Established Tenets Research Articles

"Doing the right thing": Moral conflicts and ethical issues experienced by military nurses during wartime.

The War on Terrorism, which included Operation Enduring Freedom (OEF) in Afghanistan from 2001 to 2014 and the concurrent Operation Iraqi Freedom (OIF) from 2003 to 2011, exposed military nurses to situations and challenges for which many reported feeling unprepared. Clinically, nurses faced multi-trauma injuries and devastating wounds suffered by military troops and civilians alike. Cultural issues and harsh living conditions added further complications to the care environment. The purpose of this study was to address the research question: How do military nurses identify, assess, manage, and personally resolve ethical issues occurring in nursing practice during wartime deployments? Qualitative grounded theory provided the design for this study. Using the constant comparative method, data collection, and data analysis occurred simultaneously to build a theory of ethical issues management during wartime. Using a focused interview guide responsive to emerging themes and developing theory, interviews were conducted until theoretical saturation was achieved. Participants represented primarily Army (55%) active duty (83%) female nurses (71%) who had deployed to Iraq (52%), Afghanistan (32%), or both (16%). A sampling grid was used to recruit nurses representative of the demographics deployed in support of OIF and OEF. Data analysis usedgrounded theory methods to identify a core construct to detail proposed relationships and concepts. Rigor was maintained in study methods and analysis using established tenets to support trustworthiness. The nurses shared stories regarding their experiences during deployment. Many struggled to find internal resolutions regarding the care of detainees, cultural differences, end-of-life decision-making, pain management, and care of civilian casualties. The study described the ethical issues military nurses encountered during wartime and the strategies used to mitigate moral conflict. By better understanding how nurses define, assess, and manage ethical situations, we can better prepare our deploying nurses for future conflicts. Military nurses returning from wars with unresolved moral conflicts are at risk for moral distress. Moral distress has been associated with burnout, dissatisfaction with and leaving the nursing profession, compassion fatigue, and disinterest in the provision of quality patient care. In the interest of preserving the health of military nurses, steps need to be taken to provide resources for helping them prepare for, encounter, and cope with the ethical situations inherent in wartime nursing care.

Can Artificial Intelligence (AI) Manage Behavioural Biases Among Financial Planners?

The main novelty of this paper is proposing artificial intelligence (AI) to manage behavioural biases in the financial decision-making process. An empirical study by Kahneman and Tversky identifies the evidence of behavioural biases in the investment decision-making process: a reversal of an established tenet in traditional finance. Financial planners are vulnerable to behavioural biases and are therefore unable to provide optimal investment solutions for their clients. Identifying the limitations of current practice, this research attempts to address how AI can help financial planners in subduing their behavioural biases and proposes the adoption of AI in financial planning services to circumvent behavioural biases. In recent years, AI has attained significant efficacy and has proven to be efficacious through supervised and unsupervised learning. Applying these AI techniques in mitigating behavioural biases, this study confirms that the backpropagation within the neural network and deep reinforcement learning can help overcome confirmation and hindsight biases.

Tenets for Implementing Electronic Patient-Reported Outcomes for Remote Symptom Monitoring During Cancer Treatment.

Symptoms are common in patients receiving systemic treatment for metastatic cancer. Monitoring patients with electronic patient-reported outcomes (ePROs) detects severe and worsening symptoms early, enabling care teams to intervene and prevent downstream complications and thereby improving outcomes. The Centers for Medicare & Medicaid Services will require patient-reported outcome (PRO) monitoring in the upcoming Enhancing Oncology Model, and many practices will likely attempt to implement PROs in patient care for the first time. To assist practices with the design and implementation of ePRO remote symptom monitoring programs, tenets were drawn from prior ePRO program experiences and research. Successful implementation requires a quality improvement approach to change management with attention to software functionality, measured outcomes, personnel deployment, leadership and culture, workflow, equity, and patient engagement. Specific approaches in each of these areas can optimize program participation and effectiveness. Continuous program monitoring to identify and address barriers is essential to success. Initial challenges with personnel acceptance and patient participation are common and can be overcome by using these tenets. Remote symptom monitoring with ePROs is a key component of quality cancer care and population health management that requires organizational commitment and a deliberate approach by practices using established tenets to assure successful implementation.

Advancing the state of energy equity metrics

Multiple stakeholders—ranging from regulators and developers to customer and community advocates—have roles to play in the transition to an equitable energy system. Metrics are an emerging area of importance for the operationalization of energy equity as they may guide investment and policy decisions that shape the energy system along this transition. This paper aims to advance energy equity metrics for use in regulation, planning, and operations of the electricity system within the United States. Metrics were surveyed from the literature and distilled to a set that identifies which stakeholders may be associated with which metrics. Established tenets of energy justice—distributive, procedural, recognition, restorative—were also identified for each metric, providing a link between energy equity in study and in practice. This means of organization is intended to enable discussion and collaboration among stakeholders, as the objectives embodied in energy equity metrics are often beyond the control of individual stakeholders. Further stakeholder discussion is necessary to determine which metrics are practicable, who will use them, and how they will be used to support energy equity.

Legal Nature and Features a Continuing Crime

The author singles out constituent features of a continuing crime: 1) a continuing crime, although legally completed, is happening continuously until its actual completion; 2) a continuing action has a complex two-element structure: the first element of the objective side of a continuing crime is the action or inaction of the guilty person that legally constitutes a crime, and the second element is the subsequent continuous behavior that «stretches» the objective side of the continuing crime in time; 3) a continuing crime is producing a non-stop destructive effect on the object of criminal law protection, and the long-term deformation of this object happens because of the action itself, not the consequences caused by it; 4) by committing a continuing crime, the person preserves conscious control over the action after its legal completion, regulates his behavior, controls the process of inflicting harm on the object of criminal law protection, which makes it possible to recognize the person as active (non-active) in the criminal law sense; 5) only a crime with a formal construct of corpus delicti can be continuing. The abovementioned features together could act as reliable criteria for determining the chronological boundaries of specific criminal actions, as a key to resolving theoretical disputes and law enforcement problems connected with classifying a certain action as continuing. The article stresses that the permanent character of a continuing crime cannot be explained through the prism of the theory of a continuing criminal condition. Such an interpretation of a continuing crime, common in Russian and foreign research, contradicts the established tenets of the classical theory of crime. Only an act in the form of action or inaction can be recognized as a continuing crime, but not a state, situation, or status. Based on this, the author gives a critical assessment of Art. 210.1 of the Criminal Code of the Russian Federation that provides for the liability for holding the highest position in a criminal hierarchy. The objective side of a continuing crime has the following manifestations: 1) continuing criminal inaction; 2) a crime legally completed by an action, and continuing through inaction; 3) continuing action. Based on this, the author states that the description of a continuing crime contained in the Decree of the Plenary Session of the Supreme Court of the USSR of March 4, 1929 No. 23 (edition of the Decree of the Plenary Session of March 14, 1963, No. 1) should be specified.

Innovation, on-the-job learning, and labor contracts: an organizational equilibria approach

AbstractAn established tenet of the literature is that the use of flexible labor leads to less innovation. Yet, less attention has been paid to the possibility that it is the decision to innovate that generates the incentive to hire on a permanent basis. The goal of this paper is to show the existence of interlocking complementarities between the firm's technological and hiring strategies. To do so, we develop a simple model where the workers’ decision to invest in human capital is affected by the type of employment contract (temporaryversuspermanent) and by the type of technological investments (routineversusinnovative). When the firm is unable to coordinate its actions across these different domains, two equilibria simultaneously exist: in the ‘high-road’ equilibrium, firms invest more in innovative projects and hire on a permanent basis; in the ‘low-road’ equilibrium, they invest more in routine projects and hire on a temporary basis.

Training Radiology Residents, Bloom Style

Bloom's Taxonomy, an integral component of learning theory since its inception, describes cognitive skill levels in increasing complexity (Remember, Understand, Apply, Analyze, Evaluate, and Create). Considering Bloom's Taxonomy when writing learning objectives and lecture material, teaching residents at the workstation and creating multiple choice questions can increase an educator's effectiveness. The incorporation of higher Bloom levels aids in cultivating critical thinking skills vital to image interpretation and patient care, and becomes increasingly important as the radiologist's role evolves with the continued development of artificial intelligence. Following established tenets of multiple choice question writing, involving trainees in the question writing process, and incorporating audience response systems into lectures are all strategies in which higher Bloom level skills can be accomplished.

The Harms Caused: A Narrative of Intergenerational Responsibility

Born out of the Indian Residential Schools Settlement Agreement, the Independent Assessment Process is a program that provides monetary compensation to former students who suffered sexual and physical abuse at Indian Residential Schools. As “Canada’s Representative” during hearings of the Independent Assessment Process, this author, a young lawyer at the time, bore witness to grizzly accounts of acts perpetrated against claimants that left her unsettled. Unsettled by what was heard, yes, but also in her observations that the process did not satisfy the needs of all claimants, nor did it engage with her own sense of responsibility as a non-Indigenous Canadian.
 The author weaves together her experiences and observations as “Canada’s Representative” to explore intergenerational justice in a Canadian setting, and what processes might offer a more complete approach in handling the Indian Residential Schools legacy. First, shecanvasses the existing framework of dispute settlement in the context of Indian Residential Schools, namely criminal, tort, and alternative dispute resolution mechanisms. While pointing out the strengths these mechanisms do have to address some of the harms of Indian Residential Schools, she ultimately suggests their inherent legal limitations make them inadequate tools to provide redress to victims and engage society more broadly.
 The author goes on to define transitional justice, set out its established tenets and themes, and begins to map out a Canadian application of these principles to the Indian Residential Schools policy by drawing on examples from Australia, New Zealand, and the United States. These principles take shape as innovative instruments for advancing the goals of reconciliation and of Canadian society. They are not without their own flaws, however, as the author also points out, that may affect how Canadians—in particular, non-Indigenous Canadians—view their legitimacy.
 Lastly, the author analyzes prevailing views of societal responsibility to provide a normative underpinning for intergenerational justice in a Canadian context. She concludes by advocating Canadians move from a stance of guilt and blame toward one of a broad assumption of responsibility as they continue to grapple with the legacy of Indian Residential Schools.

MS25.01 Impact of Tumor Volume on Outcome: What Are the Limitations?

MS25.01 Impact of Tumor Volume on Outcome: What Are the Limitations?

Optimising India–US Maritime-Strategic Convergence

The current trajectory of India–US relations is encouraging, but needs to be sustained by optimising their maritime-strategic convergence. In the maritime-configured Indo-Pacific region, the two countries could undertake substantive ‘transactions’ in the domain of geopolitics and military-strategic cooperation. In this context, the article examines four key aspects: the ‘restrictiveness’ and ‘permissiveness’ of India’s cornerstone policy of ‘strategic autonomy’; the emerging imperative for their navies to go beyond ‘combined exercises’ to ‘combined operations’; their joint efforts to uphold established norms and tenets of international law, while also recognising their nuanced differences on the interpretation of the law; and to progress defence trade and defence-industry cooperation. The article concludes with specific recommendations on each of these key aspects.

Chronicles of communication and power: informed consent to sterilisation in the Namibian Supreme Court’s LM judgment of 2015

The 2015 judgment of the Namibia Supreme Court in Government of the Republic of Namibia v LM and Others set an important precedent on informed consent in a case involving the coercive sterilisation of HIV-positive women. This article analyses the reasoning and factual narratives of the judgment by applying Neil Manson and Onora O'Neill's approach to informed consent as a communicative process. This is done in an effort to understand the practical import of the judgment in the particular context of resource constrained public healthcare facilities through which many women in southern Africa access reproductive healthcare. While the judgment affirms certain established tenets in informed consent to surgical procedures, aspects of the reasoning in context demand more particularised applications of what it means for a patient to have capacity and to be informed, and to appropriately accommodate the disruptive role of power dynamics in the communicative process.

India emerging: New financial architecture

The global financial crisis of 2007–2008 highlighted the need to re-evaluate several well established tenets in the world of finance. Questions have been raised the world over about the existing paradigm, leading to an acceptance that new financial architecture needed to be evolved and that new models need to emerge, keeping in mind the multiplicity of socio-economic realities that exist round the globe. In this context, the imperative for a new financial architecture in India is quite evident, and the ensuing panel discussion throws up some India-specific issues that need to be explored by the various stakeholders involved in this attempt.

The fetus, the "potential child," and the ethical obligations of obstetricians.

The right of pregnant women to refuse obstetric interventions is an established tenet of obstetric ethics. However, that does not mean that fetal considerations are inconsequential. Although respect for negative autonomy is largely a settled issue, what is less clear is the degree to which a pregnant woman's affirmative autonomy (the right to demand) should be controlling. We discuss the ethical basis for deciding when a pregnant woman's affirmative autonomy should be decisive. We focus on the ethical consequences when a fetus is considered a "potential child" because of a woman's decision to continue a pregnancy. Her intention determines the relevance and nature of the interests of the future child. Although fetal interests may temporally approach those of a born child, they are, in all cases, still circumscribed by the de facto circumstance of the potential child, ie, the child cannot be treated without treating the mother. That treatment would implicate the pregnant woman's right to bodily integrity. This right is so fundamental to our conception of autonomy that its trespass should give serious pause to all who respect basic human dignity. Accordingly, the future interests of a child should not constrain a pregnant woman's right of negative autonomy (the right to refuse any intervention intended for the putative benefit of the fetus or herself). However, the interests of the potential child may factor into considerations of affirmative autonomy and, in parallel, on a physician's right to refuse a particular intervention or plan of care.

Revising Established Tenets in Paper Conservation

This paper discusses two of the established tenets in paper conservation that permeate the existing relevant literature and define the conservation practice, in the light of recent findings.The idea that washing and deacidification can only be beneficial and that effects on ink and colours excluded, there are no negative side effects to paper properties, has been openly expressed and supported in many publications. New research and scattered uncommented results in the relevant literature though indicate that aqueous treatments may have a detrimental effect on the mechanical properties of paper, especially tensile strength and folding endurance. It is suggested that according to the principle of minimum intervention, washing and deacidification should be applied to acidic paper, and then followed by consolidation.Another tenet with important implications on conservation and preservation decision making concerns the rate of ageing. Research based exclusively on accelerated ageing tests has shown that ageing is at first a linear process which decelerates after a certain point. Nevertheless, the applicability of this scheme to the natural process of paper ageing has been argued, and another model based on accelerated ageing tests done in closed environments has been proposed which is believed to simulate natural ageing better than the previous one. In the early stages of ageing, both models give similar results, but overall, the linear model dramatically overestimates the useful life of paper. The newer model indicates that natural paper ageing in libraries and archives can be an accelerating process and puts to question the foundations of conservation research and preservation practice.

Heavy Viewing: Emergent Frames in Contemporary News Coverage of Obesity

In the last 10 years, rising rates of obesity in the United States have drawn significant and increasing public attention from various quarters, which has led to commensurately increased news coverage of the issue. A handful of scholars to date have examined how obesity has been “framed” in the news, given that news framing of issues has proven effects on cultural and political attitudes, practices, and policies as regards the subject of coverage. Consistent with these studies, this qualitative framing analysis assesses how obesity is framed in more recent mainstream news coverage. Framing patterns identified in this analysis represent a notable departure from those identified in earlier studies, specifically as relevant to troubling the individual/environmental attribution binary that historically has characterized public discourse around obesity, in particular, and health more broadly. These findings signal important shifts for contemporary cultural attitudes toward obesity and, accordingly, public health policies designed to redress the issue. Further, the findings suggest a reconsideration and elaboration of established tenets of framing theory.

A Fable: or, how to recognize a narrative when you play one

This article marshals various critical models to demonstrate to both ludologists and narratologists that their respective methodologies are not antinomic. Through an analysis of the narrative properties of two video games in the action-adventure genre, Fable and Fable II, this article exposes commonalities between traditional narrative modes and electronic multimodal narratives. Nonetheless, this article's consideration of possible worlds semantics destabilizes established tenets of mimetic theory and points to a significant distinction between traditional narrative worlds and the virtual worlds of video games.

Semantic Support for Quantitative Research Processes

Collaboration in science requires a shared model of underlying workflows and concepts. In addition to leveraging information exchange between scientists, the shared model should enable automated invocation of computational (numerical) methods from a conceptual level. In this way, the model fills the gap between humans interpreting textual information and computers processing the underlying data and mathematical models. To this end, the authors propose an ontology of quantitative research (OQR). The OQR is based on established tenets of the philosophy of science. Scientific quantities expressed in OQR can be used directly as input to computational methods. The authors demonstrate the OQR's quality by applying it to a case of quantitative food research. Finally, they describe an application in Quest, a prototype quantitative e-science tool.

Pareto-Efficient International Taxation

This paper analyzes Pareto-efficient international tax regimes. Because every country faces its own national budget constraint, the Diamond-Mirrlees production-efficiency theorem, which underlies key tenets of policy advice in international taxation—the desirability of destination basis for commodity taxation, of the residence principle for capital income taxation, and of free trade—does not apply. The paper establishes conditions—relating to the availability of explicit or implicit devices for reallocating tax revenues across countries—under which production efficiency is nevertheless desirable, and characterizes the precise ways in which Pareto-efficient international taxation may require violation of established tenets.

Usefulness of reperfusion ventricular arrhythmias in non-invasive prediction of early reperfusion and sustained coronary artery patency in acute myocardial infarction.

Established tenets of occurrence of reperfusion ventricular arrhythmias in acute myocardial infarction (AMI) do not provide insight into the timing of achieving reperfusion or whether coronary artery patency is sustained. We assessed the significance of ventricular arrhythmias in the non-invasive prediction of timely reperfusion and sustained restoration of coronary patency after thrombolysis in patients with AMI. 24-hour Holter monitors were placed in 163 patients with an AMI before administration of thrombolytic therapy. Patients were classified into 3 groups of early (within 2 hours) or late reperfusion, or no-reperfusion, according with clinical and continuous ST-segment electrocardiographic criteria. Ventricular fibrillation, ventricular tachycardia (VT) and accelerated idioventricular rhythm (AIVR) were also categorized as having occurred early (within the first 2 hours) or late (after the first 2-hour period). Angiographic confirmation of coronary patency was determined 2 to 6 days after AMI. Early reperfusion was predicted by early sustained AIVR in 86% of patients and early non-sustained AIVR in 62.5% of patients, with sensitivity 38% and 77%, and specificity 96% and 69%, respectively; p<0.0001. Late non-sustained AIVR was commonly seen in early and late reperfused patients (92-97%) as well as in non-reperfused patients (74%). Sustained coronary patency was predicted by early sustained AIVR in 93% of patients, as well as by early non-sustained AIVR in 86% of patients and late non-sustained AIVR in 79% of patients, with sensitivity 22%, 55% and 94%, and specificity 95%, 71% and 18%, respectively; p<0.05. Only the occurrence of sustained AIVR, and probably early non-sustained AIVR convey useful information about both early reperfusion and sustained coronary artery patency. The absence of AIVR does not preclude successful thrombolysis.

Pareto Efficiency in International Taxation

This paper addresses a key but neglected task in the theory of international taxation, lent increased urgency by growing awareness of the potential gains from tax coordination: the characterization of Pareto-efficient international tax regimes. It shows that the Diamond-Mirrlees theorem on the desirability of production efficiency, which underlies the key tenets of policy advice in international taxation ? the desirability of destination basis for commodity taxation, of the residence principle for capital income taxation, and of free trade ? is rendered inherently inapplicable to problems of international tax design by the distinctness of national budget constraints that is of the essence in thinking about international taxation. Conditions are established ? relating to the availability of explicit or implicit devices for reallocating tax revenues across countries ? under which production efficiency is nevertheless desirable, and a general characterization developed of the precise ways in which Pareto-efficient international taxation may require violation of established tenets.