Front-line services,complexity, research and policy

The evidence-based culture of modern mental health policy and service delivery is being extended through funded efforts to accelerate implementation of research findings in practice settings. In this paper, we argue that this linear model of research and policy-making is profoundly ill adapted to the nature of practice realities and real-world policy-making processes. Both need to be re-conceptualised using the theoretical and practical resources deriving from modern complexity theory. A short case study illustrates the nature of ‘complexity’, the reframing of the notion of ‘evidence’ it implies and the different relationship between research, practice and policy that flows from this more attuned model of mental health and therapeutic processes.     

Liberal naturalism,objectivity and the autonomy of the mental

ABSTRACT

The paper distinguishes between two different ways of cashing out the general insight that often goes by the name of ‘liberal naturalism’. The objective is to show how these two different argumentative strategies undergird two fundamentally different approaches to the project of elucidating the specificity of mental phenomena. On one approach, the central concern of such a project is the ontological status of subjective conscious phenomena; on the other, the central concern is the irreducibility of parochial capacities in the adoption of intentional stances. I begin by tracing out some of the origins of this important divergence and then focus on the motivations of the latter approach. I show that there is a tension between its motivations and the way that it has been used to rehabilitate idealist themes from the post-Kantian tradition.     

An extension of the concept of specific objectivity

Comparisons of subjects are specifically objective if they do not depend on the items involved. Such comparisons are not restricted to the 1-parameter logistic latent trait model, but may also be defined within ordinal independence models and even within the 2-parameter logistic model.     

Relativist ethics, scientific objectivity, and concern for human rights

This paper comments on the conflict between ethical relativism and anthropologists’ concerns with rights, and tries to show that neither scientific objectivity nor respect for cultural diversity require denying an extracultural stance for ethical judgments. An earlier version of this paper was presented at a symposium entitled “Ethics in Science: Special Problems in Anthropology and Archaeology” held at the 1998 Annual Meeting of the American Association for the Advancement of Science (AAAS), Philadelphia, PA, 15 February, 1998.     

Evaluating scientific research: Belief,hindsight bias,ethics, and research evaluation

Students may exhibit two forms of cognitive biases, belief and hindsight bias, in evaluating a scientific experiment. Counter to disagreement, they may only believe an outcome that agrees with their belief to be more predictable in hindsight than foresight. The focus of this research is on the relationship between these biases. Students were queried about their dichotomous beliefs (learned vs. genetic) about behavior for an animal experiment and then assigned randomly to a no‐outcome or genetic outcome condition. With agreement between students' belief and outcome, the findings revealed hindsight bias (foreseeability) supported by the outcomes for surprise, disappointment, ethics, and research evaluation. With disagreement, hindsight bias was trumped along with perceiving the experiment as being less ethical and scientifically sound. Regardless of the outcome, students seem to adhere to their beliefs. Hence, students may believe that the outcome is inconsequential because it is obvious or contrary to their beliefs.     

Statistics and ethics in medical research

Ethical conduct is an essential component in research, especially in medical research. Statistical methods for design and analysis are powerful research tools if used properly. Abuse of these principles and methods are just as unethical as other laboratory or clinical misconduct. Inadequate research design can produce worthless results and thus wastes effort and valuable resources. For clinical research, patient resources are wasted. Inappropriate analysis of data can also produce misleading results and conclusions. For clinical research, inferior therapy might be given to patients as a consequence. These ethical concerns can have implications for and affect the individuals responsible for the statistical design and analysis. Examples are provided which illustrate some possible abuses and inappropriate pressures.     

叙事医学在社区糖尿病患者管理中的应用

通过阐述叙事医学模式在社区糖尿病患者管理中的应用,探讨了叙事医学应用于社区糖尿病患者管理的模式及意义,并分析了该模式现有的不足,如患者缺乏认可度、药师叙事能力不足、患者随访困难等。认为药师在患者管理中引入叙事医学模式,有助于发现患者潜在用药风险,为患者提供个性化用药服务,提高其生存质量,同时提高药师人文素养,实现自我价值。以此模式作为社区药学人文建设的切入点,拓展叙事医学的临床领域。

     

The other side of false belief: Constructing the objectivity of reality

Young children appear not to grasp the independence between objective reality and subjective beliefs, as evidenced by their errors on false belief tasks. Whereas decades of research have examined children's developing understanding of the subjectivity of beliefs, however, almost no research has examined the other side of the issue: How do humans come to understand the objectivity of reality, and why is this understanding important? To help address this gap, this article proposes an evolutionary-developmental account of how the understanding that reality is objective may have emerged in human thinking. Three key steps are highlighted: (i) phylogenetic foundations in great ape competitive mindreading, (ii) ontogenetic foundations in preverbal infant joint attention, and (iii) key experiences of perspectival conflict in linguistic humans. Functionally, the concept of an objective reality facilitated collaborative reasoning and joint decision-making. To arrive at good joint decisions, individuals needed to recognize that both their own beliefs and others' beliefs could be wrong—with respect to the objective reality.     

The assignment of scores for output‐based research funding

This paper considers the assignment of scores to research output items, such as articles, books, contributions to conference proceedings, doctoral dissertations, etc., under four distribution criteria: the advancement of pure and applied scientific research, the advancement of innovative problem solving, the dissemination of scientific knowledge, and the coverage of the cost of the research. These scores are to be used in the allocation of research funds to the faculties of a university. The present paper describes the experiments carried out within the framework of the Decision Analysis and Support Project of the International Institute of Applied Systems Analysis, Laxenburg, Austria. It summarizes the vivid discussions triggered by the experiment, and it also presents the results of an additional experiment. Copyright © 1999 John Wiley & Sons, Ltd.     

Contributions of empirical research to medical ethics

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine.     

A Case Study of the Implementation of Outcomes-Based Funding Within a Local United Way System: Some Implications for Practicing Community Psychology

This case study provides an overview of significant organizational change within the United Way system in Franklin County/Columbus, Ohio. Franklin County is a major urban center with a population approaching 1 million. The implementation of outcomes-based funding proved to be a critical factor that served to promote change within the local United Way system. Adoption of outcomes-based funding principles resulted in significant shifts in United Way funding and major policy changes. A chronology of events and stakeholder reactions over a multiyear period are reviewed. The implications of this effort to initiate major, system-level change for the practice of community psychology are discussed.     

The logic of the medical research article

As do all forms of science, medical theories have a factual as well as a logical basis. New information is presented in medical research articles. These papers have three separate arguments: the argument of the hypothesis, the argument of the experimental protocol, and the argument of the hypothesis's judgment. These arguments may be examples of the hypothetico-deductive or confirmational model of scientific inference. The logical form of these arguments are informal and inductive rather than formal and deductive. Understanding the nature of the logic of the medical research article may help avoid erroneous conclusions.     

Macro sales force research

The call for more macro sales force research where the sales force as a whole is the unit of analysis, which was raised in “The Strategic Role of the Sales Force,” is revisited in this article. Technology, consolidation, government policies, the evolution of organizational strategy are dramatically changing the role of the sales force and the daily lives of salespeople. Yet, it is estimated that no more than 5%, and probably less, of sales and sales management research examines these developments. To shine a light on this, a case study of a health-care company that has changed its strategic focus from a product to a solutions provider is presented. Changes in the role of the sales force are examined within the five sales force capabilities identified in the “The Strategic Role” article. Research questions are raised about sales force capabilities.     

双向偏见引发冲突情境下自我归类对民族社会化觉察的影响——来自景颇族、傣族和汉族初中生的证据

采用情境实验法和故事补全任务,考察双向偏见引发冲突情境下的自我归类对景颇族、傣族与汉族初中生的民族社会化觉察的影响。结果表明,作为冲突事件的当事者,景颇族学生和傣族学生觉察到的促进和睦、文化社会化及促使不信任等民族社会化信息存在差异;景颇族、傣族和汉族学生的自我归类存在差异;自我归类对促进和睦、文化社会化与报告权威等信息的觉察的影响亦存在民族差异。在双向偏见冲突情境下,三族学生的自我归类与民族社会化觉察有一定关系:无论是做当事者/内群体归类、旁观者/外群体归类,还是做调解者/群际归类,被试对促进和睦的觉察均最多。偏见准备主要与当事者归类有关,而进行调解者归类的被试更容易觉察到"报告权威"。     

Disparities in access to family physicians among transgender people in Ontario,Canada

Background: Informed by the Gelberg-Andersen behavioral model for vulnerable populations, this study examined the prevalence of and factors associated with not having a family physician among transgender (trans) people in Ontario, Canada.

Methods: Data were drawn from a respondent-driven sampling (RDS) survey of trans Ontarians age 16 and above (n = 433) conducted between 2009 and 2010. All analyses were weighted using RDS II methods. Prevalence ratios were estimated using average marginal predictions from logistic regression models.

Results: An estimated 17.2% (95% CI, 11.0 to 22.9) of trans Ontarians (median age = 28.7, 77.3% White) did not have a regular family physician. In multivariable analyses accounting for other predisposing and need-related factors, transfeminine persons (trans women and non-binary persons assigned a male sex at birth) who were Indigenous and/or persons of color were less likely than other transfeminine persons to have a family doctor. In addition, trans persons who were homeless or had unstable housing were less likely to have a family doctor than those who were adequately housed.

Conclusions: These results provide the first quantitative evidence of health disparities by race and gender within a Canadian transgender population and suggest a social gradient in access to care within Ontario's “universal health insurance” system.     

Innovative Practice,Clinical Research,and the Ethical Advancement of Medicine

Innovative practice occurs when a clinician provides something new, untested, or nonstandard to a patient in the course of clinical care, rather than as part of a research study. Commentators have noted that patients engaged in innovative practice are at significant risk of suffering harm, exploitation, or autonomy violations. By creating a pathway for harmful or nonbeneficial interventions to spread within medical practice without being subjected to rigorous scientific evaluation, innovative practice poses similar risks to the wider community of patients and society as a whole. Given these concerns, how should we control and oversee innovative practice, and in particular, how should we coordinate innovative practice and clinical research? In this article, I argue that an ethical approach overseeing innovative practice must encourage the early transition to rigorous clinical research without delaying or deferring the development of beneficial innovations or violating the autonomy rights of clinicians and their patients.     

The Role for Public Funding of Faith-Based Organizations Delivering Behavioral Health Services: Guideposts for Monitoring and Evaluation

The paper reviews policies promoting faith-based organizations' (FBO) participation in publicly-funded programs since the Charitable Choice statute was enacted during the Clinton administration and then additional faith-based initiatives were implemented by the Bush administration. The paper focuses on research findings on FBO participation in publicly-funded human service programs under these policies. It then proposes a framework for evaluation to assess the appropriateness of public funding for behavioral health services delivered by FBOs, in order to address: (1) the programmatic and systemic effects resulting from the infusion of new players from the faith community, and the consequences to the profile of services and who gets served; and (2) the content and effectiveness of faith-infused services as a basis for identifying interventions appropriate for public funding. The analysis considers classification issues, theoretical bases of measured effects of faith-infused services, and the transferability of faith-based interventions across religious and secular applications in order to satisfy constitutional issues and client choice.