This article describes the situated nature of two intertwined dimensions of the context of medical encounters - expertise and compliance - within the interactional practices of referrals and accounts of referrals. Families who display their expertise and compliance have referral and account sequences with notably different features compared to sequences with families who display a lack of compliance and expertise. The display of expertise significantly affects the course of the interaction, and asymmetrical sequences often occur in interactions when the professionals (...) see families' expertise and compliance as problematic. (shrink)

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

Though much has been written about when paternalistic intervention is justified, and about how it is justified, much less has been written about who may do the intervening. This is a substantial lacuna in our understanding of the nature of justified paternalism. By examining the question of who it is that may most appropriately interfere with the course of our decision-making, we can learn something useful both about paternalism and about the nature of friendship.In this essay I will argue that (...) friendship and paternalistic intervention are linked. Friendship of the close, intimate variety that I will be discussing is in part constituted by the fact that one friend is morally justified in interfering with the other’s decisions. Intimate friendship involves a partial meshing of identities. This meshing of identities manifests itself in part by the liberties that one friend takes in guiding the life of the other. Paternalistic intervention between friends can thus be justified because it expresses the union of the friends, and because it preserves that union. (shrink)

The past two decades of psychoanalytic discourse have witnessed a marked transformation in the way we think about women and gender. The assignment of gender carries with it a host of assumptions, yet without it we can feel lost in a void, unmoored from the world of rationality, stability and meaning. The feminist analytic thinkers whose work is collected here confront the meaning established by the assignment of gender and the uncertainty created by its absence. The contributions brought together in (...) _Psychoanalytic Reflections on a Gender-free Case_ address a cross-section of significant issues that have both chronicled and facilitated the changes in feminist psychoanalysis since the mid 1980s. Difficult issues which have previously been ignored are considered first. The book goes on to address family perspectives as they interact and shape the child’s experience of growing up male or female. Other topics covered are the authority of personal agency as influenced by the language and theory of patriarchy, male-centred concepts that consistently define women as inferior, and the concept of gender as being co-constructed within a relationship. The gender-free case presented here will fascinate all psychoanalysts interested in exploring ways of grappling with the elusive nature of gender, as well as those studying gender studies. (shrink)

Whether level 1 predictors should be centered per cluster has received considerable attention in the multilevel literature. While most agree that there is no one preferred approach, it has also been argued that cluster mean centering is desirable when the within-cluster slope and the between-cluster slope are expected to deviate, and the main interest is in the within-cluster slope. However, we show in a series of simulations that if one has a multilevel autoregressive model in which the level 1 predictor (...) is the lagged outcome variable (i.e., the outcome variable at the previous occasion), cluster mean centering will in general lead to a downward bias in the parameter estimate of the within-cluster slope (i.e., the autoregressive relationship). This is particularly relevant if the main question is whether there is on average an autoregressive effect. Nonetheless, we show that if the main interest is in estimating the effect of a level 2 predictor on the autoregressive parameter (i.e., a cross-level interaction), cluster mean centering should be preferred over other forms of centering. Hence, researchers should be clear on what is considered the main goal of their study, and base their choice of centering method on this when using a multilevel autoregressive model. (shrink)

Interdisciplinary hospital ethics committees have been the most common response to the mandates for ethical review procedures set forth by the Joint Commission for the Accreditation of Health Care Organizations, the American Hospital Association, and within institutions themselves. A 1989 national survey reported that 60% of hospitals had ethics committees. However, little is still known about the current state of these committees in hospitals, their composition, what functions are performed, or what issues are discussed.

Friendship alters the moral demands and ideals that we live with. In this dissertation I examine precisely how those ideals must change if they are to accommodate the realities of friendship. I begin by surveying Aristotle, Kant, and Montaigne, and showing that each of those writers had useful insights into the way in which we reconceptualize the self when we become close friends with another person. I suggest that Kant and Montaigne were both right that we tend to merge our (...) identities with our friends. I then argue that if we value this sense of unity with our friends, certain changes must be made to common normative concepts. In particular, I argue that paternalistic intervention is more justified between friends than between strangers, because such intervention presupposes that the two individuals have a kind of shared autonomy. This presupposition is only true for friends, not for strangers. ;I further argue that the concept of respect must be reshaped if it is to be useful between friends. Kant noted that respect is a concept which distances people from one another, and such distance is not always appropriate between friends. I suggest that the notion of respect can be restructured so that it does not require distance and separation. Finally, I suggest that self-respect must also be restructured if the self is shared. (shrink)

Objective: To audit doctors’ knowledge of informed consent.Design: 10 consent scenarios with “true”, “false”, or “don’t know” answers were completed by doctors who care for children at a large district general hospital. These questions tested clinicians’ knowledge of who could give consent in different clinical situations.Setting: Royal United Hospital, Bath, UK.Results: 51 doctors participated . Paediatricians scored higher than other clinicians . Only 36% of paediatricians and 8% of other clinicians realised that the biological father of a child born before (...) 1 December 2003 needed a court order or a parental responsibility agreement to acquire parental responsibility, and thus be able to consent on behalf of his child, if he was not married to the child’s mother. Non-paediatric clinicians were unsure or incorrect when tested on situations where people with parental responsibility do not agree, or where young people , who are Fraser competent do not want to consult their parents. Most clinicians did not know that the parents of a 20-year-old man with severe learning difficulties are unable to consent to surgery on his behalf, and many non-paediatricians were unclear on who could give consent when a child lived with foster parents.Conclusion: Clinicians who obtain consent for the treatment of children need to increase their knowledge on who is able to give informed consent to ensure best practice. (shrink)

This article describes some potential uses of Bayesian estimation for time-series and panel data models by incorporating information from prior probabilities in addition to observed data. Drawing on econometrics and other literatures we illustrate the use of informative “shrinkage” or “small variance” priors while extending prior work on the general cross-lagged panel model. Using a panel dataset of national income and subjective well-being we describe three key benefits of these priors. First, they shrink parameter estimates toward zero or toward each (...) other for time-varying parameters, which lends additional support for an income → SWB effect that is not supported with maximum likelihood. This is useful because, second, these priors increase model parsimony and the stability of estimates and thus improve out-of-sample predictions and interpretability, which means estimated effect should also be more trustworthy than under ML. Third, these priors allow estimating otherwise under-identified models under ML, allowing higher-order lagged effects and time-varying parameters that are otherwise impossible to estimate using observed data alone. In conclusion we note some of the responsibilities that come with the use of priors which, departing from typical commentaries on their scientific applications, we describe as involving reflection on how best to apply modeling tools to address matters of worldly concern. (shrink)

Measurement error is omnipresent in psychological data. However, the vast majority of applications of autoregressive time series analyses in psychology do not take measurement error into account. Disregarding measurement error when it is present in the data results in a bias of the autoregressive parameters. We discuss two models that take measurement error into account: An autoregressive model with a white noise term (AR+WN), and an autoregressive moving average (ARMA) model. In a simulation study we compare the parameter recovery performance (...) of these models, and compare this performance for both a Bayesian and frequentist approach. We find that overall, the AR+WN model performs better. Furthermore, we find that for realistic (i.e., small) sample sizes, psychological research would benefit from a Bayesian approach in fitting these models. Finally, we illustrate the effect of disregarding measurement error in an AR(1) model by means of an empirical application on mood data in women. We find that, depending on the person, approximately 30–50% of the total variance was due to measurement error, and that disregarding this measurement error results in a substantial underestimation of the autoregressive parameters. (shrink)

BackgroundStructured, systematic methods to formulate consensus recommendations, such as the Delphi process or nominal group technique, among others, provide the opportunity to harness the knowledge of experts to support clinical decision making in areas of uncertainty. They are widely used in biomedical research, in particular where disease characteristics or resource limitations mean that high-quality evidence generation is difficult. However, poor reporting of methods used to reach a consensus – for example, not clearly explaining the definition of consensus, or not stating (...) how consensus group panellists were selected – can potentially undermine confidence in this type of research and hinder reproducibility. Our objective is therefore to systematically develop a reporting guideline to help the biomedical research and clinical practice community describe the methods or techniques used to reach consensus in a complete, transparent, and consistent manner.MethodsThe ACCORD project will take place in five stages and follow the EQUATOR Network guidance for the development of reporting guidelines. In Stage 1, a multidisciplinary Steering Committee has been established to lead and coordinate the guideline development process. In Stage 2, a systematic literature review will identify evidence on the quality of the reporting of consensus methodology, to obtain potential items for a reporting checklist. In Stage 3, Delphi methodology will be used to reach consensus regarding the checklist items, first among the Steering Committee, and then among a broader Delphi panel comprising participants with a range of expertise, including patient representatives. In Stage 4, the reporting guideline will be finalised in a consensus meeting, along with the production of an Explanation and Elaboration document. In Stage 5, we plan to publish the reporting guideline and E&E document in open-access journals, supported by presentations at appropriate events. Dissemination of the reporting guideline, including a website linked to social media channels, is crucial for the document to be implemented in practice.DiscussionThe ACCORD reporting guideline will provide a set of minimum items that should be reported about methods used to achieve consensus, including approaches ranging from simple unstructured opinion gatherings to highly structured processes. (shrink)

Although written consent forms are standard in clinical research, there is little regulatory or empirical guidance regarding how to most effectively review consent forms with potential participants. We developed an algorithm for embedding five questions with corrective feedback while reading consent forms with potential participants, and then applied it in the context of seven clinical research studies. A substantial proportion of participants within each protocol displayed initially inadequate responses to at least one question, but after the protocol elements were explained (...) again, most people demonstrated adequate understanding of them. These data illustrate the need for more attention not just to the content of consent forms, but also to the manner in which the forms are incorporated into the consent process. Embedding explicit inquiries about key protocol elements during consent form review and giving corrective feedback appears to be a simple yet effective way to foster better understanding of disclosed information. (shrink)

One of the most lasting contributions of Marr's posthumous book is his articulation of the different “levels of analysis” that are needed to understand vision. Although a variety of work has examined how these different levels are related, there is comparatively little examination of the assumptions on which his proposed levels rest, or the plausibility of the approach Marr articulated given those assumptions. Marr placed particular significance on computational level theory, which specifies the “goal” of a computation, its appropriateness for (...) solving a particular problem, and the logic by which it can be carried out. The structure of computational level theory is inherently teleological: What the brain does is described in terms of its purpose. I argue that computational level theory, and the reverse-engineering approach it inspires, requires understanding the historical trajectory that gave rise to functional capacities that can be meaningfully attributed with some sense of purpose or goal, that is, a reconstruction of the fitness function on which natural selection acted in shaping our visual abilities. I argue that this reconstruction is required to distinguish abilities shaped by natural selection—“natural tasks” —from evolutionary “by-products”, rather than merely demonstrating that computational goals can be embedded in a Bayesian model that renders a particular behavior or process rational. (shrink)

The problem of 'no fault' compensation for patients who suffer adverse effects as a result of their participation in clinical trials is discussed in the light of the guidelines issued by the Association of the British Pharmaceutical Industry (ABPI) and our recent experiences in reviewing protocols submitted to the local ethics of surgical research sub-committee. We have found a variety of qualifications being applied by pharmaceutical firms which are not in the spirit of the guidelines, let alone the interests of (...) the patient, and we suggest a means whereby the patients can be assured of fair treatment in the event of 'no fault' injury. (shrink)

The combination of breeding for increased production and the intensification of housing conditions have resulted in increased occurrence of behavioral, physiological, and immunological disorders. These disorders affect health and welfare of production animals negatively. For future livestock systems, it is important to consider how to manage and breed production animals. In this paper, we will focus on selective breeding of laying hens. Selective breeding should not only be defined in terms of production, but should also include traits related to animal (...) health and welfare. For this we like to introduce the concept of robustness. The concept of robustness includes individual traits of an animal that are relevant for health and welfare. Improving robustness by selective breeding will increase (or restore) the ability of animals to interact successfully with the environment and thereby to make them more able to adapt to an appropriate husbandry system. Application of robustness into a breeding goal will result in animals with improved health and welfare without affecting their integrity. Therefore, in order to be ethically acceptable, selective breeding in animal production should accept robustness as a breeding goal. (shrink)

O presente artigo objetiva apresentar uma compreensão crítica do tempo presente, que se pode chamar de contemporaneidade. Nessa direção, as reflexões sobre esse momento histórico priorizaram os questionamentos filosóficos de Heidegger. Para interpretação mais ampla do pensamento heideggeriano, foi abordada, rapidamente, as concepções existenciais de homem e de mundo trazidas em sua obra “Ser e tempo”. Após essas considerações, a “Era da Técnica”, marcada pelo esquecimento do ser, foi tomada enquanto foco de discussão. Por fim, ressalta-se a inquietação não com (...) relação ao crescimento da técnica planetária, mas sim acerca do fato de o homem não compreender a dimensão e o sentido das transformações empreendidas por esta destinação; rejeitando, com isso, aquilo que tem de mais próprio, a condição de ser o único ser que reflete. (shrink)

I extend Jones & Love's (J&L's) critique of Bayesian models and evaluate the conceptual foundations on which they are built. I argue that: (1) the part of Bayesian models is scientifically trivial; (2) theory is a fiction that arises from an inappropriate programming metaphor; and (3) the real scientific problems lie outside Bayesian theorizing.

Everyone agrees that testing hypotheses is important, but Bowers et al. provide scant details about where hypotheses about perception and brain function should come from. We suggest that the answer lies in considering how information about the outside world could be acquired – that is, learned – over the course of evolution and development. Deep neural networks (DNNs) provide one tool to address this question.

Higher education institutions are mining and analyzing student data to effect educational, political, and managerial outcomes. Done under the banner of “learning analytics,” this work can—and often does—surface sensitive data and information about, inter alia, a student’s demographics, academic performance, offline and online movements, physical fitness, mental wellbeing, and social network. With these data, institutions and third parties are able to describe student life, predict future behaviors, and intervene to address academic or other barriers to student success (however defined). Learning (...) analytics, consequently, raise serious issues concerning student privacy, autonomy, and the appropriate flow of student data. We argue that issues around privacy lead to valid questions about the degree to which students should trust their institution to use learning analytics data and other artifacts (algorithms, predictive scores) with their interests in mind. We argue that higher education institutions are paradigms of information fiduciaries. As such, colleges and universities have a special responsibility to their students. In this article, we use the information fiduciary concept to analyze cases when learning analytics violate an institution’s responsibility to its students. (shrink)