases, the ill-being of poor and unemployed people declines. Therefore, policy makers who seek to increase the well-being of economically disadvantaged people could adopt policies to promote the creation of social enterprises. (shrink)

Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centred outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated (...) patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centred TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centred TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centred outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarised, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilisation of multivariate prediction models to inform individually-tailored interventions targeting a range of health conditions. (shrink)

There is an impressive literature on organizational capacities that enable specific types of performance, but no work has been done on whether such capabilities extend to an organizational capacity for trustworthiness (CFT). This paper introduces the notion of a capacity for trustworthiness (CFT) defined as the collective capability of the organization to produce positive signals of trustworthiness to stakeholders. The antecedents to the CFT are bundles of organization routines that enable the firm to manifest trustworthiness and balance attending to both (...) financial and relational goals. The consequences of a high CFT are outcomes and behaviors that are congruent with pivotal stakeholder expectations and are, therefore, trust inducing. A process model is offered that outlines how an organization’s routines and CFT change in response to feedback and pressure and increase or decrease stakeholders’ trust. Implications for the management of stakeholder relations, trust repair, and the management of organizational systems are reviewed. (shrink)

In an old paper of our group in Milano a formalism was introduced for the continuous monitoring of a system during a certain interval of time in the framework of a somewhat generalized approach to quantum mechanics. The outcome was a distribution of probability on the space of all the possible continuous histories of a set of quantities to be considered as a kind of coarse grained approximation to some ordinary quantum observables commuting or not. In fact the (...) main aim was the introduction of a classical level in the context of QM, treating formally a set of basic quantities, to be considered as beables in the sense of Bell, as continuously taken under observation. However the effect of such assumption was a permanent modification of the Liouville-von Neumann equation for the statistical operator by the introduction of a dissipative term which is in conflict with basic conservation rules in all reasonable models we had considered. Difficulties were even encountered for a relativistic extension of the formalism. In this paper I propose a modified version of the original formalism which seems to overcome both difficulties. First I study the simple models of an harmonic oscillator and a free scalar field in which a coarse grain position and a coarse grained field respectively are treated as beables. Then I consider the more realistic case of spinor electrodynamics in which only certain coarse grained electric and magnetic fields are introduced as classical variables and no matter related quantities. (shrink)

The presence of parents or other guardians (commonly termed ‘supervision’) and parental knowledge are factors that are both robustly negatively associated with a range of anti-social and risky behavioural outcomes such as adolescent crime. However, parental presence/supervision and parental knowledge are both (i) regularly used inaccurately as proxies for parental monitoring, (ii) poorly defined and operationalised, and (iii) rarely linked to negative behavioural outcomes with plausible mechanisms that adequately explain their association. These problematic aspects of the parental monitoring (...) literature are a barrier to research into adolescent outcomes and the varied role of parents. This theoretical paper facilitates solutions these problems by clarifying the concepts of parental presence, supervision and knowledge. This discussion delineates presence from supervision and knowledge from monitoring. It specifies how presence and knowledge are not parenting actions, and neither constitute parental monitoring. These concepts are clarified within the parameters of a recent framework of goal-directed parental action and parental monitoring. Doing so constitutes under-labouring that facilitates future discovery of their distinct and yet inter-related mechanisms of influence on adolescent action and development. These structured conceptual developments are also of benefit for our better future understanding of parenting and parental monitoring by providing a framework within which to re-situate existing empirical research findings. (shrink)

Topics in Cognitive Science, Volume 13, Issue 1, Page 63-78, January 2021.

BackgroundThe use of genetic test results in risk-rated insurance is a significant concern internationally, with many countries banning or restricting the use of genetic test results in underwriting. In Australia, life insurers’ use of genetic test results is legal and self-regulated by the insurance industry (Financial Services Council (FSC)). In 2018, an Australian Parliamentary Inquiry recommended that insurers’ use of genetic test results in underwriting should be prohibited. In 2019, the FSC introduced an industry self-regulated moratorium on the use of (...) genetic test results. In the absence of government oversight, it is critical that the impact, effectiveness and appropriateness of the moratorium is monitored. Here we describe the protocol of our government-funded research project, which will serve that critical function between 2020 and 2023.MethodsA realist evaluation framework was developed for the project, using a context-mechanism-outcome (CMO) approach, to systematically assess the impact of the moratorium for a range of stakeholders. Outcomes which need to be achieved for the moratorium to accomplish its intended aims were identified, and specific data collection measures methods were developed to gather the evidence from relevant stakeholder groups (consumers, health professionals, financial industry and genetic research community) to determine if aims are achieved. Results from each arm of the study will be analysed and published in peer-reviewed journals as they become available.DiscussionThe A-GLIMMER project will provide essential monitoring of the impact and effectiveness of the self-regulated insurance moratorium. On completion of the study (3 years) a Stakeholder Report will be compiled. The Stakeholder Report will synthesise the evidence gathered in each arm of the study and use the CMO framework to evaluate the extent to which each of the outcomes have been achieved, and make evidence-based recommendations to the Australian federal government, life insurance industry and other stakeholders. (shrink)

Purpose Advances in electronic performance monitoring have raised employees’ concerns regarding the invasion of privacy and erosion of trust. On the other hand, EPM promises to improve performance and processes. This paper aims to focus on how the alignment of EPM design and organizational culture through effective organizational mechanisms can address privacy concerns, and, hence, positively affect employees’ perception toward technology. Design/methodology/approach Based on a theoretical lens extending two conceptual frameworks, a qualitative approach was used to analyze interview data (...) collected from a comparative case study of two organizations in the USA and Qatar within the oil and gas sector. These two contexts were selected to emphasize the cross-cultural and organizational differences in employees’ acceptance of EPM. Findings The study revealed that national and corporate cultures affected employees’ perception and acceptance of monitoring in both countries. Because of diversity, though EPM was better accepted in Qatar, as they are an easy way to enforce standardization and to push employees to adapt to a dominating corporate culture. Conversely, in the USA where culture is more innovation-oriented, organizational mechanisms shifted the perceptions of EPM to being mean to obtain feedback rather than to impose standards. Research limitations/implications This qualitative study is based on a descriptive comparative case study of two organizations with two cultural contexts. The limited sample size and cross-sectional nature of data may need to be extended to a larger cultural scope that is observed over a longer period to safely generalize the findings. Practical implications Decision-makers in multinational corporations with different cultural backgrounds may benefit of this study’s outcomes, as it emphasizes the importance of the fit between EPM designs and the cultural settings. Furthermore, organizations aiming to conduct analytics on EPM data have to justify and prove its benefits to employees to facilitate acceptance. Social implications The study shows that employees in Qatar have a different cultural frame of reference in their perception of fairness and ethics than their counterparts in the USA because of changes in the meaning of social relations, personal goals and behavioral norms. Originality/value The originality of this study lays in its empirical validation of a composite framework examining both national and corporate cultures on employees’ reactions to EPM systems. It also proves the critical importance of organizational mechanisms to align the EPM design with the organization cultural settings. (shrink)

BackgroundThe introduction and wide application of non-invasive prenatal testing (NIPT) has triggered further evolution of routines in the practice of prenatal diagnosis. ‘Routinization’ of prenatal diagnosis however has been associated with hampered informed choice and eugenic attitudes or outcomes. It is viewed, at least in some countries, with great suspicion in both bioethics and public discourse. However, it is a heterogeneous phenomenon that needs to be scrutinized in the wider context of social practices of reproductive genetics. In different countries with (...) their different regulatory frameworks, different patterns of routines emerge that have different ethical implications.This paper discusses an ethics of routines informed by the perspectives of organizational sociology and psychology, where a routine is defined as a repetitive, recognizable pattern of interdependent organizational actions that is carried out by multiple performers. We favour a process approach that debunks the view – which gives way to most of the concerns – that routines are always blindly performed. If this is so, routines are therefore not necessarily incompatible with responsible decision-making. Free and informed decision-making can, as we argue, be a key criterion for the ethical evaluation of testing routines. If free and informed decision-making by each pregnant woman is the objective, routines in prenatal testing may not be ethically problematic, but rather are defensible and helpful. We compare recent experiences of NIPT routines in the context of prenatal screening programmes in Germany, Israel and the Netherlands. Notable variation can be observed between these three countries (i) in the levels of routinization around NIPT, (ii) in the scope of routinization, and (iii) in public attitudes toward routinized prenatal testing.ConclusionAn ethics of routines in the field of prenatal diagnostics should incorporate and work with the necessary distinctions between levels and forms of routines, in order to develop sound criteria for their evaluation. (shrink)

Objective Routine prenatal screening for Down syndrome challenges professional non-directiveness and patient autonomy in daily clinical practices. This paper aims to describe how professionals negotiate their role when a pregnant woman asks them to become involved in the decision-making process implied by screening.Methods Forty-one semi-structured interviews were conducted with gynaecologists–obstetricians and midwives in a large Swiss city.Results Three professional profiles were constructed along a continuum that defines the relative distance or proximity towards patients’ demands for professional involvement in the (...) decision-making process. The first profile insists on enforcing patient responsibility, wherein the healthcare provider avoids any form of professional participation. A second profile defends the idea of a shared decision making between patients and professionals. The third highlights the intervening factors that justify professionals’ involvement in decisions.Conclusions These results illustrate various applications of the principle of autonomy and highlight the complexity of the doctor–patient relationship amidst medical decisions today. (shrink)

The aim of this study was to explore patients’ experiences of using the Integrated Palliative care Outcome Scale (IPOS) during specialized palliative home care. The study adopted a qualitative approach with an interpretive descriptive design. Interviews were performed with 10 patients, of whom a majority were diagnosed with incurable cancer. Our findings suggest that the use of IPOS as a basis for conversation promotes safe care by making the patients feel confident that the care provided was adapted to them (...) which gives them a sense of safety. IPOS facilitated discussions between patients and nurses about care needs. The patients believed that using IPOS enabled reflection on their well‐being and life situation. In conclusion, the study finds that using IPOS is beneficial and provide ways to enable person‐centered care and with advantage could be used in specialized palliative home care. The results may help overcome barriers and facilitate the use of patient‐reported outcome measures (PROMs). To enable the use of PROMs such as IPOS in palliative home care, nurses need education and opportunities to develop routines that enable patients’ voice to be heard and thereby compose a basis for care. (shrink)

Responses to outbreaks, epidemics and pandemics involves a heterogeneous set of activities that aim to address threats to public health. In addition to research, non-research activities, such as prevention and control interventions, and surveillance, are conducted. The boundaries between research and non-research responses can rapidly blur during a public health emergency such as the COVID-19 pandemic. There may be common elements between these types of activities, and they may draw on the same resources and infrastructure. Non-research activities, such as surveillance (...) and emergency non-research use of unproven interventions, and research activities must all be undertaken in an ethical manner as components of emergency response. However, care is needed to distinguish between non-research public health activities and research, because research often has considerations and requirements for its ethical conduct which are distinct from non-research public health activities. Research aims to produce generalizable knowledge, and mechanisms such as participant consent and independent ethics review aim to ensure that the rights and interests of research participants are respected. Ensuring that research and non-research activities are appropriately distinguished can additionally promote proper coordination of such activities, and increase trust and social accountability in pandemic responses. Consequently, it is important to distinguish between these different activities on the basis of their primary aim, and to consider whether their implementation is justifiable, based on their aims and the relevant ethical framework for each type of activity, and how they are coordinated as part of the larger collective activity of emergency response and management. Complex questions arise about how the different stakeholders involved in decision-making should make valid and justifiable decisions about whether the response activity is research or non-research. The cases in this chapter invite consideration about how such decisions should be made, and their implications, in the context of applications to conduct retrospective research into the outcomes of emergency uses of unproven interventions outside clinical trials, and of characterising antibody-testing initiatives and systematic data collection activities as surveillance or research. (shrink)

Education in the twenty-first century witnessed a profound shift in emphasis from the teacher to the learner, or from pedagogical inputs to learner outcomes. According to neoliberal logic, the teacher is the primary value-add in a relationship that is best characterized as cause (instruction) and effect (learner outcome). As a result, the problem of teacher quality has emerged as the central question of our day. What is effective teaching? What does teacher quality look like? Traditional music educators will posit (...) that excellence in norm-governed forms is the most reliable measure of teacher quality. This essay makes a case for a richer and more varied conception, embracing diversity and openness as defining ideals. (shrink)

A non-inferiority design accepts the possibility of some efficacy loss, as part of a “successful”, statistically significant result. That loss may be excessive when the non-inferiority threshold is lenient. However, even stringent significance thresholds and safety monitoring may fail to adequately protect study participants when the primary outcome is death. The OPTIMAAL trial, a large randomized clinical trial performed in high-risk patients, is discussed as an example, using the Belmont Report principles as an ethical frame of reference. OPTIMAAL (...) compared losartan, a new drug, to captopril, a drug known to reduce the risk of death in patients with heart failure after a myocardial infarction. Serious ethical challenges occurred in that study. Firstly, subjects had to tolerate captopril to participate, meaning that participation implied the possibility of higher risk of death if randomized to the losartan arm, as compared to the standard of care. Additionally, the stopping rules had to ensure enough powe... (shrink)

BackgroundMeasuring the outcomes of palliative care plays an important role to improve the quality, efficiency, and availability of these services in patients with cancer. Using valid, reliable, and culturally appropriate tools has a considerable role to measure these outcomes. This study aimed to assess the psychometric properties of the translated version of the Palliative care Outcome Scale.MethodsThis methodological study was conducted in two outpatient clinics related to Shohada Tajrish and Baqiyatallah hospitals in Tehran in 2019–2020. The translation was done (...) using the Forward-Backward approach after gaining permission from the developer. Face validity was tested with 10 patients with cancer through cognitive interviewing, as well as content validity with four experts. Construct validity was performed by exploratory factor analysis and confirmation. To assess the reliability, internal consistency was assessed by using Cronbach's alpha coefficient, and relative stability was assessed using the interclass correlation coefficient. Furthermore, interpretability and ceiling and floor effects were assessed.ResultsA total of 353 patients with cancer under palliative care were included in the study. Then, three psychological, physical, and social factors with a cumulative variance of 54.34% were extracted in exploratory factor analysis. Confirmatory factor analysis showed that the model has a good fit of information. Cronbach's alpha coefficient for scale was 0.719. Furthermore, the ICC was 0.812. The scale was interpretable, and ceiling and floor effects were 0%.ConclusionPersian version of the POS was evaluated as a valid and reliable tool. Therefore, it can be used by the clinician to monitor the consequences of palliative care in Iranian cancer patients. (shrink)

BackgroundClinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies (...) and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process.MethodsThe revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes.ResultsThe Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. ‘now’) instead of an assumed improvement over time (e.g. ‘better’) and we omitted the question about perceived importance.ConclusionsThe Euro-MCD 2.0 is shorter, less complex and more strongly substantiated by an integration of empirical findings, theoretical reflections and dialogues with participants and experts. Use of the Euro-MCD 2.0 will facilitate evaluation of MCD and can thereby monitor and foster implementation and quality of MCD. The Euro-MCD 2.0 will strengthen future research on evaluation of outcomes of MCD. (shrink)

Background Clinical moral case deliberation consists of the systematic reflection on a concrete moral case␣by health care professionals. This paper presents the study of a 4-year moral deliberation project.Objectives The objectives of this paper are to: (a) describe the practice and the theoretical background of moral deliberation, (b) describe the moral deliberation project, (c) present the outcomes of␣the evaluation of the moral case deliberation sessions, and (d) present the implementation process.Methods The implementation process is both monitored and supported by an (...) interactive responsive evaluation design with: (a) in-depth interviews, (b) Maastricht evaluation questionnaires, (c) evaluation survey, and (d) ethnographic participant observation. In accordance with the theory of responsive evaluation, researchers acted both as evaluators and moderators (i.e. ethicists).Results Both qualitative and quantitative results showed that the moral case deliberations, the role of the ethics facilitator, and the train-the-facilitator program were regarded as useful and were evaluated as (very) positive. Health care professionals reported that they improved their moral competencies (i.e. knowledge, attitude and skills). However, the new trained facilitators lacked a clear organisational structure and felt overburdened with the implementation process. The paper ends with both practical and research suggestions for future moral deliberation projects. (shrink)