Physicians' silent decisions: because patient autonomy does not always come first

Physicians make some medical decisions without disclosure to their patients. Nondisclosure is possible because these are silent decisions to refrain from screening, diagnostic or therapeutic interventions. Nondisclosure is ethically permissible when the usual presumption that the patient should be involved in decisions is defeated by considerations of clinical utility or patient emotional and physical well-being. Some silent decisions--not all--are ethically justified by this standard. Justified silent decisions are typically dependent on the physician's professional judgment, experience and knowledge, and are not likely to be changed by patient preferences. We condemn the inappropriate exclusion of the patient from the decision-making process. However, if a test or treatment is unlikely to yield a net benefit, disclosure and discussion are at times unnecessary. Appropriate silent decisions are ethically justified by such considerations as patient benefit or economy of time.     

An evaluation and comparison of claims made in behavioural investigative advice reports compiled by the National Policing Improvements Agency in the United Kingdom

This study examined the content of a contemporary sample of behavioural investigative advice reports produced by the National Policing Improvements Agency (NPIA), formally known as the National Centre for Policing Excellence, and compared this sample with previous offender‐profiling samples reported by Alison, Smith, Eastman, and Rainbow in 2003. Forty‐seven reports written in 2005 were content analysed. The reports contained 805 claims, although 96% of the claims contained grounds for their claim, only 34% had any formal support or backing. In terms of confirmability, 70% of the claims were verifiable. However, only 43% were falsifiable, in that they could be objectively measured post‐conviction. Analysis also showed that there were differences when comparing the different types of claims made (i.e. behavioural, temporal) and the different types of reports compiled by the NPIA (i.e. behavioural assessment report, linking report, etc.) Comparisons show that there is a very large positive difference between the contemporary behavioural investigative advice sample and previous non‐NPIA expert advice in terms of the substantiveness of their arguments. Contemporary NPIA behavioural investigative advice has clearer boundaries around the claims made and presents material in a more coherent and evidence‐based format than previous expert advice. Copyright © 2007 John Wiley & Sons, Ltd.     

The neuroscience of "free will"

Advances in neuroscience over the past 40 or more years are causing a re-visiting of an old debate: Does man possess free will over his actions, or do forces out of his control determine his behavior? Philosophers and biologists since the beginning of recorded history have taken positions on each side of the debate. Recent discoveries of brain activation prior to conscious awareness and genetic conditions that induce impulsive violent behavior are fortifying the perspective that biological determinism is basic to the human condition. But some contemporary thinkers are conflicted in this viewpoint since “free will” is a necessary element for self-determination and for attributing personal responsibility for one's actions. Hence, modifications of strict determinism have emerged which try to incorporate the features of determinism enforced by neuroscience findings with some element of “free will”, making the two seemingly opposed positions compatible. How successful this will be to rescue “free will” in the long term depends on future discoveries in neuroscience and genetics. Copyright © 2007 John Wiley & Sons, Ltd.     

Educational Assessments in Latin America: The State of the Art

On s'intéresse de plus en plus à travers le monde aux évaluations dans la domaine de l'éducation. Cet article décrit les progrès que plusieurs pays d'Amérique latine ont réalisé dans ce secteur, y compris la participation de l'Amérique latine à un ensemble d'initiatives internationales. L'article expose quelques questions et problèmes et indique comment les programmes d'évaluation de ces pays pourrait être mieux exploités pour améliorer la qualité de l'éducation.
Interest in educational assessments has grown throughout the world. This paper examines advances in educational assessments in several countries of Latin America, including Latin American participation in a variety of international efforts. The paper identifies issues and problems and suggests how assessment programs in this region can be used more effectively to improve the quality of education. ¹     

Dual imputation model for incomplete longitudinal data

Missing values are a practical issue in the analysis of longitudinal data. Multiple imputation (MI) is a well‐known likelihood‐based method that has optimal properties in terms of efficiency and consistency if the imputation model is correctly specified. Doubly robust (DR) weighing‐based methods protect against misspecification bias if one of the models, but not necessarily both, for the data or the mechanism leading to missing data is correct. We propose a new imputation method that captures the simplicity of MI and protection from the DR method. This method integrates MI and DR to protect against misspecification of the imputation model under a missing at random assumption. Our method avoids analytical complications of missing data particularly in multivariate settings, and is easy to implement in standard statistical packages. Moreover, the proposed method works very well with an intermittent pattern of missingness when other DR methods can not be used. Simulation experiments show that the proposed approach achieves improved performance when one of the models is correct. The method is applied to data from the fireworks disaster study, a randomized clinical trial comparing therapies in disaster‐exposed children. We conclude that the new method increases the robustness of imputations.     

Antiphasis as Homonym in Aristotle

Antiphasis is a case of core-dependent homonymy, and has three significations in Aristotle's philosophy: (1) antiphasis as an opposition between propositions (a propositional signification); (2) antiphasis as the opposition between ‘subject’ and ‘not a subject’ in coming-to-be and perishing (an ontological signification); and (3) antiphasis as the opposition between possession and privation (an ontological signification). Argument based on the fifth type of priority described in Cat. 12 shows that, for Aristotle, the ontological significations are prior to the propositional.     

Toward a Culturally Responsive Model of Mental Health Literacy: Facilitating Help‐Seeking Among East Asian Immigrants to North America

Studies have consistently found that East Asian immigrants in North America are less likely to use mental health services even when they experience levels of distress comparable to Euro‐Americans. Although cultural factors that may prevent East Asian immigrants from seeking mental health care have been identified, few studies have explored ways to foster appropriate help‐seeking and use of mental health services. Recent work on mental health literacy provides a potential framework for strategies to increase appropriate help‐seeking and use of services. This paper reviews the literature on help‐seeking for mental health problems among East Asian immigrants living in Western countries to critically assess the relevance of the mental health literacy approach as a framework for interventions to improve appropriate use of services. Modifications needed to develop a culturally responsive framework for mental health literacy are identified.     

Social influence on metacognitive evaluations: The power of nonverbal cues

Metacognitive evaluations refer to the processes by which people assess their own cognitive operations with respect to their current goal. Little is known about whether this process is susceptible to social influence. Here we investigate whether nonverbal social signals spontaneously influence metacognitive evaluations. Participants performed a two-alternative forced-choice task, which was followed by a face randomly gazing towards or away from the response chosen by the participant. Participants then provided a metacognitive evaluation of their response by rating their confidence in their answer. In Experiment 1, the participants were told that the gaze direction was irrelevant to the task purpose and were advised to ignore it. The results revealed an effect of implicit social information on confidence ratings even though the gaze direction was random and therefore unreliable for task purposes. In addition, nonsocial cues (car) did not elicit this effect. In Experiment 2, the participants were led to believe that cue direction (face or car) reflected a previous participant's response to the same question—that is, the social information provided by the cue was made explicit, yet still objectively unreliable for the task. The results showed a similar social influence on confidence ratings, observed with both cues (car and face) but with an increased magnitude relative to Experiment 1. We additionally showed in Experiment 2 that social information impaired metacognitive accuracy. Together our results strongly suggest an involuntary susceptibility of metacognitive evaluations to nonverbal social information, even when it is implicit (Experiment 1) and unreliable (Experiments 1 and 2).     

Intuitive Dualism and Afterlife Beliefs: A Cross-Cultural Study

It is widely held that intuitive dualism—an implicit default mode of thought that takes minds to be separable from bodies and capable of independent existence—is a human universal. Among the findings taken to support universal intuitive dualism is a pattern of evidence in which “psychological” traits (knowledge, desires) are judged more likely to continue after death than bodily or “biological” traits (perceptual, physiological, and bodily states). Here, we present cross-cultural evidence from six study populations, including non-Western societies with diverse belief systems, that shows that while this pattern exists, the overall pattern of responses nonetheless does not support intuitive dualism in afterlife beliefs. Most responses of most participants across all cultures tested were not dualist. While our sample is in no way intended to capture the full range of human societies and afterlife beliefs, it captures a far broader range of cultures than in any prior study, and thus puts the case for afterlife beliefs as evidence for universal intuitive dualism to a strong test. Based on these findings, we suggest that while dualist thinking is a possible mode of thought enabled by evolved human psychology, such thinking does not constitute a default mode of thought. Rather, our data support what we will call intuitive materialism—the view that the underlying intuitive systems for reasoning about minds and death produce as a default judgment that mental states cease to exist with bodily death.