COVID-19 and the law in Uganda: a case study on development and application of the public health act from 2020 to 2021

BACKGROUND

Despite the discovery of vaccines, the control, and prevention of Coronavirus disease 2019 (COVID-19) relied on non-pharmaceutical interventions (NPIs). This article describes the development and application of the Public Health Act to implement NPIs for COVID-19 pandemic control in Uganda.

METHODS

This is a case study of Uganda's experience with enacting COVID-19 Rules under the Public Health Act Cap. 281. The study assessed how and what Rules were developed, their influence on the outbreak progress, and litigation. The data sources reviewed were applicable laws and policies, Presidential speeches, Cabinet resolutions, statutory instruments, COVID-19 situation reports, and the registry of court cases that contributed to a triangulated analysis.

RESULTS

Uganda applied four COVID-19 broad Rules for the period March 2020 to October 2021. The Minister of Health enacted the Rules, which response teams, enforcement agencies, and the general population followed. The Presidential speeches, their expiry period and progress of the pandemic curve led to amendment of the Rules twenty one (21) times. The Uganda Peoples Defense Forces Act No. 7 of 2005, the Public Finance Management Act No. 3 of 2015, and the National Policy for Disaster Preparedness and Management supplemented the enacted COVID-19 Rules. However, these Rules attracted specific litigation due to perceived infringement on certain human rights provisions.

CONCLUSIONS

Countries can enact supportive legislation within the course of an outbreak. The balance of enforcing public health interventions and human rights infringements is an important consideration in future. We recommend public sensitization about legislative provisions and reforms to guide public health responses in future outbreaks or pandemics.

Neural evidence suggests phonological acceptability judgments reflect similarity, not constraint evaluation

Acceptability judgments are a primary source of evidence in formal linguistic research. Within the generative linguistic tradition, these judgments are attributed to evaluation of novel forms based on implicit knowledge of rules or constraints governing well-formedness. In the domain of phonological acceptability judgments, other factors including ease of articulation and similarity to known forms have been hypothesized to influence evaluation. We used data-driven neural techniques to identify the relative contributions of these factors. Granger causality analysis of magnetic resonance imaging (MRI)-constrained magnetoencephalography (MEG) and electroencephalography (EEG) data revealed patterns of interaction between brain regions that support explicit judgments of the phonological acceptability of spoken nonwords. Comparisons of data obtained with nonwords that varied in terms of onset consonant cluster attestation and acceptability revealed different cortical regions and effective connectivity patterns associated with phonological acceptability judgments. Attested forms produced stronger influences of brain regions implicated in lexical representation and sensorimotor simulation on acoustic-phonetic regions, whereas unattested forms produced stronger influence of phonological control mechanisms on acoustic-phonetic processing. Unacceptable forms produced widespread patterns of interaction consistent with attempted search or repair. Together, these results suggest that speakers' phonological acceptability judgments reflect lexical and sensorimotor factors.

A global systematic review of forest management institutions: towards a new research agenda

CONTEXT

Globally, forest landscapes are rapidly transforming, with the role of institutions as mediators in their use and management constantly appearing in the literature. However, global comparative reviews to enhance comprehension of how forest management institutions (FMIs) are conceptualized, and the varying determinants of compliance, are lacking. And so too, is there knowledge fragmentation on the methodological approaches which have and should be prioritized in the new research agenda on FMIs.

OBJECTIVES

We review the regional variations in the conceptualization of FMIs, analyze the determinants of compliance with FMIs, and assess the methodological gaps applied in the study of FMIs.

METHODS

A systematic review of 197 empirically conducted studies (491 cases) on FMIs was performed, including a directed content analysis.

RESULTS

First, FMIs literature is growing; multi-case and multi-country studies characterize Europe/North America, Africa and Latin America, over Asia. Second, the structure-process conceptualization of FMIs predominates in Asia and Africa. Third, global south regions report high cases of compliance with informal FMIs, while non-compliance was registered for Europe/North America in the formal domain. Finally, mixed-methods approaches have been least employed in the studies so far; while the use of only qualitative methods increased over time, the adoption of only quantitative approaches witnessed a decrease.

CONCLUSION

Future research should empirically ground informality in the institutional set-up of Australia while also valorizing mixed-methods research globally. Crucially, future research should consider multidisciplinary and transdisciplinary approaches to explore the actor and power dimensions of forest management institutions.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10980-022-01577-8.

Modeling Medical Guidelines by Prova and SHACL Accessing FHIR/RDF. Use Case: The Medical ABCDE Approach

Decision-making based on so-called medical guidelines supported by semantic AI solutions is an essential and significant task for medical personnel in both a pre-clinical setting and an inner-clinical environment. Semantic representations of medical guidelines and Fast Healthcare Interoperability Resources (FHIR) using Semantic Web technologies, i.e., Resource Description Framework (RDF), rules (RuleML and Prova), and Shape Constraint Language (SHACL), provide a semantic knowledge base for the decision-making process and ease technical implementation and automation tasks. Current medical decision support systems lack Semantic Web integration using FHIR-RDF representations as a data source. In this paper, we implement a particular medical guideline using two different approaches: Prova [8] and SHACL [13]. We generate a series of raw FHIR-data for a selected guideline, the ABCDE approach, and compare the implemented two programs' (Prova and SHACL) results. Both approaches deliver the same results in terms of content. Both may be used within a distributed medical environment depending on the need of organizations.

Exploring changes in integration, differentiation, rules, coordination and performance following the introduction of a hospital planning centre: a case study

PURPOSE

This study explores how a hospital works, which is important for further enhancing hospital performance. Following the introduction of a Hospital Planning Centre (HPC), changes are explored in a hospital in terms of integration (the coordination and alignment of tasks), differentiation (the extent to which tasks are segmented into subsystems), rules, coordination mechanisms and hospital performance.

DESIGN/METHODOLOGY/APPROACH

A case study was conducted examining the hospital's social network, rules, coordination mechanisms and performance both before and after the introduction of the HPC. All planning and execution tasks for surgery patients were studied using a naturalistic inquiry and mixed-method approach.

FINDINGS

After the introduction of the HPC, the overall network structure and coordination mechanisms and coordination mechanisms remained largely the same. Integration and certain rules changed for specific planning tasks. Differentiation based on medical discipline remained. The number of local rules decreased and hospital-wide rules increased, and these remained largely in people's minds. Coordination mechanisms remained largely unchanged, primarily involving mutual adjustment and standardization of work both before and after the introduction of the HPC. Overall, the hospital's performance did not change substantially. The findings suggest that integration seems to "emerge" instead of being designed. Hospitals could benefit, we argue, from a more conscious system-wide approach that includes collective learning and information sharing.

ORIGINALITY/VALUE

This exploratory study provides in-depth insight into how a hospital works, yielding important knowledge for further research and the enhancement of hospital performance.

Rules and Resistance: A Commentary on "An Archeology of Corruption in Medicine"

In the paper "An archeology of corruption in medicine" (2018), Miles Little, Wendy Lipworth, and Ian Kerridge ("the authors" or "Little et al.") present an account of corruption and describe its prevalent forms in medicine. In presenting an individual-focused account of corruption found within "social entities" (organizations, institutions, and systems), Little et al. argue that these entities are corruptible by nature and that certain individuals are prone to take advantage of the corruptibility of social entities to pursue their own ends. The authors state that this is not preventable, so the way to remedy corruption is via management and, where necessary, punishment. This commentary will briefly lay out the key features and functions of corruption as presented by Little et al., before providing a critical discussion that will focus on whether corruptibility is a necessary feature of social entities. I will propose that it is not a necessary feature, though it may frequently arise where individualistic values are unchecked. Corruption can be prevented within social entities by enhancing structures that direct toward virtue and which promote and reward cooperation instead of competition.

Risk, Responsibility, Rudeness, and Rules: The Loneliness of the Social Distance Warrior

We have a responsibility to obey COVID-19 rules, in order to minimize risk. Yet it is still seen as rude to challenge people who do not respect those rules, when in fact the opposite is true; it is rude to increase risk to others. In this paper I analyse the relationship between risk, responsibility, and rudeness by analysing the evolution of the main governmental slogans and rules and explore the complex relationship between simplicity, safety, and perceived fairness of these rules, and how these features in turn influence the extent to which we act responsibly. I begin by exploring the relationship between rudeness and risk in our interactions about coronavirus, before going on to analyse the importance of clear rules in minimizing tension between us, illustrating the argument with various slogans including "stay at home," "stay alert," and the now infamous "rule of six," which is actually at least three different rules. Ultimately, we are faced with a paradox: people annoyed about complex/unfair rules are less likely to obey them, even if that means rules will apply for longer and even though it was noncompliance with earlier simpler rules that means new rules are necessary. And if rules make less or no sense it is harder to try to get people to follow them in your own capacity as a citizen; it is hard to police rules that are seen as arbitrary or unfair.

A Component Evaluation of a Randomised Control Community Intervention to Reduce Adolescent Alcohol Use in Australia

Despite a decline in Australian adolescents reporting to have consumed alcohol, a high proportion of the adolescent population still consumes alcohol. Community-led prevention interventions that systematically and strategically implement evidence-based programs have been shown to be effective in producing population-behaviour change related to youth alcohol and drug use. This study evaluated the post-intervention effects of a multi-component community intervention in Australia. It comprised social marketing targeting adolescents and parents, and a community intervention to reduce underage alcohol sales. Structural equation modelling was used to examine direct and indirect effects of community intervention components on intention and consumption. Self-report surveys (N = 3377) and community sales data (27 communities) were analysed to evaluate the effect of the intervention components on intention and consumption before the age of 18. The intervention reduced alcohol sales to minors (OR = .82). Exposure to the social marketing was significantly associated with household no-alcohol rules (OR = 2.24) and parents not supplying alcohol (OR = .72). The intervention predicted intention not to consume alcohol before age 18; intention was associated with not consuming alcohol (OR = 5.70). Total indirect effects from the intervention through to intention were significant. However, parents setting a rule and not supplying alcohol were the only significant direct effects to intention. Parents setting a rule was directly associated with lower consumption. Overall, the intervention logic was supported by the data modelling. The study extends prior knowledge of community-based interventions to prevent adolescent alcohol use by identifying critical intervention components and effect mechanisms. ClinicalTrials.gov Identifier: ACTRN12612000384853.

A Behavior-Analytic Approach to Antivaccination Practices

In recent years, there has been an increase in outbreaks of diseases that are preventable by vaccination. As vaccination involves behavior, behavior analysts are uniquely positioned to contribute solutions to this socially significant problem. The present article explores a behavior-analytic approach to understanding the function of the behavior of both people who have their children vaccinated and those who do not have their children vaccinated, and potential interventions to increase vaccination rates. An introduction to the problem is followed by a brief history of the antivaccination movement. In our analysis, a failure to vaccinate is conceptualized as a noncompliance response (i.e., medical nonadherence), and conditions giving rise to that noncompliance are evaluated. In this process, the roles of avoidance, the functional-altering impact of rule-governed behavior, relational frames, and countercontrol are considered. Potential solutions informed by applied behavior-analytic literature, including contingency management and behavioral safety, are discussed.

Exploratory and confirmatory factor analysis of the parental rules toward adolescent drinking questionnaire: Two factors are better than the original one

The parental rules toward drinking questionnaire (PRQ; Van der Vorst et al., 2005) assesses strictness toward adolescent drinking situations. The aim of the current study was to address a gap in the literature on the psychometric testing and evaluation of the factor structure of the PRQ. The current sample consisted of Dutch adolescents (N = 2922) who participated in a randomized control trial with three intervention groups (parent, student, and parent + student) and a control. PRQ and frequency of alcohol use (past month and year) were measured at baseline (T1) and 12 months later (T2). Results from Exploratory and Confirmatory Factor Analyses revealed two reliable factors: (a) rules about normative drinking situations and (b) rules about non-normative drinking situations (both αs ≥ 0.88). Regression analyses conducted to examine the prospective effects of the interventions revealed that both parent conditions predicted increases in strictness toward normative drinking situations relative to the control condition, while only the parent + student condition affected the original PRQ (single factor). Further, the normative subscale predicted increases in drinking (past month and year), as did the original PRQ. Significant effects with the normative subscale indicate that rules toward these drinking situations are ones that account for the effects in the original PRQ, and that the original PRQ can mask effects. The results illustrate that the PRQ is multidimensional. The effects of the normative subscale suggest that intervention efforts should focus on preventing drinking situations that parents normally permit their adolescents to engage in.

On the Generalization of Simple Alternating Category Structures

A fundamental question in the study of human cognition is how people learn to predict the category membership of an example from its properties. Leading approaches account for a wide range of data in terms of comparison to stored examples, abstractions capturing statistical regularities, or logical rules. Across three experiments, participants learned a category structure in a low-dimension, continuous-valued space consisting of regularly alternating regions of class membership (A B A B). The dependent measure was generalization performance for novel items outside the range of the training space. Human learners often extended the alternation pattern--a finding of critical interest given that leading theories of categorization based on similarity or dimensional rules fail to predict this behavior. In addition, we provide novel theoretical interpretations of the observed phenomenon.

Should I say that? An experimental investigation of the norm of assertion

Assertions are our standard communicative devices for sharing and acquiring information. Recent studies seemingly provide converging evidence that assertions are subject to a factive norm: you are entitled to make an assertion only if it is true. However, these studies assume that we can treat participants' judgements about what an agent 'should say' as evidence of their intuitions about assertability. This paper argues that this assumption is incorrect, so the conclusions drawn in the aforementioned studies are unwarranted. We provide evidence that most people do not interpret statements about what one 'should say' as statements about assertability, but rather as statements about what is in the agent's interest to do. Measures for prompting the intended reading of the test question are identified, and their efficacy is tested. We found that when these measures are implemented, people's judgements consistently and overwhelmingly align with non-factive accounts of assertion.

Explaining integration and differentiation by identifying the rules and coordination mechanisms in a hospital's logistical system

Purpose

Integration, that is, the coordination and alignment of tasks, is widely promoted as a means to improve hospital performance. A previous study examined integration and differentiation, that is, the extent to which tasks are segmented into subsystems, in a hospital's social network. The current study carries this research further, aiming to explain integration and differentiation by studying the rules and coordination mechanisms that agents in a hospital network use.

Design/methodology/approach

The current case study deepens the analysis of the social network in a hospital. All planning tasks and tasks for surgery performance were studied, using a naturalistic inquiry approach and a mixed method.

Findings

Of the 314 rules found, 85% predominantly exist in people's minds, 31% are in documents and 7% are in the information system. In the early planning stages for a surgery procedure, mutual adjustment based on hospital-wide rules is dominant. Closer to the day of surgery, local rules are used and open loops are closed through mutual adjustment, thus achieving integration. On the day of surgery, there is mainly standardization of work and output, based on hospital-wide rules. The authors propose topics for future research, focusing on increasing the hospital's robustness and stability.

Originality/value

This exploratory case study provides an overview of the rules and coordination mechanisms that are used for organizing hospital-wide logistics for surgery patients. The findings are important for future research on how integration and differentiation are effectively achieved in hospitals.

Covid-19 and the power of rules

This article discusses the role of human-created rules in our collective adapting to Covid-19 and our survival in its wake. Rules that make sense become institutionalised and play a dual role in our response to the pandemic: they provide a guide for individual behavior and they provide a mechanism for coordinating all our behaviors.

Simple monetary rules: many strengths and few weaknesses

This paper endeavors to examine the basic idea in Richard Epstein's book Simple Rules for a Complex World. It does so by considering a specific simple rule which was explicitly designed for complex world. A basic idea in Epstein's book is that the more complex is the world the better is the case for simple rules. To show this, he develops six simple rules pertaining to the rights of individuals, first possession, contracts, torts, government eminent domain and the power of taxation to provide public goods. This paper considers one rule rather than six rules, and it looks at monetary policy rather than policy in general. While the context is different, the case for simple rules made here provides a useful comparison with the case made by Epstein.

Genome editing for crop improvement: A perspective from India

Human population is expected to reach to about 10 billion by 2050. Climate change affects crop production, thus posing food security challenges. Conventional breeding alone will not bridge the gap between current level of crop production and expected levels in the decades to come in the food production systems. Rate of genetic gain with time has remained narrow considerably. Biotechnology-enabled crops developed through genome editing will have a part to play in improving crop productivity, meeting food, nutrition security besides catering to regional preferences and fetching valuable foreign exchange. Political, social, economical proposition, scientific will, retailer and consumer acceptance are a must for genome editing (GE) to succeed and add value in the food value chain. This will also help to make agriculture a lucrative profession and attract youth. Therefore, the present review looks into existing regulations governing crops developed using biotechnology in India, institutes involved in genome editing, prospects of new tools developed in this sphere such as DNA-free editing systems, nanotechnology, their applicability in crop improvement efforts, social and future prospects taking cue from recent global developments. This will make GE more appealing to stakeholders and defray any safety concerns.

Evaluation of Lag Schedules and Rules on Persistent Response Variability With Preschoolers in a Group

In the present study, experimenters evaluated the influence of lag schedules of reinforcement in combination with accurate and inaccurate (complete and incomplete) rules on the response variability of naming category items for typically developing preschoolers in a group format. Results showed that when lag schedules were introduced with 2 categories, response variability generalized to the third category. Furthermore, after participants experienced the lag schedule, variability persisted when the contingency no longer required variability. Participants continued to vary their responses unless the rule and contingency required them to repeat responses. We discuss potential clinical applications of using lag schedules in a group format and including rules during teaching, as well as directions for future research in this area.

Rules and Eligibility Criteria for Supervised Consumption Services Feasibility Studies - A Scoping Review

INTRODUCTION

Supervised consumption services (SCS) reduce HIV risks and overdose for people who use drugs (PWUD) and are known to have wide-ranging public health benefits. Feasibility studies are often conducted as part of program/implementation development. We conducted a scoping review of SCS feasibility/pre-implementation studies to answer: what is known about stakeholders' opinions of SCS rules and eligibility criteria?

METHODS

Using the PRISMA-ScR guidelines, we searched Medline, PsychINFO, Embase, CINAHL, and SCOPUS databases for: (a) empirical research, (b) reported in English, (c) focused on SCS, (d) pre-implementation feasibility studies (research conducted prior to implementation of SCS in a given context), (e) examining SCS operational rules and eligibility criteria. Abstracts were reviewed to verify appropriateness; full articles/reports were retrieved; data were extracted and charted.

RESULTS

Of the 1,268 data sources identified/reviewed, 19 sources, were included. Manuscripts showed the following criteria that might be considered when determining who can and cannot use SCS: age, pregnancy status, and opioid substitution treatment status. To govern behaviours at SCS, manuscripts focused on: acceptable modes of drug consumption, assisted injections, sharing drugs on-site, pill injecting, and mandatory hand washing, etc. Stakeholders generally agreed that; eligibility restrictions and site rules should be minimal to establish low-barrier services. SCS are often forced to contend with the tension between adhering to a medical or public health model and creating low-barrier services. SCS rules are at the center of this intersection because rules and eligibility criteria implemented to mirror other health services may not align with the needs of PWUD.

CONCLUSION

Given the public health significance of SCS, establishing best practices for service delivery is critical for increasing access and addressing implementation issues. Future research should examine other operational elements of SCS, such as design elements, staffing models, and ancillary services. Additional research should also focus on supervised smoking services.

Should you save the more useful? The effect of generality on moral judgments about rescue and indirect effects

Across eight experiments (N = 2310), we studied whether people would prioritize rescuing individuals who may be thought to contribute more to society. We found that participants were generally dismissive of general rules that prioritize more socially beneficial individuals, such as doctors instead of unemployed people. By contrast, participants were more supportive of one-off decisions to save the life of a more socially beneficial individual, even when such cases were the same as those covered by the rule. This generality effect occurred robustly even when controlling for various factors. It occurred when the decision-maker was the same in both cases, when the pairs of people differing in the extent of their indirect social utility was varied, when the scenarios were varied, when the participant samples came from different countries, and when the general rule only covered cases that are exactly the same as the situation described in the one-off condition. The effect occurred even when the general rule was introduced via a concrete precedent case. Participants' tendency to be more supportive of the one-off proposal than the general rule was significantly reduced when they evaluated the two proposals jointly as opposed to separately. Finally, the effect also occurred in sacrificial moral dilemmas, a general phenomenon occurring in multiple moral contexts. We discuss possible explanations of the effect, including concerns about negative consequences of the rule and a deontological aversion against making difficult trade-off decisions unless they are absolutely necessary.

Legal decision-making and the abstract/concrete paradox

Higher courts sometimes assess the constitutionality of law by working through a concrete case, other times by reasoning about the underlying question in a more abstract way. Prior research has found that the degree of concreteness or abstraction with which an issue is formulated can influence people's prescriptive views: For instance, people often endorse punishment for concrete misdeeds that they would oppose if the circumstances were described abstractly. We sought to understand whether the so-called 'abstract/concrete paradox' also jeopardizes the consistency of judicial reasoning. In a series of experiments, both lay and professional judges sometimes reached opposite conclusions when reasoning about concrete cases versus the underlying issues formulated in abstract terms. This effect emerged whether participants reasoned with broad principles, such as human dignity, or narrow rules, and was largest among individuals high in trait empathy. Finally, to understand whether people reflectively endorse the discrepancy between abstract and concrete resolutions, we examined their reactions when evaluating both, either simultaneously or sequentially. These approaches revealed no single pattern across lay and expert populations, or exploratory and confirmatory studies. Taken together, our studies suggest that empathic concern plays a greater role in guiding the judicial resolution of concrete cases than in illuminating judges' professed standards-which may result in concrete decisions in violation of their own abstract principles.

Development of a consensus statement on the role of the family in the physical activity, sedentary, and sleep behaviours of children and youth

BACKGROUND

Children and youth who meet the physical activity, sedentary, and sleep behaviour recommendations in the Canadian 24-Hour Movement Guidelines are more likely to have desirable physical and psychosocial health outcomes. Yet, few children and youth actually meet the recommendations. The family is a key source of influence that can affect lifestyle behaviours. The purpose of this paper is to describe the process used to develop the Consensus Statement on the Role of the Family in the Physical Activity, Sedentary, and Sleep Behaviours of Children and Youth (0-17 years) and present, explain, substantiate, and discuss the final Consensus Statement.

METHODS

The development of the Consensus Statement included the establishment of a multidisciplinary Expert Panel, completion of six reviews (three literature, two scoping, one systematic review of reviews), custom data analyses of Statistics Canada's Canadian Health Measures Survey, integration of related research identified by Expert Panel members, a stakeholder consultation, establishment of consensus, and the development of a media, public relations, communications and launch plan.

RESULTS

Evidence from the literature reviews provided substantial support for the importance of family on children's movement behaviours and highlighted the importance of inclusion of the entire family system as a source of influence and promotion of healthy child and youth movement behaviours. The Expert Panel incorporated the collective evidence from all reviews, the custom analyses, other related research identified, and stakeholder survey feedback, to develop a conceptual model and arrive at the Consensus Statement: Families can support children and youth in achieving healthy physical activity, sedentary and sleep behaviours by encouraging, facilitating, modelling, setting expectations and engaging in healthy movement behaviours with them. Other sources of influence are important (e.g., child care, school, health care, community, governments) and can support families in this pursuit.

CONCLUSION

Family is important for the support and promotion of healthy movement behaviours of children and youth. This Consensus Statement serves as a comprehensive, credible, and current synopsis of related evidence, recommendations, and resources for multiple stakeholders.

On the validity of "Candidatus Dirofilaria hongkongensis" and on the use of the provisional status Candidatus in zoological nomenclature

The fast development of molecular taxonomy is impacting our knowledge of the world parasite diversity at an unprecedented level. A number of operational taxonomic units have been uncovered and new species described. However, it is not always that new parasite species are being described in compliance with the International Code of Zoological Nomenclature. This is the case of “Candidatus Dirofilaria hongkongensis”, a nematode found in dogs, jackals and humans in Hong Kong and parts of India. This name has been proposed without a formal description and without the designation of a holotype, and therefore is an unavailable name. Finally, we argue that using the provisional status Candidatus in zoological nomenclature is inappropriate, considering this term is not considered in the International Code of Zoological Nomenclature.

Postgraduate training in surgery: From theory to practice

INTRODUCTION

Postgraduate training is a time-honored entity, the goal of which was to develop and ensure the acquisition of new medical knowledge for the medical profession.

MATERIAL AND METHODS

The main goal of this retrospective study is to analyze the current situation of postgraduate training in surgical disciplines within the framework of the French Universities. We studied the legal texts found in the LéxisNéxis® and Légifrance® sites up until December 1, 2018; references were sought from the Web of Science repository.

RESULTS

Postgraduate training in France is mandatory from the legal point of view. Currently there are two possibilities for validation of postgraduate training: either through a recognized continuing professional development (CPD) organization controlled by the National Agency of Continuing Professional Development (NACPD), or by asking for certification through an official accreditation council (AC) (one exists for each surgical specialty), controlled by the High Health Authority that can automatically provide the equivalence of passing through the NACPD organization.

DISCUSSION

The continuing education process remains complex. It could well be modified in the near future by the creation of a new certification procedure. With regard to surgical education, whether it concerns the CPD or the accreditation process, the goal is to decrease patient risk and to be an integral part of the overall policy to decrease health care costs. The role of professional national counsels will be more and more important; this is an advantage for each of the surgical specialties. Nonetheless, from the regulatory viewpoint, the decree concerning the role of National Professional Councils has not yet been published in the Journal Officiel de la République Française (French Republic official journal) at the time of writing.

CONCLUSIONS

Currently two systems are available for surgeons to comply with the 2016 legislative obligation of continuing education: CPD which is run by the NACPD, and the accreditation process, run by an AC and controlled by the HAS; in the first instance, surgeons can ask for reimbursement from the NACPD and in the second, request that the National Health Insurance Fund for Salaried Employees cover a portion of the litigation insurance premium.

LEVEL OF EVIDENCE

Retrospective study: level of evidence IV.

Hereditary gastric cancer: Three rules to reduce missed diagnoses

Gastric cancer remains one of the most lethal cancers. The incidence and mortality rates are quite similar. The main reason for the high mortality is diagnosis at advanced stages of disease, when treatment options are poor. One of the supposed strategies to overcome late-stage diagnosis is identifying people at high risk with the aim of establishing rigorous clinical control, including routine endoscopy and biopsies. Hereditary gastric cancer (HGC) syndromes, though representing a sizeable group to monitor for prevention or, at least, for early diagnosis, are apparently extremely rare. The low rate of HGC diagnosis might be related to the low rates of suspicion, insufficient familiarity about clinical diagnosis criteria, and the supposed conditional necessity of a molecular diagnosis. In this review, we will discuss simple measures to increase HGC diagnosis by applying three rules that might provide an opportunity for precision care to benefit the families affected by this disease.

Rules and Statements of Reinforcer Loss in Differential Reinforcement of Other Behavior

Providing a rule regarding consequences for behavior can increase the efficacy of differential reinforcement of other behavior (DRO) procedures in the treatment of severe problem behavior (Watts, Wilder, Gregory, Leon, and Ditzian, Journal of Applied Behavior Analysis, 46, 680-684, 2013). The purpose of the current study was to replicate and extend the literature on DRO procedures by evaluating the efficacy of rules and statements of reinforcer loss (SRL) in the treatment of severe problem behavior. Conditions included baseline, no rule DRO, rule DRO, and rule DRO with SRL. For 2 of 3 participants, neither the no rule DRO nor the rule DRO condition reduced problem behavior. The rule DRO with SRL condition produced a substantial decrease in problem behavior for all participants, suggesting that a consequent rule enhances the efficacy of DRO. The current study extends the literature on DRO procedures by providing data on nontargeted ("other") behavior. An increase in other behavior was observed for 2 participants.

Comprehensive analysis of rule formalisms to represent clinical guidelines: Selection criteria and case study on antibiotic clinical guidelines

BACKGROUND

The over-use of antibiotics in clinical domains is causing an alarming increase in bacterial resistance, thus endangering their effectiveness as regards the treatment of highly recurring severe infectious diseases. Whilst Clinical Guidelines (CGs) focus on the correct prescription of antibiotics in a narrative form, Clinical Decision Support Systems (CDSS) operationalize the knowledge contained in CGs in the form of rules at the point of care. Despite the efforts made to computerize CGs, there is still a gap between CGs and the myriad of rule technologies (based on different logic formalisms) that are available to implement CDSSs in real clinical settings.

OBJECTIVE

To helpCDSS designers to determine the most suitable rule-based technology (medical-oriented rules, production rules and semantic web rules) with which to model knowledge from CGs for the prescription of antibiotics. We propose a framework of criteria for this purpose that is extensible to more generic CGs.

MATERIALS AND METHODS

Our proposal is based on the identification of core technical requirements extracted from both literature and the analysis of CGs for antibiotics, establishing three dimensions for analysis: language expressivity, interoperability and industrial aspects. We present a case study regarding the John Hopkins Hospital (JHH) Antibiotic Guidelines for Urinary Tract Infection (UTI), a highly recurring hospital acquired infection. We have adopted our framework of criteria in order to analyse and implement these CGs using various rule technologies: HL7 Arden Syntax, general-purpose Production Rules System (Drools), HL7 standard Rule Interchange Format (RIF), Semantic Web Rule Language (SWRL) and SParql Inference Notation (SPIN) rule extensions (implementing our own ontology for UTI).

RESULTS

We have identified the main criteria required to attain a maintainable and cost-affordable computable knowledge representation for CGs. We have represented the JHH UTI CGs knowledge in a total of 12 Arden Syntax MLMs, 81 Drools rules and 154 ontology classes, properties and individuals. Our experiments confirm the relevance of the proposed set of criteria and show the level of compliance of the different rule technologies with the JHH UTI CGs knowledge representation.

CONCLUSIONS

The proposed framework of criteria may help clinical institutions to select the most suitable rule technology for the representation of CGs in general, and for the antibiotic prescription domain in particular, depicting the main aspects that lead to Computer Interpretable Guidelines (CIGs), such as Logic expressivity (Open/Closed World Assumption, Negation-As-Failure), Temporal Reasoning and Interoperability with existing HIS and clinical workflow. Future work will focus on providing clinicians with suggestions regarding new potential steps for CGs, considering process mining approaches and CGs Process Workflows, the use of HL7 FHIR for HIS interoperability and the representation of Knowledge-as- a-Service (KaaS).

Parent-adolescent bicycling safety communication and bicycling behavior

INTRODUCTION

Efforts to encourage bicycling to school have increased in the United States. However, little is known about how parent-child communication affects bicycle safety. The purpose of this study was to examine parent-child agreement on biking instructions and their correlation with the early adolescents' real-world riding behavior.

METHODS

Parent-child dyads were asked open-ended questions about instructions they had given/received about bicycling. Answers were then coded into nine categories (e.g., crossing the road, bicycle control/handling). Distributions of parent-child agreement on parent-given bicycle safety instructions were examined in relation to the adolescent's real-world riding behaviors.

RESULTS

36 parent-child dyads were included. Average age was 11.9 (Range: 10-15) for adolescents and 43.3 (Range: 30-59) for parents. Common parental instructions included: wear helmet, ride on sidewalk, and trip routing specifications. High 'ride on sidewalk' instruction (38.9% both parent and adolescent, 22.2% parent only, 16.7% adolescent only) was concerning due to potential driveway conflicts. Agreement between parents and adolescents on reported instructions was low, overall. Mean safety-relevant event rates in real-world cycling did not differ significantly between bicycle safety instruction agreement groups (both parent & adolescent reported, parent only, adolescent only, neither). The proportion of time an adolescent rode on different infrastructure types (sidewalk, street, etc.) did not vary between dyads reporting parents had given instructions to ride on the sidewalk and those who had not.

CONCLUSIONS

Results highlight lack of agreement between parents and adolescents on cycling instructions the adolescent receives from the parent. Parent instructions to adolescents regarding bicycling safety were not associated with actual riding behaviors. Results suggest parent messaging to adolescents may be ineffective. Given parents are in a position of influence, results indicate a need for parental training on effective safety-related communication strategies to assist them in capitalizing on their parental role to increase their child's safety.

Excuse Validation: A Cross-cultural Study

If someone unintentionally breaks the rules, do they break the rules? In the abstract, the answer is obviously "yes." But, surprisingly, when considering specific examples of unintentional, blameless rule-breaking, approximately half of people judge that no rule was broken. This effect, known as excuse validation, has previously been observed in American adults. Outstanding questions concern what causes excuse validation, and whether it is peculiar to American moral psychology or cross-culturally robust. The present paper studies the phenomenon cross-culturally, focusing on Korean and American adults, and proposes a new explanation of why people engage in excuse validation, in terms of competing forces in human norm-psychology. The principal findings are that Americans and Koreans engaged in excuse validation at similar levels, and older adults were more likely to engage in excuse validation. OPEN RESEARCH BADGES: This article has been awarded Open Materials and Open Data badges. All materials and data are publicly accessible via the Open Science Framework at https://osf.io/8juyc/. Learn more about the Open Practices badges from the Center for Open Science: https://osf.io/tvyxz/wiki .

Adult instruction limits children's flexibility in moral decision making

Children's moral behavior is guided, in part, by adults teaching children how to treat others. However, when circumstances change, such instructions may become either unhelpful or limiting. In the current study, 48 dyads of 5-year-olds played a collaborative game and either (a) received an instruction by an adult to share the spoils of the game equally, (b) did not receive any instruction (but still chose to share equally), or (c) agreed between themselves on a rule to share equally. Afterward, each child played with a new partner who was needier or worked harder in his or her collaboration and so plausibly deserved more than just half of the spoils. Results showed that children who were instructed by an adult shared less with their more deserving partner than children who did not receive any instruction. Thus, moral instruction by adults may, in some circumstances, make children more rigid in their moral decisions.

Presence of anesthesiologists and nurses in the operating room: Liability of surgeons and health care facilities

The presence of an anesthesiologist and certified registered nurse anesthesiologist in the operating room remains a topic of discussion in many facilities. This article provides an overview on the legislation and recommendations on this topic and recounts some of the related jurisprudence. The opinions of various actors, surgeons, anesthesiologists, anesthesiology-intensive care physicians, certified registered nurse anesthesiologists, care-facility directors and insurance companies are included. Based on these elements, we attempt to answer the question of presence of competence in anesthesiology in the operating room.

OntoSIDES: Ontology-based student progress monitoring on the national evaluation system of French Medical Schools

We introduce OntoSIDES, the core of an ontology-based learning management system in Medicine, in which the educational content, the traces of students' activities and the correction of exams are linked and related to items of an official reference program in a unified RDF data model. OntoSIDES is an RDF knowledge base comprised of a lightweight domain ontology that serves as a pivot high-level vocabulary of the query interface with users, and of a dataset made of factual statements relating individual entities to classes and properties of the ontology. Thanks to an automatic mapping-based data materialization and rule-based data saturation, OntoSIDES contains around 8 millions triples to date, and provides an integrated access to useful information for student progress monitoring, using a powerful query language (namely SPARQL) allowing users to express their specific needs of data exploration and analysis. Since we do not expect end-users to master the raw syntax of SPARQL and to express directly complex queries in SPARQL, we have designed a set of parametrized queries that users can instantiate through a user-friendly interface.

Perspectives on Smartphone Ownership and Use by Early Adolescents

PURPOSE

Increasing numbers of youth are becoming smartphone owners as early adolescents (EAs). Understanding how EAs receive and use their initial smartphones is important towards informing provider counseling and parental guidance. The purpose of this qualitative study was to understand EA perspectives and experiences with smartphone ownership.

METHODS

Focus groups were conducted with EAs ages 10-14years in Washington State. We utilized purposeful sampling to represent different communities and health status. During focus groups, trained facilitators used a semi-structured facilitator guide to prompt discussion about EAs' smartphone ownership and use.

RESULTS

A total of 45 EAs with average age 11.2 (SD=0.77), 51.1% female, 64.4% white and 20% rural, participated in 12 focus groups. Of 3 major themes, the first was Maturity, which included EAs' views that they should achieve milestones rather than an age for smartphone ownership. The second theme was Deference to Parents, which included EAs' interest in engaging with parents to establish rules for smartphone use. The final theme was Accountability, as EAs described the importance of responsibility and cost-sharing. Two minor themes arose which included the role of EAs asking for phones and the individuality of phone use.

CONCLUSIONS

Early adolescents supported timing of a first smartphone tied to meaningful milestones, and wanted parent engagement in developing rules to support them in initial smartphone ownership. Findings can be used to empower parent involvement in EA smartphone use to promote safe and productive behavior.

Children and Adults as Language Learners: Rules, Variation, and Maturational Change

Here we overview our recent research investigating children and adults' learning of rules and variation. In all these studies, our findings are that children and adults differ in how they acquire linguistic patterns that are productive, variable, inconsistently used, or lexically restricted. Some of our studies examine children's learning of natural languages; other studies expose learners to miniature languages and then ask them to produce novel sentences or judge their grammaticality. In every case there are important differences between learners as a function of their ages. Young children learn categorical rules and categorically follow patterns that are widespread in natural languages, even when their linguistic input exemplifies these patterns only probabilistically. In contrast, adult learners reproduce the probabilistic patterns of the input. Older children are in between, producing regular patterns somewhat more often than they appear in the input but also acquiring some probabilistic variation. These results suggest that the outcome of learning is quite different at different ages and that many of the properties of natural languages may be shaped by the behavior of children as they learn their native languages.

Does practice in category learning increase rule use or exemplar use-or both?

Categorization research has demonstrated the use of both rules and remembered exemplars in classification, although there is disagreement over whether learners shift from one to the other or use both strategies simultaneously. Theoretical arguments can motivate predictions for both rule use and exemplar use increasing with more practice. We describe a single large experiment (n = 190) that manipulated the number of training items (category size), the number of presentations of each training item, and the similarity between the training and the transfer stimuli in order to discover when rules and exemplars are most likely to be used. Results showed that rules and exemplars both influenced classification and that exemplars were used more often with smaller categories, with more training on items, and when test items were similar to training items. There was no consistent evidence of a shift from rule-based to exemplar-based categorization with more learning. Importantly, we found a number of conditions in which rules and exemplars were both used, even within individual participants. We discuss our results in terms of hybrid models of classification.

Awareness of professional rules among Iranian nurses: a cross-sectional study

Background

One of the main responsibilities of professional nurses is protecting themselves against legal complications. Hence, they have to be sufficiently aware of the professional rules. This study examines the Iranian nurses’ awareness of professional rules.

Methods

A total of 260 nurses were randomly selected from among the nurses working at various wards and included in this cross-sectional descriptive analytical study. Data were collected using a researcher-made questionnaire. The collected data were then analyzed using descriptive (mean and frequency percentage) and inferential (Kolmogorov-Smirnov, Mann-Whitney U, and Kruskal-Wallis) statistics.

Results

The nurses’ mean awareness of professional rules was 28.3 ± 4.0 out of 37. There was a significant relationship between the mean awareness of the nurses and ward (p = 0.001). However, this relationship was not significant regarding demographic variables age, sex, marital status, job title, working experience, education and history of participation in retraining courses on professional rules.

Conclusion

A significant number of nurses were not adequately aware of professional rules, which can put them and their working organization at serious risks. Some measures such as holding web-based or in-person training courses and providing educational booklets and pamphlets can be helpful in this regard.

Children use rules to coordinate in a social dilemma

Humans are frequently required to coordinate their actions in social dilemmas (e.g. when one of two drivers has to yield for the other at an intersection). This is commonly achieved by individuals following communally known rules that prescribe how people should behave. From relatively early in development, children swiftly pick up the rules of their culture and even start creating game rules among peers. Thus far, however, little is known about children's abilities create rules to regulate their own interactions in social dilemma situations in which individuals' interests are partially in conflict. Here, we repeatedly selected dyads of children (5- and 8-year-olds, N = 144) at random from a group and presented them with a chicken game - a social dilemma in which individuals have conflicting motives but coordination is required to avoid mutual failure. In game breaks, groups reconvened and had the opportunity to think of additional game rules. Eight- but not five-year-olds readily came up with and agreed upon impartial rules to guide their subsequent game behavior (but only after adult prompting). Moreover, when playing by the self-made rules, children achieved higher payoffs, had fewer conflicts, and coordinated with greater efficiency than when playing without a rule - which mimics the functional consequences of rules on a societal level. These findings suggest that by at least age 8, children are capable of using rules to independently self-regulate potential conflicts of interest with peers.

Crime but not punishment? Children are more lenient toward rule-breaking when the "spirit of the law" is unbroken

Even early in development, children understand how rules work, and they harshly evaluate rule violators. Furthermore, we know that adults make nuanced evaluations about rule violations; in many situations, they believe that it can be acceptable to violate the technical language of a rule (the "letter of a rule") if doing so does not violate the reason why the rule was created (the "spirit of the rule"). Distinguishing between the letter and spirit of a rule is critical for a developed normative understanding. We investigated whether and when children begin to believe that it is less wrong to violate the letter of a rule if one does not violate the rule's spirit. Participants (N = 246 4- to 10-year-olds) were asked to evaluate a rule-breaker who either violated the letter of a rule but not the spirit or violated both the letter and spirit of a rule. We found that by 4 years of age, children acknowledged that the rule had technically been broken in both cases, but their evaluations of the rule-breaker were much more lenient in the case where the spirit of the rule remained intact. We also found that children are increasingly more lenient in the case where the spirit of the rule remains intact case as they age, and they are increasingly harsher in the case where the spirit is violated. We discuss how these studies provide insight into early normative reasoning, including implications for future research on social cognitive development, rule learning, and legislative intent.

Unspoken Rules: Resolving Underdetermination With Closure Principles

When people learn normative systems, they do so based on limited evidence. Many of the possible actions that are available to an agent have never been explicitly permitted or prohibited. But people will often need to figure out whether those unspecified actions are permitted or prohibited. How does a learner resolve this incompleteness? The learner might assume if an action-type is not expressly forbidden, then acts of that type are permitted. This closure principle is one of Liberty. Alternatively, the learner might assume that if an action-type is not expressly permitted, then acts of that type are prohibited. This closure principle would be one of Residual Prohibition (Mikhail, 2011). On the basis of principles of pedagogical sampling (e.g., Shafto, Goodman, & Griffiths, ), we predicted that participants would infer the Liberty Principle (LP) when trained on prohibitions, and they would infer the Residual Prohibition Principle when trained on permissions. This is exactly what we found across several experiments. We also found a bias in favor of Liberty insofar as participants trained on both a prohibition and a permission rule tended still to infer the LP. However, we also found that if an action is potentially harmful, this diminishes the tendency to infer the LP.

Excessive generalisation of conditioned fear in trait anxious individuals under ambiguity

Trait anxiety has been widely accepted as a vulnerability factor for the development of anxiety disorders. However, few studies have examined how trait anxiety may affect fear generalisation, which is believed to be a core feature of anxiety disorders. Using a single-cue conditioning paradigm, the current study found a range of discrete generalisation gradients in both expectancy ratings and skin conductance, which were highly consistent with participants' reported abstract rules. Trait anxious participants showed the same level of threat expectancy to the conditioned cue as low anxious participants. However they showed over-generalisation to novel test stimuli, but only when they failed to identify a clear rule. This result suggests that over-generalisation of fear may be a special case of the more general principle that trait anxiety is associated with excessive threat appraisal under conditions of ambiguity.

Extracting cancer mortality statistics from death certificates: A hybrid machine learning and rule-based approach for common and rare cancers

OBJECTIVE

Death certificates are an invaluable source of cancer mortality statistics. However, this value can only be realised if accurate, quantitative data can be extracted from certificates-an aim hampered by both the volume and variable quality of certificates written in natural language. This paper proposes an automatic classification system for identifying all cancer related causes of death from death certificates.

METHODS

Detailed features, including terms, n-grams and SNOMED CT concepts were extracted from a collection of 447,336 death certificates. The features were used as input to two different classification sub-systems: a machine learning sub-system using Support Vector Machines (SVMs) and a rule-based sub-system. A fusion sub-system then combines the results from SVMs and rules into a single final classification. A held-out test set was used to evaluate the effectiveness of the classifiers according to precision, recall and F-measure.

RESULTS

The system was highly effective at determining the type of cancers for both common cancers (F-measure of 0.85) and rare cancers (F-measure of 0.7). In general, rules performed superior to SVMs; however, the fusion method that combined the two was the most effective.

CONCLUSION

The system proposed in this study provides automatic identification and characterisation of cancers from large collections of free-text death certificates. This allows organisations such as Cancer Registries to monitor and report on cancer mortality in a timely and accurate manner. In addition, the methods and findings are generally applicable beyond cancer classification and to other sources of medical text besides death certificates.

The Role of Culture and Acculturation in Researchers' Perceptions of Rules in Science

Successfully navigating the norms of a society is a complex task that involves recognizing diverse kinds of rules as well as the relative weight attached to them. In the United States (U.S.), different kinds of rules-federal statutes and regulations, scientific norms, and professional ideals-guide the work of researchers. Penalties for violating these different kinds of rules and norms can range from the displeasure of peers to criminal sanctions. We proposed that it would be more difficult for researchers working in the U.S. who were born in other nations to distinguish the seriousness of violating rules across diverse domains. We administered a new measure, the evaluating rules in science task (ERST), to National Institutes of Health-funded investigators (101 born in the U.S. and 102 born outside of the U.S.). The ERST assessed perceptions of the seriousness of violating research regulations, norms, and ideals, and allowed us to calculate the degree to which researchers distinguished between the seriousness of each rule category. The ERST also assessed researchers' predictions of the seriousness that research integrity officers (RIOs) would assign to the rules. We compared researchers' predictions to the seriousness ratings of 112 RIOs working at U.S. research-intensive universities. U.S.-born researchers were significantly better at distinguishing between the seriousness of violating federal research regulations and violating ideals of science, and they were more accurate in their predictions of the views of RIOs. Acculturation to the U.S. moderated the effects of nationality on accuracy. We discuss the implications of these findings in terms of future research and education.

Medical use of cannabis and cannabinoids containing products - Regulations in Europe and North America

In 1937, the United States of America criminalized the use of cannabis and as a result its use decreased rapidly. In recent decades, there is a growing interest in the wide range of medical uses of cannabis and its constituents; however, the laws and regulations are substantially different between countries. Laws differentiate between raw herbal cannabis, cannabis extracts, and cannabinoid-based medicines. Both the European Medicines Agency (EMA) and the United States Food and Drug Administration (FDA) do not approve the use of herbal cannabis or its extracts. The FDA approved several cannabinoid-based medicines, so did 23 European countries and Canada. However, only four of the reviewed countries have fully authorized the medical use of herbal cannabis - Canada, Germany, Israel and the Netherlands, together with more than 50% of the states in the United States. Most of the regulators allow the physicians to decide what specific indications they will prescribe cannabis for, but some regulators dictate only specific indications. The aim of this article is to review the current (as of November 2017) regulations of medical cannabis use in Europe and North America.

Should Authors be Requested to Suggest Peer Reviewers?

As part of a continuous process to explore the factors that might weaken or corrupt traditional peer review, in this paper, we query the ethics, fairness and validity of the request, by editors, of authors to suggest peer reviewers during the submission process. One of the reasons for the current crisis in science pertains to a loss in trust as a result of a flawed peer review which is by nature biased unless it is open peer review. As we indicate, the fact that some editors and journals rely on authors' suggestions in terms of who should peer review their paper already instills a potential way to abuse the trust of the submission and publishing system. An author-suggested peer reviewer choice might also tempt authors to seek reviewers who might be more receptive or sympathetic to the authors' message or results, and thus favor the outcome of that paper. Authors should thus not be placed in such a potentially ethically compromising situation, especially as a mandatory condition for submission. However, the fact that they do not have an opt-out choice during the submission process-especially when using an online submission system that makes such a suggestion compulsory-may constitute a violation of authors' rights.

Use of Read-Across Tools

Read-across has become popular since the introduction of regulations, such as the European REACH regulation. This chapter provides instructions on how to use ToxRead, new freely available software for read-across analysis, and on how to interpret its output predictions for mutagenicity assessments.This tool offers two seminal sources: a set of rules/structural alerts, which may explain the toxicity, and a similarity tool, associated with a large database of chemicals with their properties.

The effect of subjective awareness measures on performance in artificial grammar learning task

Systematic research into implicit learning requires well-developed awareness-measurement techniques. Recently, trial-by-trial measures have been widely used. However, they can increase complexity of a study because they are an additional experimental variable. We tested the effects of these measures on performance in artificial grammar learning study. Four groups of participants were assigned to different awareness measures conditions: confidence ratings, post-decision wagering, decision strategy attribution or none. Decision-strategy-attribution participants demonstrated better grammar learning and longer response times compared to controls. They also exhibited a conservative bias. Grammaticality by itself was a stronger predictor of strings endorsement in decision-strategy-attribution group compared to other groups. Confidence ratings and post-decision wagering only affected the response times. These results were supported by an additional experiment that used a balanced chunk strength design. We conclude that a decision-strategy-attribution procedure may force participants to adopt an analytical decision-making strategy and rely mostly on conscious knowledge of artificial grammar.

Stochastic simulation of multiscale complex systems with PISKaS: A rule-based approach

Computational simulation is a widely employed methodology to study the dynamic behavior of complex systems. Although common approaches are based either on ordinary differential equations or stochastic differential equations, these techniques make several assumptions which, when it comes to biological processes, could often lead to unrealistic models. Among others, model approaches based on differential equations entangle kinetics and causality, failing when complexity increases, separating knowledge from models, and assuming that the average behavior of the population encompasses any individual deviation. To overcome these limitations, simulations based on the Stochastic Simulation Algorithm (SSA) appear as a suitable approach to model complex biological systems. In this work, we review three different models executed in PISKaS: a rule-based framework to produce multiscale stochastic simulations of complex systems. These models span multiple time and spatial scales ranging from gene regulation up to Game Theory. In the first example, we describe a model of the core regulatory network of gene expression in Escherichia coli highlighting the continuous model improvement capacities of PISKaS. The second example describes a hypothetical outbreak of the Ebola virus occurring in a compartmentalized environment resembling cities and highways. Finally, in the last example, we illustrate a stochastic model for the prisoner's dilemma; a common approach from social sciences describing complex interactions involving trust within human populations. As whole, these models demonstrate the capabilities of PISKaS providing fertile scenarios where to explore the dynamics of complex systems.

The missing person: The outcome of the rule-based totalitarianism of too much contemporary healthcare

OBJECTIVES

Medicine has an obsession with scientific progress and a misplaced belief in the perfectibility of the human body and mind and, as a result, there seems never to be time for the necessary backward glance. If we in healthcare are to learn any of the lessons of history, it seems important that we pay attention to those who have suffered at the sharp end of historical events.

METHODS AND RESULTS

This paper invokes thinkers and writers who lived lives scarred by totalitarian politics. Their testimony emphasises the importance of paying attention to the particularity of individual experience and demonstrates the importance of story, listening, seeing, imagination, and attention.

CONCLUSION

If we are to resist the secular totalitarianism of contemporary healthcare and reinstate the missing person at the centre of what we do, we as healthcare professionals must find the courage to disregard the rules.

PRACTICE IMPLICATIONS

In every consultation it is important to be aware of the wider historical, political and social context that may direct and constrain the choices available to both patients and professionals.

Aristotle and Autism: Reconsidering a Radical Shift to Virtue Ethics in Engineering

Virtue-based approaches to engineering ethics have recently received considerable attention within the field of engineering education. Proponents of virtue ethics in engineering argue that the approach is practically and pedagogically superior to traditional approaches to engineering ethics, including the study of professional codes of ethics and normative theories of behavior. This paper argues that a virtue-based approach, as interpreted in the current literature, is neither practically or pedagogically effective for a significant subpopulation within engineering: engineers with high functioning autism spectrum disorder (ASD). Because the main argument for adopting a character-based approach is that it could be more successfully applied to engineering than traditional rule-based or algorithmic ethical approaches, this oversight is problematic for the proponents of the virtue-based view. Furthermore, without addressing these concerns, the wide adoption of a virtue-based approach to engineering ethics has the potential to isolate individuals with ASD and to devalue their contributions to moral practice. In the end, this paper gestures towards a way of incorporating important insights from virtue ethics in engineering that would be more inclusive of those with ASD.

Treating Food Approval-Seeking Behavior: One Bite at a Time

The prevalence of feeding problems in children with autism is high. The current investigation was a treatment of a unique presentation of food-related prompt dependence with a 6-year-old boy with autism who was reliant upon approval from adults for consumption of every bite of food. Instructions were used to establish independent eating, in which the number of bites specified in the instruction was systematically increased. Independent bites increased from a baseline level of 0.67% to a final phase level of almost 100%, and the instruction was faded to "eat your lunch".

Dealing with nanosafety around the globe-Regulation vs. innovation

In recent years, nanotechnology has become increasingly important for global industries. Today, many nanomaterials are used as ingredients in cosmetics, food products, medical devices and pharmaceuticals. In some cases they exert unexpected risks and potentially pose a threat to human health and the environment. Regulatory authorities all over the world carefully observe recent developments in this area, striving to find a balance between consumer safety and the interests of the industry. In the following, the current legislation in the United States of America, the European Union, Asia and Brazil will be presented. Further, the requirements defined by these different authorities and methodology to investigate relevant characteristics of nanomaterials will be discussed.