Buildings are constructed for accommodating living and industrial needs. Floor cleaning robots have been developed to cater to the demand of these buildings. Area coverage and coverage time are crucial performance factors of a floor cleaning robot. Reconfigurable tiling robots have been introduced over fixed shape robots to improve area coverage in floor cleaning applications compared to robots with fixed morphologies. However, area coverage and coverage time of a tiling robot compromised one another. This study proposes a novel concept that (...) considers the ability of a tiling robot to configure both its morphology and size according to the environment. This concept is inspired by the pleomorphism that could be seen in bacteria. In this regard, P-hTetro, a pleomorphic tiling robot that can reconfigure its morphology and size, is considered. A novel coverage strategy for realizing the size reconfiguration is also proposed. According to this strategy, the robot covers obstacle-free areas with its maximum size, while an obstacle cluster is covered after shrinking to an optimum size. The optimum size for reconfiguration is determined by the genetic algorithm based on the arrangement of the environment. The performance and behavior of the proposed P-hTetro have been compared against that of an existing tiling robot which has a fixed size. According to the statistical outcomes, a tiling robot with the ability to reconfigure its size can significantly improve the performance in the aspects of area coverage and coverage time compared to a tiling robot with no ability to reconfigure its size. (shrink)

BackgroundStreet-connected children and youth in low- and middle-income countries have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY’s specific vulnerabilities in LMIC.MethodsAs part of three interrelated research projects in western Kenya, we created procedures to (...) address SCCY’s vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report.ResultsSubstantial community engagement provided input on SCCY’s participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation.ConclusionsAlthough a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity. (shrink)

El artículo considera en primer lugar el papel asignado por Heidegger, en su análisis del viraje , al acontecimiento-apropiación como el punto medio entre el ser y el Dasein. En el carácter abismal de la oscilación entre el llamado del primero y la pertenencia del segundo reside la unidad originaria del tiempo-espacio que deja emerger ambos momentos hacia su separación. Esto permite a su vez el despliegue de un tiempo derivado y un orden para la medición. En segundo lugar, se (...) intentan encontrar puntos de vista similares en los análisis de Husserl sobre la temporalidad. Así, al abismo del ser corresponde un horizonte inicial originario; al tiempo-espacio abismal, la pretemporalización de una protohyle de la mano con kinestesias espacializantes; a la proyección del Dasein para captar la oscilación mediante una contraoscilación, el volverse del yo hacia la prototemporalización; a la separación del tiempo a partir del abismo, la constitución de las distinciones temporales; y a la derivación del orden del tiempo, la constitución del tiempo como forma. En tercer lugar, se expone la noción heideggeriana de decisión respecto de la pertenencia o no-pertenencia al ser a fin de criticar una parte componente de la historia del ser, esto es, la posición. En cuarto lugar, el artículo se ocupa de la noción husserliana de decisión en tanto ligada a la institución de un horizonte histórico. Por último, se destacan semejanzas y diferencias entre las nociones de acontecimiento-apropiación y presente viviente en la medida en que ambas desempeñan el mismo papel en la búsqueda de un nivel último que hace posible todo. (shrink)

Is what could have happened but never did as real as what did happen? What did happen, but isn't happening now, happened at another time. Analogously, one can say that what could have happened happens in another possible world. Whatever their views about the reality of such things as possible worlds, philosophers need to take this analogy seriously. Adriane Rini and Max Cresswell exhibit, in an easy step-by-step manner, the logical structure of temporal and modal discourse, and show that every (...) temporal construction has an exact parallel that requires a language that can refer to worlds, and vice versa. They make precise, in a way which can be articulated and tested, the claim that the parallel is at work behind even ordinary talk about time and modality. The book gives metaphysicians a sturdy framework for the investigation of time and modality - one that does not presuppose any particular metaphysical view. (shrink)

African American distrust of medicine has consequences for treatment seeking and healthcare behaviour. Much work has been done to examine acute events that have contributed to this phenomenon and a sophisticated bioethics discipline keeps watch on current practices by medicine. But physicians and clinicians are not the only actors in the medical arena, particularly when it comes to health beliefs and distrust of medicine. The purpose of this paper is to call attention not just to ethical shortcomings of the past, (...) but to the structural contexts of those events and the contributions and responsibilities of popular media and academic disciplines in the production of knowledge. We argue that ignoring context and producing inaccurate work has real impacts on health and healthcare, particularly for African Americans, and thus engenders ethical obligations incumbent on disciplines traditionally recognised as purely academic. (shrink)

This paper explores possible connections between gender and the willingness to tolerate unethical academic behavior. Data from a sample of 285 accounting majors at four public institutions reveal that females are less tolerant than males when questioned about academic misconduct. Statistically significant differences were found for 17 of 23 questionable activities. Furthermore, females were found to be less cynical and less often involved in academic dishonesty. Overall, the results support the finding of Betz et al. (1989) that the gender socialization (...) approach dominates the structural approach. (shrink)

In the clinical setting, questions of medical ethics raise a host of perplexing problems, often complicated by conflicting perspectives and the need to make immediate decisions. In this volume, bioethicists and physicians provide a nuanced, in-depth approach to the difficult issues involved in bioethics consultation. Addressing the needs of researchers, clinicians, and other health professionals on the front lines of bioethics practice, the contributors focus primarily on practical concerns -- whether ethics consultation is best done by individuals, teams, or committees (...) how an ethics consult service should be structured the need for institutional support and techniques and programs for educating and training staff -- without neglecting more theoretical considerations, such as the importance of character or the viability of organizational ethics. (shrink)

Background: Legislation on physician-assisted suicide is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians.Objective: To determine variables predictive of physicians’ opinions on PAS in a rural state, Vermont, USA.Design: Cross-sectional mailing survey.Participants: 1052 physicians licensed by the state of Vermont.Results: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should (...) not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation . Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness . 30% of the respondents had experienced a request for assistance with suicide.Conclusions: Vermont physicians’ opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Do continuing education (CE) mandates increase participation in ethics programs and enhance their perceived outcomes? In a study of 5,198 North American psychologists, significant differences were found between mandated and nonmandated psychologists in relation to their participation in ethics programs but not in the perceived outcomes associated with those trainings. Although 64.3% of those psychologists operating under ethics mandates reported completing at least one ethics training within the previous year, only 40.7% of those without such mandates reported doing likewise. Overall, (...) both groups tended to view their ethics training quite favorably in relation to its perceived outcomes, though they differed in relation to their endorsement of CE mandates. Results are discussed in relation to the ongoing development of evidence-based CE and its role in developing critical professional competencies. (shrink)

Residency training in the Netherlands is to be restructured over the coming years. To this end a general competence profile for medical specialists has been introduced. This profile is nearly the same as the Canadian CanMEDS 2000 model, which describes seven general areas of medical specialist competence, one of which is professionalism. In order to establish a training programme for residents and their instructors based on this competence, it is necessary to develop a vision that does justice to everyday medical (...) practice. The two most prevailing views of professionalism—as personal, or as a behavioural characteristic—fall short of this. Only when professionalism is understood as reflective professionalism does it encompass the fundamental contextuality of medical treatment. This means that the focus of training and assessment must be shifted to accountability for treatment. (shrink)

Stakeholder theory provides a framework for investigating the relationship between corporate social performance (CSP) and corporate financial performance. This relationship is investigated by examining how change in CSP is related to change in financial accounting measures. The findings provide some support for a tenet in stakeholder theory which asserts that the dominant stakeholder group, shareholders, financially benefit when management meets the demands of multiple stakeholders. Specifically, change in CSP was positively associated with growth in sales for the current and subsequent (...) year. This indicates that there are short-term benefits from improving CSP. Return on sales was significantly positively related to change in CSP for the third financial period, indicating that long-term financial benefits may exist when CSP is improved. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

The effects of school inspections on school improvement have been investigated only to a limited degree. The investigation reported on in this article is meant to expand our knowledge base regarding the impact of school inspections on school improvement. The theoretical framework for this research is partly based on the policy theory behind the Dutch Educational School Supervision Act (the latter includes assumptions about how school inspections lead to school improvement). Interviews and a survey with school inspectors gave insight into (...) how school inspectors implement the Supervision Act and how they assess schools, and stimulate schools to improve. The results of ten case studies showed that all schools started to improve after a school visit. The innovation capacity of the school and the school environment do not seem to contribute to school improvement after school inspections. No effects were found on school-improvement processes of the number of insufficient scores that schools received from inspectors, the extent of feedback and suggestions for improvement, and the number of agreements. The provision of feedback about weaknesses, the assessment of these weak points as unsatisfactory, and the agreements between an inspector and the school regarding improvement activities do appear to make a difference in promoting school improvement. (shrink)

Attention and consciousness are two distinct neural processes which are intricately intertwined. However, there is asymmetry in the distribution of attentional abilities across the two hemispheres. The right hemisphere is asserted to be dominant for attentional abilities. Research suggests that the ventral frontoparietal cortex of the right hemisphere is dominant for exogenous attentional abilities, attention is phylogenetically more primitive than endogenous attention, and, compared to the left hemisphere, the right hemisphere is more adept at abilities and functions that are of (...) more primitive origin. This review explores the attentional abilities of the mute right hemisphere, the extent to which these may affect consciousness, and whether the unilateral dominance of the exogenous network influences consciousness. (shrink)

Respecting and encouraging autonomy in the elderly is basic to the practice of geriatrics. In this paper, we examine the practice of cardiopulmonary resuscitation (CPR) and "artificial" feeding in a geriatric unit in a general hospital subscribing to jewish orthodox religious principles, in which the sanctity of life is a fundamental ethical guideline. The literature on the administration of food and water in terminal stages of illness, including dementia, still shows division of opinion on the morality of withdrawing nutrition. We (...) uphold the principle that as long as feeding by naso-gastric (N-G) or percutaneous endoscopic gastrostomy (PEG) does not constitute undue danger or arouse serious opposition it should be given, without causing suffering to the patient. This is part of basic care, and the doctor has no mandate to withdraw this. The question of CPR still shows much discrepancy regarding elderly patients' wishes, and doctors' opinions about its worthwhileness, although up to 10 percent survive. Our geriatric patients rarely discuss the subject, but it is openly ventilated with families who ask about it, who are then involved in the decision-making, and the decision about CPR or "do-not-resuscitate" (DNR) is based on clinical and prognostic considerations. (shrink)