The “hijacking” and “drug instrumentalization” models of psychoactive drug use predict opposite outcomes in terms of adaptive behavior and fitness benefits. Which is the range of applicability of each model? To answer this question, we need more data than those reported by studies focusing on medical, psychiatric, and legal problems in addicted users. An evolutionary analysis requires a much wider focus.

BackgroundCountries are increasingly devoting significant resources to creating or strengthening research ethics committees, but there has been insufficient attention to assessing whether these committees are actually improving the protection of human research participants.DiscussionResearch ethics committees face numerous obstacles to achieving their goal of improving research participant protection. These include the inherently amorphous nature of ethics review, the tendency of regulatory systems to encourage a focus on form over substance, financial and resource constraints, and conflicts of interest. Auditing and accreditation programs (...) can improve the quality of ethics review by encouraging the development of standardized policies and procedures, promoting a common base of knowledge, and enhancing the status of research ethics committees within their own institutions. However, these mechanisms focus largely on questions of structure and process and are therefore incapable of answering many critical questions about ethics committees' actual impact on research practices.The first step in determining whether research ethics committees are achieving their intended function is to identify what prospective research participants and their communities hope to get out of the ethics review process. Answers to this question can help guide the development of effective outcomes assessment measures. It is also important to determine whether research ethics committees' guidance to investigators is actually being followed. Finally, the information developed through outcomes assessment must be disseminated to key decision-makers and incorporated into practice. This article offers concrete suggestions for achieving these goals.ConclusionOutcomes assessment of research ethics committees should address the following questions: First, does research ethics committee review improve participants' understanding of the risks and potential benefits of studies? Second, does the process affect prospective participants' decisions about whether to participate in research? Third, does it change participants' subjective experiences in studies or their attitudes about research? Fourth, does it reduce the riskiness of research? Fifth, does it result in more research responsive to the local community's self-identified needs? Sixth, is research ethics committees' guidance to researchers actually being followed? (shrink)

Outcome bias and hindsight bias are important in philosophical debates and have wide-ranging implications outside of philosophy. Recently, Hedden has articulated a novel line of argumnt that the empirical evidence for what he labels hindsight bias is largely misguided and that empirical researchers who postulate such a bias are engaged in a fallacy fallacy. In this paper, I articulate Hedden’s core insights in terms of two principles and argue that in the relevant empirical research, these principles are often (i) recognized, (...) (ii) invoked in theoretical explanation, and (iii) guiding study designs and interpretation of data. On this basis, I argue that there is ample empirical evidence for outcome and hindsight bias and that cognitive psychologists do not generally exhibit a fallacy fallacy of postulating such biases in cases where there are none. More constructively, the present paper articulates some general principles that help us to better understand when an empirical study provides evidence of these types of bias. Thus, the debate casts light on both the specific evidence for outcome and hindsight bias but also on the general division of labor between philosophy and psychology. (shrink)

To improve the value of pharmaceutical spending, some manufacturers and payers have introduced outcomes-based contracts, where rebates are tied to specified outcomes. We reviewed the literature and interviewed key experts to assess these contracts' potential to slow pharmaceutical spending. We found that while outcomes-based contracts are increasingly common in the US, they are still limited by multiple factors — including the lack of meaningful outcomes data. Moreover, there is no evidence to date that they slow pharmaceutical (...) spending or increase access. Experts favored having CMS test and rigorously evaluate this model to achieve a better understanding of the implications. (shrink)

This study examines the effects of transformational, transactional, and non-transactional leadership on hotel employees’ outcomes including extra effort, perceived efficiency, and satisfaction with managers. Employees from eleven 4-star hotels in Spain provided the collected data. A series of statistical analyses identify the elements of three leadership styles using a multi-factor leadership questionnaire ; examine the effect of leadership styles on employees’ outcomes. The results of this study indicate that “idealized attributes” of transformational leadership and “contingent reward” from transactional (...) leadership are the most important factors that positively affect all three outcomes ; and to assess the moderating effect of different types of ownership of hotel properties on the relationship between styles of leadership and outcomes of employees’ activities other than these two elements, the significant factors indicating positive or negative relationships vary depending on the types of individual outcomes as well as ownership of hotel properties. The discussion sections indicate theoretical and practical implications of the findings. (shrink)

The purpose of this study is to examine differences in attainment of learning outcomes between students who take a class in an online format as compared to students who take a similar class in a traditional classroom setting. While on the face of it the online learners appear to attain these outcomes to a higher degree, when we control for withdrawal rates between the two groups, as well as demographic differences related to age and class standing, we see (...) that online learners no longer outperform classroom learners. We conclude that learner outcome attainment for the two delivery formats is similar for students who are more mature and/or are experienced college students. Inexperienced college freshmen, in contrast, better attain learner outcomes in a traditional classroom setting. (shrink)

This paper examines the International Student Competition on Place Brand­ing and Mediterranean Diet held in Fermo, Italy, in the context of the devel­opment of rural areas. This one-week food-related educational programme was organised by the University of Macerata’s Department of Education, Cultural Heritage and Tourism in collaboration with The Piceno Laboratory on the Mediterranean Diet, a local network of public and private stakehold­ers committed to the promotion of Fermo area as a touristic destination based on traditional gastronomy. The aim of (...) this study was to understand how and to what extent such food-related educational events may con­tribute to providing students with the knowledge, expertise and soft skills needed for careers in the food tourism sector. Of interest also was how such events may benefit the development of rural areas. The ISC was founded in 2016 and continued in 2017, 2018 and 2019. In order to assess students’ perceptions about the experience, specifically regarding what they felt they had learned about food tourism, and which soft skills they had acquired or honed, 13 students who participated in the 2017 event were interviewed for a qualitative study. Moreover, the authors drew upon information gleaned from interactions with students and teachers, as well as with several important actors of the local food and tourism sector, in­cluding tourism and hospitality entrepreneurs and representatives of gov­ernment agencies, with whom they collaborated in the context of planning, running and evaluating the events. The findings show that the ISC can provide students with a good general understanding of the territory and practical knowledge about place branding and food tourism. In terms of career preparation, the combination of fieldwork activities with traditional lectures and group activities was particularly fruitful in promoting soft skills such as communication, efficient use of social media, teamwork, problem-solving and decision making. (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)

This study investigates the role of perceived power relation between target and perpetrator regarding victimization and turnover intent following exposure to bullying behavior at the workplace. We hypothesized that targets of bullying behavior who self-label as victims experiences a larger power imbalance with the perpetrator compared to targets who do not self-label as victims, and that the association between exposure to bullying behavior and intent to leave the job is stronger when there is power balance between target and perpetrator than (...) when there is a power imbalance. The hypotheses were tested in a probability sample of employees working in the child welfare service in Oslo municipality, Norway, and that had been exposed to at least one instance of mistreatment from a colleague at their workplace. Targets of bullying behavior whom self-labeled as victims reported a larger power imbalance with the perpetrator. Supporting the study hypothesis, and representing a reverse buffering effect, exposure to bullying behavior was most strongly associated with intent to leave among targets in power balance with the perpetrator. For targets in a perceived power imbalance, both low and high exposure to bullying behavior were associated with higher levels of intent to leave. These findings highlight the importance of implementing measures directed at preventing bullying and other forms of mistreatment, irrespective of the power relation between the two parties. (shrink)

Although current educational priorities tend to avoid strong moral positions, one of the world's most venerable yet persistently influential moral traditions not only lays out a number of major moral principles but also incorporates them into its pedagogy. Confucius teaches us about the importance of seeking knowledge, learning how to learn, applying ancient wisdom to contemporary situations, valuing virtue over material gain, following the Golden Rule, and living by our principles. He also has ways of assessing his own students' progress (...) in these matters. Confucius' pedagogy is an interesting model to consider and contrast with contemporary models. This chapter introduces these principles and assessments from the Analects and draws out some comparisons to and contrasts with two alternative theories in western moral thought, Augustine and John Dewey. -/- The accepted version of the paper is included here. Pagination does not match the published version. (shrink)

Engagement with the historical and theoretical underpinnings of measuring quality of life (QoL) and patient‐reported outcomes (PROs) in healthcare is important. Ideas and values that shape such practices—and in the endgame, people's lives—might otherwise remain unexamined, be taken for granted or even essentialized. Our aim is to explicate and theoretically discuss the philosophical tenets underlying the practices of QoL assessment and PRO measurement in relation to the notion of person‐centredness. First, we engage with the late‐modern history of the (...) concept of QoL and the act of assessing and measuring it. Working with the historical method of genealogy, we describe the development of both QoL assessments and PRO measures (PROMs) within healthcare by accounting for the contextual conditions for their possibility. In this way, the historical and philosophical underpinnings of these measurement practices are highlighted. We move on to analyse theoretical and philosophical underpinnings regarding the use of PROMs and QoL assessments in clinical practice, as demonstrated in review studies thereof. Finally, we offer a critical analysis regarding the state of theory in the literature and conclude that, although improved person‐centredness is an implied driver of QoL assessments and PROMs in clinical practice, enhanced theoretical underpinning of the development of QoL assessments is called for. (shrink)

BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation. Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA (...) North European field survey among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.ResultsAll outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.ConclusionsThe findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such as moral reflexivity and moral attitude outcomes, should still be included. In the future, a combination of empirical findings and normative reflection will contribute to the revision of the instrument. (shrink)

Healthcare expenditures account for approximately 9% of GDP in OECD countries and are on an upward trajectory (OECD, 2017). This significant financial burden, combined with an aging global population and increasing demand, emphasizes the imperative for sustained research and innovation to enhance health system efficacy. Key to this transformation are technological advancements, including digital health, which presents novel opportunities for improvement. Emerging digital health technologies, such as virtual consultations, complex imaging procedures, and electronic medical records, are fundamental to modern healthcare (...) infrastructures. However, significant gaps remain in the evaluation and understanding of these innovations, especially for nascent technological areas. This thesis addresses this subject, aiming to delineate how individuals and institutions can bolster their evaluative capabilities, strategic decision-making, and planning for the deployment of emerging digital healthcare technologies. The research methodology amalgamates theoretical exploration, literature scrutiny, and empirical examinations, presenting an integrated perspective that intersects the disciplines of Management & Decision Science, Technology & Innovation, and Health Economics & Outcomes Research. From an applied perspective, this research focuses on developing evidence within the context of pediatric healthcare in Canada — a context notably underrepresented in healthcare management research, despite its disproportionate per capita expenditure. Technologically, the predominant focus is on applications in virtual reality (VR) and three-dimensional (3D) printing and virtualization, though with the aspiration of ensuring the generalizability of results. The current thesis is structured to parallel the progression of the research itself, as three distinct phases; this begins with a comprehensive Background that contextualizes the initial intent, exploring the relationship between technology, innovation, and health outcomes. In this phase, each academic discipline is analyzed to identify base theoretical underpinnings for the research. The second phase of this work includes five empirical studies, each preceded by context-specific literature reviews for the respective technological domain, providing insight into the current state of evidence related to value-based assessment and economic evaluation in that area. Empirical studies included a randomized controlled trial and a cost consequences assessment of VR for pre-procedural preparation for medical imaging. Additionally, novel applications of 3D printing and virtualization are critically analyzed, accompanied by a multi-case study on the implementation of 3D printing in pediatrics, a cost-consequences study of applications for thoracoabdominal surgeries, and an outcomes study on the use of 3D virtualization in medical education during the COVID-19 pandemic. The final phase of this research includes the critical analysis and synthesis of findings into a proposal for a novel value-based assessment and decision-making framework specific to emerging health innovations; this framework integrates insights and resources for clinicians, administrators, and policymakers. The outcomes of this research are skewed toward Knowledge Users, but also aims to advance the theoretical basis for health technology assessment (HTA). (shrink)

How should we assess programs dedicated to education in virtue? One influential answer draws on quantitative research designs. By measuring the inputs and processes that produce the highest levels of virtue among participants according to some reasonable criterion, in this view, we can determine which programs engender the most desired results. Although many outcomes of character education can undoubtedly be assessed in this way, taken on its own, this approach may support favorable judgments about programs that indoctrinate rather than (...) educate, because education in character entails teleological thinking that is volitional not merely determined. I argue instead that proper assessment of virtue requires an expansive view of character education in both particular and common goods that avoids the tendency to indoctrinate and an inclusive conception of measurement that takes into account qualitative in addition to quantitative methodologies. (shrink)

In this essay we develop and argue for the adoption of a more comprehensive model of research ethics than is included within current conceptions of responsible conduct of research (RCR). We argue that our model, which we label the ethical dimensions of scientific research (EDSR), is a more comprehensive approach to encouraging ethically responsible scientific research compared to the currently typically adopted approach in RCR training. This essay focuses on developing a pedagogical approach that enables scientists to better understand and (...) appreciate one important component of this model, what we call intrinsic ethics . Intrinsic ethical issues arise when values and ethical assumptions are embedded within scientific findings and analytical methods. Through a close examination of a case study and its application in teaching, namely, evaluation of climate change integrated assessment models, this paper develops a method and case for including intrinsic ethics within research ethics training to provide scientists with a comprehensive understanding and appreciation of the critical role of values and ethical choices in the production of research outcomes. (shrink)

This second research paper on science education in Māori‐medium school contexts complements an earlier article published in this journal (Stewart, 2005). Science and science education are related domains in society and in state schooling in which there have always been particularly large discrepancies in participation and achievement by Māori. In 1995 a Kaupapa Māori analysis of this situation challenged New Zealand science education academics to deal with ‘the Māori crisis’ within science education. Recent NCEA results suggest Pūtaiao (Māori‐medium Science) education, (...) for which a national curriculum statement was published in 1996, has so far increased, rather than decreased, the level of inequity for Māori students in science education. What specific issues impact on this lack of success, which contrasts with the overall success of Kura Kaupapa Māori, and how might policy frameworks and operational systems of Pūtaiao need to change, if better achievement in science education for Māori‐medium students is the goal? A pathway towards further research and development in this area is suggested. (shrink)

Background: Clinical ethics support services have been advocated in recent decades. In clinical practice, clinical ethics support services are often requested for difficult decisions near the end of life. However, their contribution to improving healthcare has been questioned and demands for evaluation have been put forward. Research indicates that there are considerable challenges associated with defining adequate outcomes for clinical ethics support services. In this systematic review, we report findings of qualitative studies and surveys, which have been conducted to (...) evaluate clinical ethics support services near the end of life. Methods: Electronic databases and other sources were queried from 1970 to May 2018. Two authors screened studies independently. Methodological quality of studies was assessed. For each arm of the review, an individual synthesis was performed. Prospero ID: CRD42016036241. Ethical Considerations: Ethical approval is not needed as it is a systematic review of published literature. Results: In all, 2088 hits on surveys and 2786 on qualitative studies were found. After screening, nine surveys and four qualitative studies were included. Survey studies report overall positive findings using a very wide and heterogeneous range of outcomes. Negative results were reported only occasionally. However, methodological quality and conceptual justification of used outcomes was often weak and limits generalizability of results. Conclusion: Evidence points to positive outcomes of clinical ethics support services. However, methodological quality needs to be improved. Further qualitative or mixed-method research on evaluating clinical ethics support services may contribute to the development of evaluating outcomes of clinical ethics support services by means of broaden the range of appropriate (process-oriented) outcomes of (different types of) clinical ethics support services. (shrink)

Impaired neurodevelopmental outcome, in particular cognitive impairment, after neonatal hypoxic-ischemic encephalopathy is a major concern for parents, clinicians, and society. This study aims to investigate the potential benefits of using advanced quantitative electroencephalography analysis for early prediction of cognitive outcomes, assessed here at 2 years of age. EEG data were recorded within the first week after birth from a cohort of twenty infants with neonatal hypoxic-ischemic encephalopathy. A proposed regression framework was based on two different sets of features, namely (...) graph-theoretical features derived from the weighted phase-lag index and entropies metrics represented by sample entropy, permutation entropy, and spectral entropy. Both sets of features were calculated within the noise-assisted multivariate empirical mode decomposition domain. Correlation analysis showed a significant association in the delta band between the proposed features, graph attributes and entropy features from the neonatal EEG data and the cognitive development at age two years. These features were used to train and test the tree ensemble regression models. The highest prediction performance was reached to 14.27 root mean square error, 12.07 mean absolute error, and 0.45 R-squared using the entropy features with a boosted tree regression model. Thus, the results demonstrate that the proposed qEEG features show the state of brain function at an early stage; hence, they could serve as predictive biomarkers of later cognitive impairment, which could facilitate identifying those who might benefit from early targeted intervention. (shrink)

During the 1990s, international society increasingly recognised that states who abuse their citizens in the most egregious ways ought to lose their sovereign inviolability and be subject to humanitarian intervention. The emergence of this norm has given renewed significance to the debate concerning what it is about humanitarian intervention that makes it legitimate. The most popular view is that it is humanitarian motivations that legitimise intervention. Others insist that humanitarian outcomes are more important that an actor's motivations, pointing for (...) instance to the ousting of the Khmer Rouge by Vietnam. Given the centrality of this debate, this article reinvestigates the ?motives versus outcomes? debate and suggests an alternative reading based on the classic Just War tradition. It argues that an actor's intentions are vital to assessing the legitimacy of an intervention. (shrink)

The Group Calibration Index (GCI) provides a means of assessing the quality of forecasters’ predictions in situations that lack external feedback or outcome data. The GCI replaces the missing outcome data with aggregated ratings of a well-defined reference group. A simulation study and two experiments show how the GCI classifies forecaster performance and distinguishes between forecasters with restricted information and those with complete information. The results also show that under certain circumstances, where members of the reference group have high-quality information, (...) the new GCI will outperform expert classification that is based on traditional calibration indices. (shrink)

Learning outcomes currently play an increasingly important role in higher education. This paper identifies a number of key issues that need to be taken into account in identifying and making use of them. It includes a review of the background from which learning outcomes have emerged. It also highlights the behaviourist approach underlying their use in teaching and assessment and identifies key issues that need to be taken into account in adopting such an approach.

Learning outcomes currently play an increasingly important role in higher education. This paper identifies a number of key issues that need to be taken into account in identifying and making use of them. It includes a review of the background from which learning outcomes have emerged. It also highlights the behaviourist approach underlying their use in teaching and assessment and identifies key issues that need to be taken into account in adopting such an approach.

Suppose an agent is choosing between rescuing more people with a lower probability of success, and rescuing fewer with a higher probability of success. How should they choose? Our moral judgments about such cases are not well-studied, unlike the closely analogous non-moral preferences over monetary gambles. In this paper, I present an empirical study which aims to elicit the moral analogues of our risk preferences, and to assess whether one kind of evidence—concerning how they depend on outcome probabilities—can debunk them. (...) I find significant heterogeneity in our moral risk preferences—in particular, moral risk-seeking and risk-neutrality are surprisingly popular. I also find that subjects’ judgments aren't probability-dependent, thus providing an empirical defense against debunking arguments from probability dependence. (shrink)

There has been much philosophical interest regarding the ‘hierarchy of evidence’ used to determine which study designs are of most value for reporting on questions of effectiveness, prognosis, and so on. There has been much less philosophical interest in the choice of outcome measures with which the results of, say, an RCT or a cohort study are presented. In this paper, we examine the FDA’s recently published guidelines for assessing the psychometric adequacy of patient-reported outcome measures. We focus on their (...) recommendations for demonstrating content validity and also for how researchers should weigh up the sum of psychometric evidence when choosing these measures. We argue that questions regarding judgment and understanding meaning of these measures should play a more central role in determining their adequacy. (shrink)