Acceptable Course Of Action Research Articles

Stability and disruptive speech

Stability and disruptive speech

Limited disease progression in endocrine surgery patients with treatment delays due to COVID-19

BackgroundThe COVID-19 pandemic profoundly impacted the delivery of care and timing of elective surgical procedures. Most endocrine-related operations were considered elective and safe to postpone, providing a unique opportunity to assess clinical outcomes under protracted treatment plans.MethodsAmerican Association of Endocrine Surgeon members were surveyed for participation. A REDCap survey was developed and distributed to 27 institutions to assess the impact of COVID-19-related delays. Information collected included patient demographics, primary diagnosis, resumption of care, and assessment of disease progression by the surgeon.ResultsTwelve out of 27 institutions completed the survey (44.4%). Of 850 patients, 74.8% (636) were female; median age was 56 (IQR 44-66) years. 4.0% (34) of patients, had not been seen since their original surgical appointment was delayed. 86.2% (733) of patients had a delay in care with women more likely to have a delay (87.6% vs. 82.2% of men, =3.84, p=0.05). Median length of delay was 70 (IQR 42-118) days. Among patients with a delay in care, primary disease site included thyroid (54.2%), parathyroid (37.2%), adrenal (6.5%), and pancreatic/GI neuroendocrine tumors (1.3%). 4.0% (26) of patients experienced disease progression and 4.1% (24) had a change from the initial operative plan. Length of delay was not associated with disease progression (p=0.96) or a change in operative plan (p=0.66).ConclusionWhile some patients experienced disease progression during COVID-19 delays to endocrine disease-related care, most patients with follow-up did not. Our analysis indicates that temporary delay may be an acceptable course of action in extreme circumstances for most endocrine-related surgical disease.

Evidence-based guidelines for managing patients with primary ER+ HER2\u2212 breast cancer deferred from surgery due to the COVID-19 pandemic

Many patients with ER+ HER2− primary breast cancer are being deferred from surgery to neoadjuvant endocrine therapy (NeoET) during the COVID-19 pandemic. We have collated data from multiple international trials of presurgical endocrine therapy in order to provide guidance on the identification of patients who may have insufficiently endocrine-sensitive tumors and should be prioritised for early surgery or neoadjuvant chemotherapy rather than NeoET during or in the aftermath of the COVID-19 pandemic for safety or when surgical activity needs to be prioritized. For postmenopausal patients, our data provide strong support for the use of ER and PgR status at diagnosis for triaging of patients into three groups in which (taking into account clinical factors): (i) NeoET is likely to be inappropriate (Allred ER <6 or ER 6 and PgR <6) (ii) a biopsy for Ki67 analysis (on-treatment Ki67) could be considered after 2–4 weeks of NeoET (a: ER 7 or 8 and PgR <6 or b: ER 6 or 7 and PgR ≥6) or (iii) NeoET is an acceptable course of action (ER 8 and PgR ≥6). Cut-offs for percentage of cells positive are also given. For group (ii), a high early on-treatment level of Ki67 (>10%) indicates a higher priority for early surgery. Too few data were available for premenopausal patients to provide a similar treatment algorithm. These guidelines should be helpful for managing patients with early ER+ HER2− breast cancer during and in the aftermath of the COVID-19 crisis.

The algebraic geometry of perfect and sequential equilibrium: an extension

We extend the generic equivalence result of Blume and Zame (Econometrica 62:783–794, 1994) to a broader context of perfectly and sequentially rational strategic behavior (including equilibrium and nonequilibrium behavior) through a unifying solution concept of “mutually acceptable course of action” (MACA) proposed by Greenberg et al. (Econ Theory 40:91–112, 2009. https://doi.org/10.1007/s00199-008-0349-5 ). As a by-product, we show, in the affirmative, Dekel et al.’s (J Econ Theory 89:165–185, 1999) conjecture on the generic equivalence between the sequential and perfect versions of rationalizable self-confirming equilibrium.

The “Hero‐Protector Narrative”: Manufacturing Emotional Consent for the Use of Force

How do political leaders manufacture collective emotions to justify the use of force? This article introduces the “hero‐protector narrative” as a conceptual model to analyze how political leaders try to manufacture specific collective emotions to encourage their audience to perceive violence as the only morally acceptable course of action. In our model, we formalize a set of distinctive narrative structures (roles and sequences), which are combined to activate compassion and moral anger as well as identification with “heroic” behavior. Furthermore, we argue that the resonance of this narrative draws on values of hyper‐masculinity in patriarchal societies. As such this narrative is to be found across different types of actors (state/nonstate) and culturally diverse settings. To test our model, we use a computer‐assisted QDA approach. We compare systematically discourses produced by political actors legitimizing the use of force versus actors opposing the use of force. We find that discourses supporting the use of force, such as those produced by George W. Bush and Osama bin Laden in the context of the Iraq war, share the structural characteristics of the hero‐protector narrative. In this regard, they differ remarkably from violence‐opposing discourses, regardless of their cultural background.

Clinical Ethics Cultural Competence and the Importance of Dialogue a Case Study

The traditional bioethical approach to addressing clinical ethical dilemmas is to apply ethical principles to analyse the dilemma to reach an ethically acceptable course of action. This paper will address the problem of what to do when the patient or patient’s proxy disagree with this advice. I will argue that ethical principles have limitations in a culturally diverse world, and that best practice guidelines whilst helpful rarely address the specifics of an individual clinical dilemma, and are often not based on robust evidence. Bioethical mediation has been proposed as an important process for clinical ethics support services. Whilst I agree with the need for this my contention is that this is not a new bioethical skill but is in fact the very core of what a good consultation consists of. I will illustrate this discussion with a general practice case study of vaccination refusal. My conclusion is that an approach that accepts and respects diversity and focusses on developing a trusting relationship is the most effective way to reach the best available resolution for clinical ethical dilemmas.

Possibility Engineering

Possibility engineering is a variant of decision analysis that focuses on highlighting a robust set of acceptable courses of action that satisfy a decision maker’s value constraints rather than identifying and prescribing a single, optimal course of action. A shift from a conventional decision-analytic approach to a possibility engineering approach can facilitate problem resolution by sparing decision makers from misconceptions surrounding the term “decision analysis” and freeing them from its demands for structural precision, preferential fidelity, and prescription adherence. In this work, I will develop possibility engineering as a framework for resolving problems of choice under uncertainty. This development will include motivation for adopting a possibility engineering framework, establishment of synthetic probabilities and synthetic decision trees as core framework elements, formalization of concatenation and clone operations for matrices, and ultimately establishment of the possibility matrix as the mechanism for partitioning the set of all available courses of action in a manner consistent with the decision maker's value constraints.

The empty specimen bottle: Legal, moral, and ethical considerations for the dermatologist and dermatopathologist

The case cited herein poses a moral, ethical, and legal dilemma for the practicing clinical dermatologist. From the authors’ perspective, among the various options available to the clinical dermatologist, there is only one acceptable course of action.

Building Character: A Model for Reflective Practice

In 1950, Harrison and colleagues proposed that the physician's ultimate and sufficient destiny should be to "build an enduring edifice of character." Recent work in philosophy underscores the importance of character ethics (virtue ethics) as a complement to ethical systems based on duty (deontology) or results (consequentialism). Recent work in psychology suggests that virtues and character strengths can, to at least some extent, be analyzed and taught. Building character might be enhanced by promoting among students, residents, and faculty a four-step method of reflective practice that includes (1) the details of a situation, (2) the relevant virtues, (3) the relevant principles, values, and ethical frameworks, and (4) the range of acceptable courses of action. Exercises using such a model bring together the major goals of ethics education in U.S. medical schools--teaching the set of skills needed for resolving ethical dilemmas and promoting virtue and professionalism among physicians.

Development of a novel framework for the design of transport policies to achieve environmental targets

The formulation of policies requires the selection and configuration of effective and acceptable courses of action to reach explicit goals. A one-size-fits-all policy is unlikely to achieve the desired goals; as a result, the identification of a suite of alternative policies, together with clear indications of their trade-offs, is crucial to accommodate the diversity of stakeholders’ preferences. At present, the formulation of transport policies is done manually; this fact, together with the size of the space of possible policies, results in a large part of that space being left unexplored. A six-step framework to explore the space of alternative transport policies in order to achieve environmental targets is proposed. The process starts with a user-defined set of specific policy measures, using them as building blocks in the generation of alternative policy packages, clusters and future images according to the user's preferences and goals. The analysis framework is based on the visioning and backcasting approach used in the VIBAT report [Banister, D., & Hickman, R. (2006a). Visioning and backcasting for UK transport policy (VIBAT) project. Department for Transport's Horizons Research Programme 2004/06. The Bartlett school of planning and Halcrow Group Ltd. Retrieved 1/18/2008 http://www.ucl.ac.uk/∼ucft696/vibat2.html]. The framework is being implemented as a prototype decision support system around a case study: the formulation and analysis of policies required to achieve CO 2 emission targets for the transport sector in the UK. Important insights on how to develop the framework have also been elicited from engineering design. The goal is to accelerate the task of policy-making and improve the effectiveness of the resulting policies. The proposed method and computer implementation is fundamentally different from the tools commonly used in the transport sector and is intended to assist (not replace) transport policy makers, and complement (not substitute nor compete with) existing mathematical modelling tools. This research constitutes the first step towards the development of a general family of computer-based systems that support the design of policies to achieve environmental targets—not only for transport, but also for other sectors such as energy and water.

Mutually acceptable courses of action

We offer a game-theoretic framework that enables the analysis of situations whereby rational individuals with different beliefs and views of the world agree to a shared course of action. We introduce a new solution concept: a mutually acceptable course of action, which can be viewed as an (incomplete) contract or a social norm that free rational individuals would be willing to follow for their own diverse reasons. We show that by varying the degree of completeness of the underlying course of action, our concept can be related to commonly used solutions, such as perfect equilibrium, perfect Bayesian equilibrium, (rationalizable) self-confirming equilibrium, and rationalizable outcomes.

Strategic decision-making under conditions of complex demand and market risks

Strategic management decisions are increasingly affected by high-impact external factors such as new technologies, regulatory changes, and market shifts. It is often difficult to assess likely impacts of such significant changes on an organisation and even harder to find an acceptable course of action in response to different possible futures. Decision makers need to adopt a whole system approach that incorporates the uncertainty associated with dominant factors and permits an assessment of the likelihood of outcomes to plan effective responses. In this paper, we discuss a Monte Carlo simulation model that supports the whole system approach in the context of a healthcare resource capacity decision for a large urban hospital.

MORAL REFORM, MORAL DISAGREEMENT, AND ABORTION

Abstract: Bernard Gert argues that legitimate moral disagreement calls for tolerance and moral humility; when there is more than one morally acceptable course of action, then intolerance and what Gert calls “moral arrogance” would be objectionable. This article identifies some possible difficulties in distinguishing moral arrogance from moral reform and then examines Gert's treatment of abortion as a contemporary example of moral disagreement that he characterizes as irresolvable.

Metaphors, Moral Imagination and the Healthy Business Organisation: A Manager’s Perspective

In this paper I outline an approach to managerial decision making that incorporates the important role that metaphors and moral imagination play in our moral reasoning coupled with an organisational moral concept I call the Health of the Organisation. I have used this concept in my managerial (and philosophical) career to interpret and evaluate potential, and actual, courses of action. I have concluded that this concept fits in nicely with Mark Johnson’s analysis of the metaphor of morality is health, which he argues is one of the central moral metaphors in the conceptual framework that we use to interpret and evaluate actions from a reasonable moral point of view. He argues that metaphors are the essential components in defining the rational mental framework utilised in interpreting, evaluating, predicting likely outcomes from various alternatives, and choosing morally acceptable courses of action. I argue that the metaphor morality is health explicated as the Health of the Organisation can serve as an antidote to the unimaginative moral decision making processes that Patricia Werhane has shown can result in bad moral decisions. I do this by demonstrating that a healthy organisation is one that is optimally functional. This means that the components that make up the organisation are so structured that there is no better possible organisational arrangement available for achieving the goals designed to ensure successful performance in the marketplace.

Not ‘by those old books of international law, but only by war’: Ottoman Intellectuals on the Eve of the Great War

Prevailing understanding of the Ottoman entry into Word War I has focused on the role of Enver Pasha and the so-called pro-German faction in the Ottoman Committee of Union and Progress (CUP). This article examines Ottoman views on international relations and the future of the Ottoman Empire in contemporary Ottoman publications. The article concludes that substantial parts of Ottoman society viewed war in 1914 not only as an acceptable course of action, but as a morally justified, potentially liberating, and unifying experience for many Ottomans. Ottoman views, therefore, form part of a much wider non-Western response to Western expansion, and Ottoman entry into World War I is best understood as a reaction against the international system which the Ottoman leaders thought had betrayed them.

Fuzzy goal programming in multi-criteria decision systems: A case study in agricultural planning

This paper proposes a general Fuzzy Goal Programming (FGP) methodology involving pre-emptive priorities and fuzzy goals which can be applied to tackle Multi-Criteria Decision Systems (MCDS) with imprecise parameters. Specifically, it emphasizes certain assumptions about the psychology of the decision system (DS) where the dynamic involvement of the decision-maker (DM) is highlighted. The methodology, which is mostly DM oriented, is applied to a case study of a tube-well command area planning. The results demonstrate that (i) the DM normally satisfices rather than optimizes and (ii) the output of a DS is his best acceptable course of action.