C. Wong

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582.

ABSTRACT Despite acknowledgment that character operates as a multi-faceted system of multiple attributes, few efforts have examined this system by investigating how character attributes may combine in profiles and how profiles are related to individual internal strengths and contextual assets. Using data from 552 adolescents from the Northeastern United States (Mage = 14.11 years, 60% girls, 56% identified as White), we identified five latent profiles including the character attributes honesty, humility, persistence, future orientation, and purpose (beyond-the-self life goals). Three profiles were characterized by Low, Middle, and High levels of all attributes, respectively, the fourth profile by low levels of future orientation and persistence (termed Present-oriented), and the fifth profile (termed Aspirational) by low levels of honesty and humility with high levels of future orientation, purpose (beyond-the-self life goals), and persistence. The internal strength of intentional self-regulation differentiated between profile membership, whereas prosocial socialization from a known character role model did not. Limitations and future directions are discussed.

BackgroundThe use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in biomedical research.MethodsThis multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 (not important) to 5 (very important).ResultsOf the 2484 questionnaires distributed, 2113 (85.1%) were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making (mean score, ranging from 3.58 to 4.47). Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF (mean score = 4.47, 4.47, and 4.45, respectively).ConclusionsResearch participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF.

Peer-assisted learning has the potential to improve learning in academic settings and beyond. However, the cognitive and motivational mechanisms of learning through interaction with other learners are not fully understood. Here, we present an empirical study in which we compare a peer-assisted learning condition with two individual learning conditions. The empirical findings suggest that both positive and negative peer effects occurred. On the positive side, learners placed in a peer-assisted learning condition allocated more time to practice and they benefited from selectively interacting with the more knowledgeable peers. On the negative side, error exposure and increased cognitive load may have hindered learning in the peer-assisted learning condition. A computational cognitive model developed in the ACT-R cognitive architecture is presented and used to explain the mechanisms of knowledge spillover, trust, and error exposure. This research has implications for designing collaborative learning protocols to increase human collective intelligence and designing artificial intelligence systems that can support human−machine teaming.

Background: While conscientious objection is a well-known phenomenon in normative and bioethical literature, there is a lack of evidence to support an understanding of what it is like for nurses to make a conscientious objection in clinical practice including the meaning this holds for them and the nursing profession. Research question: The question guiding this research was: what is the lived experience of conscientious objection for Registered Nurses in Ontario? Research design: Interpretive phenomenological methodology was used to gain an in-depth understanding of what it means to be a nurse making a conscientious objection. Purposive sampling with in-depth interview methods was used to collect and then analyze data through an iterative process. Participants and research context: Eight nurse participants were interviewed from across practice settings in Ontario, Canada. Each participant was interviewed twice over 9 months. Ethical considerations: This study was conducted in accordance with Health Science Research Ethics Board approval and all participants gave consent. Findings: Six themes emerged from data analysis: encountering the problem, knowing oneself, taking a stand, alone and uncertain, caring for others, and perceptions of support. Discussion: This study offers an initial understanding of what it is like to be a nurse making a conscientious objection in clinical practice. Implications for nursing practice, education, policy, and further research are discussed. Conclusion: Addressing ethical issues in nursing practice is complex. The need for education across nursing, healthcare disciplines and socio-political sectors is essential to respond to nurses’ ethical concerns giving rise to objections. Conscience emerged as an informant to nurses’ conscientious objections. The need for morally inclusive environments and addressing challenging ethical questions as well as the concept of conscience are relevant to advancing nursing ethics and ethical nursing practice.

Innovation adoption is the necessary element for the success of any organization around the globe, and this phenomenon needs a foremost solution. The current study examines this area and explores the impact of customers, employees, and social enterprises' traditional behavior on the resistance to innovation in social enterprises in China. The current article also investigates the mediating role of fear for change among customers, employees, and social enterprises' traditional behavior and resistance to innovation in social enterprises in China. This article has followed the primary data gathering methods and adopted the questionnaires for this purpose. The employees and customers of social enterprises are the respondents and ~11,000 population in the study. According to Krejcie & Morgan, the sample size criteria is around 370. Thus, the researchers' have forwarded around 615 surveys and received only 357 after a few weeks. The present research has also applied the SPSS-AMOS to analyze the association among variables and test the hypotheses. The results revealed that the traditional behavior of customers, employees, and social enterprises has a significant and positive linkage with resistance to innovation in social enterprises in China. The findings also exposed that the fear of change also significantly mediates among customers, employees, and social enterprises' traditional behavior and resistance to innovation in social enterprises in China. This study helps the regulators establish policies related to innovation adoption by changing traditional behavior to advance the behavior of customers, employees, and social enterprises.

Background Adherence to ethical guidelines and regulations and protecting and respecting the dignity and autonomy of participants by obtaining a valid informed consent form (ICF) prior to participation in research are crucial; The subjects did not add signatures next to the corrections made to signatures or dates on the ICF, Multiple signatures in other fields, ICF missing/missing signature, Incorrect ICF version Signed after modification, Correction tape used to correct signature, Impersonated signature, Non-research-member signature, however, ICFs are often not properly completed, which must be addressed. This study analyzed ICF signing errors and implemented measures to reduce or prevent these errors. Methods We used the plan–do–check–act (PDCA) cycle to help improve the correctness and validity of ICF signing. Results Interim and final reports from January 2016 to February 2020 including 363 ICFs were studied. The total proportion of correct ICF signatures (200, 83.3%) following the PDCA intervention was significantly higher than that before the intervention (P < 0.05). Analysis of the types of signing error demonstrated that signature errors were significantly reduced after the intervention, particularly for subjects did not add signatures next to the corrections made to signatures or dates on the ICF (16, 6.7%) and impersonated signature (0; P < 0.05). Conclusions The proportions of other error types—multiple signatures in other fields, missing or unsigned ICF, incorrect signature order, incorrect ICF version, use of correction tape to correct signature, and non-medical profession members signing the ICF—did not differ significantly.

In The Thread of Life, Richard Wollheim argues that a person's sense of value is grounded in the power of love to generate certain favourable perceptions of an object. Following from his view is a psychoanalytic conception of valuing as constituted by the imaginative force of phantasy, rather than rational deliberation. In this paper, I shall defend this conception with a view to explaining the relation between values and desires. I suggest that valuing qua phantasy-making can ‘tune up’ a person's desires to fit his perception of the good. Such power of phantasy is to be contrasted with various types of motivational failure in moral imagination. Finally, I argue that ‘effective valuing’, which makes us capable of desiring what we perceive to be good, requires an affective kind of imagination which assures us that we have the ability to love and to be loved

Aging at work is a dynamic process. As individuals age, their motives, abilities and values change as suggested by life-span development theories (Kanfer & Ackerman, 2004; Lang & Carstensen, 2002). Their growth and extrinsic motives weaken while intrinsic motives increase (Kooij, De Lange, Jansen, Kanfer, & Dikkers, 2011), which may result in workers investing their resources in different areas accordingly. However, there is significant individual variability in aging trajectories (Hedge, Borman, & Lammlein, 2005). In addition, the changing nature of work, the evolving job demands, as well as the available opportunities at work may no longer be suitable for older workers, increasing the likelihood of person-job misfit. The potential misfit may, in turn, impact how older workers perceive themselves on the job, which leads to conflicting work identities. With the traditional job redesign approach being a top-down process, it is often difficult for organizations to take individual needs and skills into consideration and tailor jobs for every employee (Berg, Dutton, & Wrzesniewski, 2010). Therefore, job crafting, being an individualized process initiated by employees themselves, can be a particularly valuable mechanism for older workers to realign and enhance their demands-abilities and needs-supplies fit. Through job crafting, employees can exert personal agency and make changes to the task, social and cognitive aspects of their jobs with the goal of improving their work experience (Wrzesniewski & Dutton, 2001). Building on the Life Span Theory of Control (Heckhausen & Schulz, 1995), we posit that job crafting, particularly cognitive crafting, will be of increasing value as employees age. Through reframing how they think of their job and choosing to emphasize job features that are personally meaningful, older workers can optimize their resources to proactively redesign their jobs and maintain congruent, positive work identities.

Freud’s psychoanalytic theory of morality is often regarded as a deflationist one, to the effect that it takes morality ‘s authority as a sheer product of human irrationality originating in the formation of the superego, and that it should be discarded on pain of its harmful effects on human life. In this paper, I shall discuss three views on this deflationist reading of Freud: that he is right in holding the alleged moral deflationism; that he is wrong in holding it; and that this deflationism is wrong, but he may not actually hold it at all. I attribute the first two views to the philosophers Richard Wollheim and Samuel Scheffler, and argue that both accounts of psychoanalytic moral psychology are inadequate, because they fail to appreciate the role of irrationality in a person’s search for the good life. I then propose a non-deflationist reading of Freud, according to which both the loving and authoritative aspects of morality are deeply rooted in our human nature, and a truly fulfilling life requires more a balancing between the two than an elimination of irrationality. The appreciation of Freud’s moral naturalism, in effect, will require us to drop the presumption that rationality is the only source of goodness.

We develop a paraconsistent logic by introducing new models for conditionals with acceptive and rejective selection functions which are variants of Chellas’ conditional models. The acceptance and rejection conditions are substituted for truth conditions of conditionals. The paraconsistent conditional logic is axiomatized by a sequent system \ which is an extension of the Belnap-Dunn four-valued logic with a conditional operator. Some acceptive extensions of \ are shown to be sound and complete. We also show the finite acceptive model property and decidability of these logics.

Background: Ethical nursing practice is increasingly challenging, and strategies for addressing ethical dilemmas are needed to support nurses’ ethical care provision. Conscientious objection is one such strategy for addressing nurses’ personal, ethical conflicts, at times associated with conscience. Exploring both conscience and conscientious objection provides understanding regarding their implications for ethical nursing practice, research, and education. Research aim: To analyze the concepts of conscience and conscientious objection in the context of nurses. Design: Concept analysis using the method by Walker and Avant. Research context: Data were retrieved from Philosopher’s Index, PubMed, and CINAHL with no date restrictions. Ethical consideration: This analysis was carried out per established, scientific guidelines. Findings: Ethical concepts are integral to nursing ethics, yet little is known about conscientious objection in relation to conscience for nurses. Of note, both concepts are well established in ethics literature, addressed in various nursing codes of ethics and regulatory bodies, but the meaning they hold for nurses and the impact they have on nursing education and practice remain unclear. Discussion and conclusion: This article discusses the relevance of conscience and conscientious objection to ethical nursing practice and proposes a model case to show how they can be appreciated in the context of nurses. Conscientious objection is an option for ethical transparency for nurses but is situated in contentious discussions over its use and has yet to be fully understood for nursing practice. Conscience is an element in need of more exploration in the context of conscientious objection. Further research is warranted to understand how nurses respond to conscience concerns in morally, pluralistic nursing contexts.

The progress of electronic health technologies and biobanks holds enormous promise for efficient research. Evidence shows that studies based on sharing and secondary use of data/samples have the potential to significantly advance medical knowledge. However, sharing of such resources for international collaboration is hampered by the lack of clarity about ethical and legal requirements for transfer of data and samples across international borders. Here, the International Clinical Trial Center Network reports the legal and ethical requirements governing data and sample exchange across four continents. The most recurring requirement is ethical approval, whereas only in specific conditions approval of national health authorities is required. Informed consent is not required in all sharing situations. However, waiver of informed consent is only allowed in certain countries/regions and under certain circumstances. The current legal and ethical landscape appears to be very complex and under constant evolution. Regulations differ between countries/regions and are often incomplete, leading to uncertainty. With this work, ICN illuminates the unmet need for a single international collaborative framework to facilitate DSE. Harmonising requirements for global DSE will reduce inefficiency and waste in research. There are many challenges to realising this ambitious vision, including inconsistent terminology and definitions, and heterogeneous and dynamic legal constraints. Here, we identify areas of agreement and significant difference as a necessary first step towards facilitating international collaboration. We propose the establishment of a working group to continue the comparison across jurisdictions, create a standardised glossary and define a set of basic principles and fundamental requirements for DSE.

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF.

ObjectiveTo prospectively study the cingulate cortex for the localization and role of the grasping action in humans during electrical stimulation of depth electrodes.MethodsAll the patients with intractable focal epilepsy and a depth electrode stereotactically placed in the cingulate cortex, as part of their pre-surgical epilepsy evaluation from 2015 to 2017, were included. Cortical stimulation was performed and examined for grasping actions. Post-implantation volumetric T1 MRIs were co-registered to determine the exact electrode position.ResultsFive patients exhibited contralateral grasping actions during electrical stimulation. All patients had electrodes implanted in the ventral bank of the right cingulate sulcus adjacent to the vertical anterior commissure line. Stimulation of other electrodes in adjacent regions did not elicit grasping.ConclusionGrasping action elicited from a localized region in the mid-cingulate cortex directly supports the concept of the cingulate cortex being crucially involved in the grasping network. This opens an opportunity to explore this region with deep brain stimulation as a motor neuromodulation target for treatment in specific movement disorders or neurorehabilitation.

The counseling process involves attention, emotional perception, cognitive appraisal, and decision-making. This study aimed to investigate cognitive appraisal and the associated emotional processes when reading short therapists' statements of motivational interviewing (MI). Thirty participants with work injuries were classified into the pre-contemplation (PC,n= 15) or readiness stage of the change group (RD,n= 15). The participants viewed MI congruent (MI-C), MI incongruent (MI-INC), or control phrases during which their electroencephalograms were captured. The results indicated significant Group × Condition effects in the frontally oriented late positive complex (P600/LPC). The P600/LPC's amplitudes were more positive-going in the PC than in the RD group for the MI congruent statements. Within the PC group, the amplitudes of the N400 were significantly correlated (r= 0.607–0.649) with the participants' level of negative affect. Our findings suggest that the brief contents of MI statements alone can elicit late cognitive and emotional appraisal processes beyond semantic processing.

This chapter seeks to explore the sequential cyclical growth of science, technology, and science-based technology for two economies—China and South Korea—in the course of transitioning to the postcatching-up phase. Both China and South Korea intend to capitalize on scientific and technological knowledge in order to transition to the postcatching-up phase of development. This chapter highlights the production trajectories of science and technology towards the postcatching-up phase in terms of:Scientific publicationsGranted patentsCopatenting patternForward citationsScience-based patents.China and South Korea have been active in terms of scientific publication and patenting activities. In regard to patenting, both economies have shown the capability to produce patents and are able to converge the growth of patents with that of publications. This chapter highlights a generic cyclical growth path for science, technology, and science-based technology in the course of transitioning to an advanced knowledge-based economy. It is nonetheless important to explore if there are different paths pursued by other emerging economiesemerging economies.

Despite the enforcement of safety protocols, several workplaces and organizations still face accidents in Malaysia. SOSCO reported >34,000 workplace related accidents in 2012, 983 of which were fatal. Leadership is important when creating a culture that supports and promotes health and safety. Management and Team leaders are vital in inspiring workers to higher levels of safety consciousness and productivity, which means they must personally apply good leadership attributions daily. A ‘Safety Culture’ describes a safety management style in the workplace that reflects attitudes, beliefs, perceptions and values shared by all workers with regard to safety. The objectives of this study include raising the awareness among leaders in the workplace of their role and responsibility in the mitigation and construction of a safety culture that approaches zero incidents in the workplace. The methodology used in this paper includes a qualitative literature research on safety culture and leadership in addition to a quantitative survey that focused on safety culture at two Malaysian universities. This research thus provides an in-depth analysis and platform for organizations to identify areas of weakness and concern and can lead to further research that builds on existing systems to strengthen safety culture awareness and praxis.