When silence threatens safety: lessons from the first Canberra Hospital neurosurgical inquiry

Despite widespread institutional and professional support, the recommendations of the Bristol Royal Infirmary Inquiry may be insufficient to reduce patient risk from impaired senior medical practitioners. Using the First Inquiry into Neurosurgical Services at the Canberra Hospital as a case study, this article argues that the Bristol-type recommendations--which emphasise reformulation of clinical governance structures, including early reporting of "sentinel events" and compulsory clinical audits--will be ineffective without a reformed institutional ethos that encourages open transparency and respect for those committed to such processes. Such reformulation may need to commence in medical education and involve new strategies including the use of portable digital technology to facilitate self-assessment of performance and immediate reporting of adverse incidents.     

Managing incidental findings in human subjects research: analysis and recommendations.

No consensus yet exists on how to handle incidental findings (IFs) in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are findings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed.     

Bhaṭṭa Jayanta on Epistemic Complexity

Journal of Indian Philosophy - This essay seeks to characterize one of the leading ideas in Bha??a Jayanta's Nyāyamañjarī, the fundamental role that...     

Teaching criminal investigation: A critical thinking approach

The purpose of this paper is to explore the “critical thinking” approach to teaching and develop those concepts into meaningful instructional activities in the classroom. The authors offer practical suggestions based on the critical thinking philosophy for implementing an active learning approach. The case study method serves as the foundation for an investigative process course and lead-up activity to the simulated preliminary and follow-up investigation. The instructor presents the critical thinking process and content information that enables students to perform five basic progressions: (1) case studies; (2) the preliminary investigation; (3) follow-up; (4) suppression hearing; and (5) moot court criminal justice simulations.     

ADOLESCENTS' VIEWS ON THE FAIRNESS OF PARENTING AND FINANCIAL ARRANGEMENTS AFTER SEPARATION

Interviews were conducted with 60 young people aged 12–19 in Australia, concerning their views about parenting and financial arrangements after separation. Half the young people reported that they had no say at all in where they would live after separation. A quarter said they were never able to see their nonresident parent when they wanted to. There was a strong relationship between young people's perceptions of the fairness of the parenting arrangements and the extent to which they were allowed to participate in making those arrangements. Half said that they did not have enough time with their nonresident parent. Having a continuing and meaningful relationship with both parents and with siblings was very important to them. More than a third favored arrangements of spending equal time with each parent. The young people were also very concerned with issues about fairness between first and second families, both in terms of time availability and financial provisions.     

Consent in escrow

Disasters such as flash flooding, mass shootings, and train and airplane accidents involving large numbers of victims produce significant opportunity for research in the biosciences. This opportunity exists in the extreme tails of life events, however, during which decisions about life and death, valuing and foregoing, speed and patience, trust and distrust, are tested simultaneously and abundantly. The press and urgency of these scenarios may also challenge the ability of researchers to comprehensively deliver information about the purposes of a study, risks, benefits, and alternatives. Under these circumstances, we argue that acquiring consent for the immediate use of data that are not time sensitive represents a gap in the protection of human study participants. In response, we offer a two-tiered model of consent that allows for data collected in real-time to be held in escrow until the acute post-disaster window has closed. Such a model not only respects the fundamental tenet of consent in research, but also enables such research to take place in an ethically defensible manner.     

Electoral equilibrium in double member districts

The median-voter result, and the issue of stability in electoral competition generally, have been examined from a number of different perspectives. Out of all these examinations, however, only a few focus on institutional variables. This essay demonstrates that the median-voter result is robust under a significant institutional change that entails altering the basic assumption of single-member districts. After developing a model of electoral competition in a two-member, first-two-past-the-post district, I show that, if there are three candidates, the set of Nash equilibria is the set of strategy triples (x ₁, x ₂, x ₃), with x ₁ = x ₂ = x ₃ = x*, and such that x* lies between the quantiles of order 1/3 and 2/3. If there are four candidates, I show that a unique Nash equilibrium exists with all candidates adopting a position at the medianvoter's ideal point.