Accidental Harm Research Articles

Exciting the Right Temporo-Parietal Junction with Transcranial Direct Current Stimulation Influences Moral Intention Processing

When we evaluate the moral status of an action,we consider not only its consequences but also the beliefs and intentions of the actor,which relies on the capacity to infer others' mental states.Functional MRI studies showed that the right temporo-parietal junction(RTPJ) is the critical brain region for understanding others' mental states.Previous studies have found that the role of intention processing in moral judgment was reduced by disrupting the RTPJ with transcranial magnetic stimulation(TMS).In the current study,we enhanced the role of intention processing in moral judgment with the transcranial direct current sitmulation(tDCS),a painless,non-invasive brain stimulation technique that allows us to induce polarity-specific excitability changes in the human brain.Many tDCS studies have confirmed the anodal excitation effect for cognitive functions.However,so far,limited work has been done to explore the tDCS effect on social cognitive function such as moral judgment.Therefore,the present study aims to investigate the anodal excitation effect of tDCS on moral judgment.We hypothesize that exciting the neural activity of RTPJ with anodal tDCS could enhance the role of intention processing in moral judgment.To test our hypothesis,18 healthy college students were recruited to participate in the study.All subjects underwent two tDCS sessions(anodal and sham tDCS) in random order and counterbalanced across subjects on 2 separate days with 1 week interval between both stimulations.We applied anodal(1.5mA,20 min) and sham tDCS(1.5mA,15 sec) on the RTPJ while subjects were introduced to keep a resting state.After stimulation,subjects read stories in a 2(intention: negative vs.neutral) × 2(outcome: negative vs.neutral) design and were asked to make moral judgment about how much blame the actor deserves.We analyzed the moral evaluation score and reaction time by a 2(intention) × 2(outcome) × 2(tDCS: anodal,sham) repeated measures ANOVA.Results showed that actors with negative intentions were judged more morally blameworthy than those with neutral intentions,and actors producing negative outcomes were judged more blameworthy than those causing neutral outcomes.The differences between no harm(neutral intention,neutral outcome) and accidental harm(neutral intention,negative outcome) were larger than that between attempted harm(negative intention,neutral outcome) and successful harm(negative intention,negative outcome).For the reaction time,judgments of negative outcomes were faster than that of neutral outcomes.The responses to attempted and accidental harm were slower than the other two conditions.Most importantly,the moral judgment was slower under anodal tDCS than sham tDCS stimulation,especially under the attempted harm and accidental harm conditions.These results highlight the role of intention processing in moral judgment.People will spend more time integrating the intention and outcome information in order to make normal moral judgment.Furthermore,the present research provides us a better understanding about the role of RTPJ in moral judgment.Using anodal tDCS to excite the neural activity of RTPJ enhanced the capacity of mentalizing in moral judgment,especially in the cases of attempted harm and accidental harm.

Rights-Based Theories of Accident Law

This article shows that extant rights-based theories of accident law contain a gaping hole. They inadequately address the following question: What justifies using community standards to assign accident costs in tort law?In the United States, the jury determines negligence for accidental harm by asking whether the defendant met the objective reasonable person standard. However, what determines the content of the reasonable person standard is enigmatic. Some tort theorists say that the content is filled out by juries using cost benefit analysis while others say that juries apply community norms and conventions. I demonstrate that what is missing from this exchange is a theory that adequately justifies using a particular way of filling out the content of the objective reasonable person standard. Rights-based theories are particularly guilty of ignoring what I call the central normative concern. That concern is what criterion should determine the amount of precaution an individual must use to avoid being justifiably assigned others’ accident costs. To identify this problem I focus on rights-based theories of accident law.After showing how several rights-based theories of accident law inadequately address the central normative concern, I briefly outline a theory of assigning accident costs that has the potential for offering the best answer to the central normative concern. The most important aspect of this theory, called democratic community standard theory, is that it provides a justification for using community standards to adjudicate tort claims. This justification employs Kantian political theory based on how free and equal individuals would choose to assign accident costs.

The development of intent-based moral judgment

Between the ages of 4 and 8 children increasingly make moral judgments on the basis of an actor’s intent, as opposed to the outcome that the actor brings about. Does this reflect a reorganization of concepts in the moral domain, or simply the development of capacities outside the moral domain such as theory of mind and executive function? Motivated by the past evidence that adults rely partially on outcome-based judgment for judgments of deserved punishment, but not for judgments of moral wrongness, we explore the same categories of judgment in young children. We find that intent-based judgments emerge first in children’s assessments of naughtiness and that this subsequently constrains their judgments of deserved punishment. We also find that this developmental trajectory differs for judgments of accidental harm (a bad outcome with benign intent) and judgments of attempted harm (a benign outcome with bad intent). Our findings support a two process model derived from studies of adults: a mental-state based process of judging wrongness constrains an outcome-based process of assigning punishment. The emergence of this two-process architecture in childhood suggests that the developmental shift from outcome- to intent-based judgment involves a conceptual reorganization within the moral domain.

The Importance of Consumer Reporting Side-effects with Regulated Products: The New Consumer Friendly FDA 3500B MedWatch Form

Copyright: © 2013 Phillips L. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The Food and Drug Administration (FDA) has a new voluntary consumer friendly MedWatch Form 3500B [1]. The new MedWatch form uses lay friendly language with a simplified layout making it easier for consumers to report problems with drugs and other regulated products to the FDA. Consumer reports to the MedWatch system are increasing [2] and have been shown to make a difference in recognizing new and serious drug adverse events. Consumers often have the most details about what they are experiencing, and are in a unique position to identify new safety signals earlier. Every Medwatch report is important; a single report can identify a safety problem and prompt the FDA into action. Recent Consumer reports alerted scientists at the FDA to a critical health issue about the accidental exposure and harm to children from to Testosterone gel used by Men [3]. These early reports prompted the FDA to mandate stronger warning labels that required that the gel be covered after applying to the skin so other people would not be exposed [3].

Surgical Instrument Tracking Optimizes Trans-Sphenoidal Endoscopic Treatment of Petrous Apex Cholesterol Granuloma

During endoscopic trans-sphenoidal treatment of petrous apex cholesterol granuloma, the challenge for the surgeon is to drill the posterior wall of the sphenoid sinus to reach the lesion while attempting to avoid the internal carotid artery (ICA). A refined neuronavigation technique is presented that diminishes bonework needed for exposure and marsupialization, and simultaneously minimizes risks of accidental harm to the ICA. The technique utilizes real-time intraoperative instrument tracking of a drill, enabling safe creation of a direct canal toward the cyst just medial to the paraclival ICA and of a curette for entirely image-guided marsupialization of the cyst's deep areas through the canal.

It Is the Outcome that Counts! Damage to the Ventromedial Prefrontal Cortex Disrupts the Integration of Outcome and Belief Information for Moral Judgment

Moral judgment involves considering not only the outcome of an action but also the intention with which it was pursued. Previous functional magnetic resonance imaging (fMRI) research has shown that integrating outcome and belief information for moral judgment relies on a brain network including temporo-parietal, precuneus, and medial prefrontal regions. Here, we investigated whether the ventromedial prefrontal cortex (vmPFC) plays a crucial role in this process. Patients with lesions in vmPFC (vmPFC patients), and brain-damaged and healthy controls considered scenarios in which the protagonist caused intentional harm (negative-outcome, negative-belief), accidental harm (negative-outcome, neutral-belief), attempted harm (neutral-outcome, negative-belief), or no harm (neutral-outcome, neutral-belief), and rated the moral permissibility of the protagonists' behavior. All groups responded similarly to scenarios involving intentional harm and no harm. vmPFC patients, however, judged attempted harm as more permissible, and accidental harm as less permissible, than the control groups. For vmPFC patients, outcome information, rather than belief information, shaped moral judgment. The results indicate that vmPFC is necessary for integrating outcome and belief information during moral reasoning. During moral judgment vmPFC may mediate intentions' understanding, and overriding of prepotent responses to salient outcomes.

The Role of Causal and Intentional Judgments in Moral Reasoning in Individuals with High Functioning Autism

In the present study, we investigated the ability to assign moral responsibility and punishment in adults with high functioning autism or Asperger Syndrome (HFA/AS), using non-verbal cartoons depicting an aggression, an accidental harm or a mere coincidence. Participants were asked to evaluate the agent's causal and intentional roles, his responsibility and the punishment he deserves for his action. Adults with HFA/AS did not differ in judgments of suffering and causality from adults with typical development. However, subtle difficulties with judgments of intentional action and moral judgments were observed in participants with HFA/AS. These results are discussed in the light of emerging studies that deal with integrity of moral reasoning in individuals with autism spectrum disorders.

THE EFFECTS OF AUTOMOBILE RECALLS ON THE SEVERITY OF ACCIDENTS

The number of automobile recalls in the United States has substantially increased over the last two decades, and after a record of over 30 million cars recalled in 2004, in the last few years it has consistently reached between 15 and 17 million, and in 2010 alone 20 million cars were recalled. Toyota's recall crisis in 2010 illustrates how recalls can affect a large number of American drivers and the defects connected to them can result in loss of life and serious accidents. However, in spite of the increase in public concern over recalls and the loss of property and life attached to them, there is no empirical evidence of the effect of vehicle recalls on safety. This paper investigates whether vehicle recalls reduce accidental harm measured by the severity of injuries in vehicle accidents. The results of our analysis show that if a recall for a new‐year model is issued, then the severity of injuries of accidents continuously diminishes during the first year after the recall, something we do not find among cars not subject to recalls. This is because defects are repaired over time but also because drivers react by driving more carefully until the defects are fixed. To minimize the losses attached to having dangerously defective cars on our roads, both quick and timely recall issuance are needed and more detailed information on defects should be delivered to owners of defective vehicles. The latter can be made possible through simple but important policy changes by the U.S. government regarding recall information sharing with drivers and insurance companies. (JELL51, L62)

Visualization of human heart conduction system by means of fluorescence spectroscopy

The conduction system of the heart is a specific muscular tissue, where a heartbeat signal originates and initiates the depolarization of the ventricles. The muscular origin makes it complicated to distinguish the conduction system from the surrounding tissues. A surgical intervention can lead to the accidental harm of the conduction system, which may eventually result in a dangerous obstruction of the heart functionality. Therefore, there is an immense necessity for developing a helpful method to visualize the conduction system during the operation time. The specimens for the spectroscopic studies were taken from nine diverse human hearts. The localization of distinct types of the tissue was preliminary marked by the pathologist and approved histologically after the spectral measurements. Variations in intensity, as well as in shape, were detected in autofluorescence spectra of different heart tissues. The most distinct differences were observed between the heart conduction system and the surrounding tissues under 330 and 380 nm excitation. The spectral region around 460 nm appeared to be the most suitable for an unambiguous differentiation of the human conduction system avoiding the absorption peak of blood. The visualization method, based on the intensity ratios calculated for two excitation wavelengths, was also demonstrated.

Innocent intentions: A correlation between forgiveness for accidental harm and neural activity

Contemporary moral psychology often emphasizes the universality of moral judgments. Across age, gender, religion and ethnicity, people's judgments on classic dilemmas are sensitive to the same moral principles. In many cases, moral judgments depend not only on the outcome of the action, but on the agent's beliefs and intentions at the time of action. For example, we blame agents who attempt but fail to harm others, while generally forgiving agents who harm others accidentally and unknowingly. Nevertheless, as we report here, there are individual differences in the extent to which observers exculpate agents for accidental harms. Furthermore, we find that the extent to which innocent intentions are taken to mitigate blame for accidental harms is correlated with activation in a specific brain region during moral judgment. This brain region, the right temporo-parietal junction, has been previously implicated in reasoning about other people's thoughts, beliefs, and intentions in moral and non-moral contexts.

The Informatics Opportunities at the Intersection of Patient Safety and Clinical Informatics

Health care providers have a basic responsibility to protect patients from accidental harm. At the institutional level, creating safe health care organizations necessitates a systematic approach. Effective use of informatics to enhance safety requires the establishment and use of standards for concept definitions and for data exchange, development of acceptable models for knowledge representation, incentives for adoption of electronic health records, support for adverse event detection and reporting, and greater investment in research at the intersection of informatics and patient safety. Leading organizations have demonstrated that health care informatics approaches can improve safety. Nevertheless, significant obstacles today limit optimal application of health informatics to safety within most provider environments. The authors offer a series of recommendations for addressing these challenges.

New mothers’ thoughts of harm related to the newborn

There are few published studies of new mothers' experiences of intrusive thoughts of harm related to the newborn. Evidence-based information about the normal phenomenology of intrusive thoughts of harm related to the newborn is needed to facilitate appropriate clinical decision-making. The objective of this project was to assess the phenomenology, prevalence, correlates, and behavioural sequelae of maternal thoughts of harm related to the newborn. One hundred women were recruited during pregnancy. Participants were assessed prenatally and at 4 and 12 weeks postpartum using questionnaires and a semi-structured interview about unwanted thoughts of harm related to the newborn. Postpartum intrusive thoughts of accidental harm to the infant were universal, and close to half of the sample reported unwanted thoughts of intentionally harming their infant. Compared with intentional harm thoughts, accidental harm thoughts were more frequent and more time consuming, but less distressing. High parenting stress and low social support predicted the occurrence of thoughts of intentional harm. Little evidence of an association between these thoughts and aggressive parenting was found. Unwanted intrusive thoughts of harming one's infant are a relatively normative experience during the early postpartum period, particularly in association with greater parenting stress and low social support.

Prospective Evaluation of Immediate Temporized Implants—Interim Analysis

with parameters mode boosted burst c and pump 5 were used according to the manufacturer’s recommendation. All osteotomies were performed by one surgeon in a latero-lateral movement as well as in a turning guidance around the bone. Method of Data Analysis: After 2 and 3 months specimen were evaluated by radiographic and histologic analysis (toluidin-blue-staining, fuchsin-vitalstaining). A complete, semi-quantitative and histomorphometrical evaluation was undertaken including fluorochromatic stainings indicative for bone remodeling. Data were compared to results gained by analogous experiments performed with other osteotomy techniques. Results: Piezoelectric osteotomy permitted a micrometric, selective cut and a clear surgical site by the cavitation effect created by irrigation/cooling solution and oscillating tip. No excessive bleeding was encountered. The evaluation of the piezosurgery specimen proved 8 weeks as well as 12 weeks after surgery an ingrowth of vital bone-forming tissue into the osteotomy gap. The remodelling in the compact bone was undisturbed and the osteotomy gap was filled with new bone. Additional radiological findings supported these findings. The bone fragments were completely healed, the bone marrow cavity restored as well as the external callus formation was subsided undergoing piezoelectric surgery. In general bone healing was faster than known from conventional methods. Conclusion: Piezosurgery definitely enhances handling of delicate structures in the oral and maxillofacial region. Concerning osteotomies of thin and fragile bones, application of ultrasound is assessed to be superior to other mechanical instruments, because of easy handling, efficient bone ablation and minimal accidental harm to adjacent soft tissue structures. As bone healing is not disturbed by the piezosurgery, but even seems to be improved, this method will have a major influence on new minimally invasive bone surgery techniques with special regard to biomechanics.

Paths of Western Law after Justinian

This article relates the story of the paths of Roman law from the periods immediately before the gradual dissolution of the Western Roman Empire following the death of Justinian I in 565 A.D. through the several centuries thereafter. This period witnessed an acceleration of the absorption of Roman law into the customary law of the various Germanic groups that now occupied and ruled the former Roman territories, and the recitation of such new law in the form of new law codes promulgated by three major Gothic groupings: the Lombards, the Burgundians and the Salacian Franks. In the main, the new Germanic rulers were attentive to the need for laws that would suit both (1) German customary law as followed for many centuries; with (2) the Roman law to which their Roman constituencies had adhered. Importantly, even such Roman law as would be applied was only a bowdlerized version of Justinian's contributions, as the Digests and other interpretative parts of the comprehensive Corpus Juris Civilis were somehow lost. Thus for the first several centuries of Germanic rule, the only remnant of written Roman law available was the blunt-edged summarization contained in the Code of Justinian. Germanic law was revolutionized by the new experience of governing stable agricultural communities. The Gothic codes also advanced continental law in many ways that today can be seen as building blocks of emerging western law. Perhaps most significantly, the three law codes studied here demonstrate a preferment for resolution of disputes by means of composition (compensation), and included monetary incentives therefore. By such means the Goths were largely successful in turning their culture away from its kinship origins of violent justice, and towards systems of composition for injury. Further to this end were the adoption of wergeld as an appropriate compensation for a homicide, and also the widespread use of codified tables of composition to be associated with particularized wrongs. These gave an increased likelihood of evenhanded administration of justice, and also a money incentive for the family of a victim to forego mayhem to solve disputes. In addition to blood feud, many other ancient Germanic practices, such as trial by boiling water, were tamed or eliminated in the pursuit of new agricultural societies. And the codes adopted remarkably modern distinctions between intentional and accidental harm, as well as negligence standards that employed uncannily modern standards of duty and proximate cause. In sum, the law codes of the Lombards, the Burgundians and the Salacian Franks provided a civilizing legal bridge between the fall of the Western Empire and the more westernized law codes that would follow in the later Middle Ages.

A Note on Negligence and Collusion-Proof Liability

Principals are often held at least partially liable for the accidental harm caused by their agents. If the liability of the principal and agent is contingent on the court's establishment of the agent's negligence, the principal has an incentive to withhold evidence of the agent's negligence. Since the principal is often in the best position to monitor the agent and gather such evidence, this can lead the agent to take insufficient care in avoiding accidents. This paper will show that a collusion-proof liability scheme gives the principal no incentive to withhold evidence and induces the same level of preventive care as strict vicarious liability.

Soft Negligence and Cause in Fact: A Comment on Ganuza and Gomez

Lowering the standard of negligence below the first-best socially optimal level has been shown by Ganuza and Gomez (2004) to increase the level of care taken by judgment proof injurers. In this paper, I consider a more complex model of negligence in which cause in fact is taken into account, and I show that this conclusion holds when the injurer’s care reduces the magnitude of the accidental harm but not when the injurer’s care reduces the probability of the accident. Thus, such soft negligence strategies aimed at tackling the adverse effects of judgment proofness need to be conditioned to the accident prevention technology available to injurers.

New Nursesʼ Perceptions of Nursing Practice and Quality Patient Care

During this time of nursing shortages, hospitals that want to maintain the competitive edge must seek ways to recruit and retain a competent nursing staff. This study was conducted in a large hospital that strives to be the primary health care provider and employer of choice in its geographic region. The purpose of the study was to assess new nurses' perceptions of nursing practice and their expectations for meeting professional goals. Sixty-seven new nurses from 13 hospital departments were interviewed. Comprehensive orientation, continuing education, and mentoring were important values identified by this group of nurses. Communication with physicians and fear of causing accidental harm to patients were expressed concerns. Data from this survey will be used by the organization to change orientation policies to better meet the needs of the nursing staff and improve recruitment and retention of nurses.

The Fault of Not Knowing: A Comment

In a recent paper, George Fletcher points out a surface anomaly in tort system's adherence to a standard (under banner of negligence), and its correlative refusal to excuse, under ordinary circumstances, individual who in good faith attempts to exercise reasonable care but simply falls short of mark. If an actor injures another through inadvertence, Fletcher observes, situation appears on its face to be one in which tort, in guise of negligence and contrary to its grounding in fault, is assigning liability in absence of personal culpability. The objective standard universally recognized in obeisance to the reasonable person seems to weave a strand of strict liability into tapestry of negligence. The central theme in Fletcher's paper is to show how negligence, in sense of the of not remains centered on a foundation of personal blameworthiness, despite its surface appearance of adhering to an external standard of conduct that risk-imposing individual may be incapable of satisfying. In this comment, I begin by indicating where I find common ground with Fletcher. In fact, I will suggest that his fault of not knowing rests on a well-established notion of role of custom in tort law. But I then indicate through discussion of leading tort scholarship and cases that his broader thesis - that once acknowledging of not knowing, negligence can be squared with personal blameworthiness - cannot withstand sustained analysis. In a final section, I open inquiry still further by briefly commenting on constraining effect of addressing problem of remedies for accidental harm exclusively in terms of and strict liability.

The Torts History Scholarship of Gary Schwartz: A Commentary

This paper examines the historical scholarship of Gary Schwartz, spanning the industrial revolution to the late twentieth century. Schwartz sought to address a cluster of related questions. In particular, he inquired, how prominent are the strands of strict liability and negligence in the development of liability for accidental harm? And what does socioeconomic context provide in the way of explanation for the contours of accident law? And finally, what does the intellectual and political climate of the times contribute to our understanding of the dynamics of tort law? In this essay, I will expand on these themes, before offering my own critique of Schwartz's views. Schwartz set out to show that the fault principle had far deeper historical roots, both before and during the Industrial Revolution, than prominent tort scholars recognized - and correspondingly, that late twentieth century tort law developments in many ways reinvigorated the judicial impulse towards a pervasive negligence system for unintentional harm. I will argue that Schwartz read the historical record correctly, for the most part. But that throughout the nineteenth century, and to a somewhat lesser extent, in the twentieth century as well, the fault principle appears less robust than his reading would suggest when assessed in the context of a wide array of no-duty and limited-duty rules that he never felt entirely comfortable embracing.

The Fault of Not Knowing: A Comment

In a recent paper, George Fletcher points out a surface anomaly in tort system's adherence to a standard (under banner of negligence), and its correlative refusal to excuse, under ordinary circumstances, individual who in good faith attempts to exercise reasonable care but simply falls short of mark. If an actor injures another through inadvertence, Fletcher observes, situation appears on its face to be one in which tort, in guise of negligence and contrary to its grounding in fault, is assigning liability in absence of personal culpability. The objective standard universally recognized in obeisance to the reasonable person seems to weave a strand of strict liability into tapestry of negligence. The central theme in Fletcher's paper is to show how negligence, in sense of the of not remains centered on a foundation of personal blameworthiness, despite its surface appearance of adhering to an external standard of conduct that risk-imposing individual may be incapable of satisfying. In this comment, I begin by indicating where I find common ground with Fletcher. In fact, I will suggest that his fault of not knowing rests on a well-established notion of role of custom in tort law. But I then indicate through discussion of leading tort scholarship and cases that his broader thesis - that once acknowledging of not knowing, negligence can be squared with personal blameworthiness - cannot withstand sustained analysis. In a final section, I open inquiry still further by briefly commenting on constraining effect of addressing problem of remedies for accidental harm exclusively in terms of and strict liability.