Good Judgment Research Articles

The Role of Judgment in Explanations of Politics

This paper explores the role of judgment in politics, the character of good political judgment and its ramifications for how we explain politics. It proceeds in four steps. The first section proposes a realist conception of political judgment: a distinct form of practical reasoning that highlights our imperfect capacity to grasp the actual causal relations of the world. The second section discusses the intellectual prerequisites of good political judgment: its deep contextualism, practical focus, conditional strategic orientation, synthetic vision and dispassionate spirit. I argue that these traits constitute a cognitive disposition that stands against styles of inquiry that privileges universal, theoretical, rationalistic, analytical and value-neutral political explanations that dominate many spheres of contemporary political science. The third section of the paper considers the conditions in which political judgment matters. I content that it varies according to the relative stability of specific political circumstances. The final section examines the various explanatory approaches that differentiate large-N statistical analyses, small-N comparative research, and intensive case studies. I argue that the failure of nomothetic theoretical accounts to take political judgment seriously limits their explanations of politics and mars their ability to improve the quality of our political judgment. Conversely, in-depth case studies and mid-range comparative analyses are more likely to perceive the role of judgment in explaining political outcomes and consequently more likely to improve our ability to judge well.

Hit or Miss: What Leads Experts to Take Advice for Long-Term Judgments?

Managers and policy makers frequently face crucial strategic decisions that inevitably rely on judgments about relevant future events. These judgments are often characterized by very high uncertainty and the absence of experience from previous good or bad judgments. Judgments of other experts are oftentimes an important—sometimes the only—source of additional information to reduce uncertainty and improve judgment accuracy. However, in many practical situations, decision makers have very limited means to evaluate the quality of such “advice” from other experts and could tend to ignore this valid source of information. In this paper, we study what leads decision makers to take advice from an expert panel when judging the probability of far-future events with high economic impact. Our analysis is based on a unique data set that comprises more than 15,000 advice-taking decisions made by almost 1,000 experts from different industries. We find that decision makers have a strong tendency to ignore advice, which pronounces even further when conflicts in terms of beliefs, past experiences, or desires arise. This paper was accepted by Yuval Rottenstreich, judgment and decision making.

Using the Hartman Value Profile in Residence Recruitment

The Hartman Value Profile is an assessment instrument created in the mid-1960s by Robert S. Hartman, one of the world’s foremost leaders in the philosophical field of axiology—the study of human beings from the perspective of their value systems. The tool is not designed to be a measure of IQ/rational intelligence, psychological tendencies, or—most importantly—“personality.” The tool focuses attention of the measurement of good judgment—the capacity to be a keen observer of situations, to discern what will constitute best responses in that situation, and to execute those best responses. The correlation of excellent skill sets and good judgment is seen as producing optimal performance outcomes. The Hartman tool has been used in major healthcare settings across the United States since the late 1970s. It has been used as a recruitment, placement, development, and team-building device. Exceptional results have been achieved by using the tool as an adjunct element in better understanding of human beings individually and in teams. In 2007, the University of South Florida—under the direction of Dr. David Smith—began to use the tool as part of its residency selection process. With success in the plastics area, its usage was expanded to all surgery areas. The tool has also been used as a developmental tool with faculty physicians. A participant is asked to rank order, prioritize two sets of 18 items in a process that requires about 20 minutes. Both generic and customized reports are created that are influenced by best-performance studies. Since the inception of the University of South Florida program, almost 600 candidates have been assessed. In a most recent study, assessment scores were matched with performance outcomes, faculty evaluations, and internship placements. Very distinct paradigms have been created that demonstrate the correlation of 7 specific scoring areas with most successful performers. Best performers score exceptionally well in areas such as problem-solving ability, creativity, ability to deal with change, being driven to excel, and sense of quality. In addition, factors such as balance in judgment and work–life balance were examined. When strength of judgment was supported by these other factors, highest excellence in performance and resiliency under stress were achieved. Now, the most concrete paradigm used in the program will be used in applications moving into the future. It is believed that these measures can be of strong benefit to other similar programs. First, the tool is used to augment the selection process. Then, it is used as a counseling/development tool in residency onboarding. At midcourse in the residency program, there is a second assessment to show score movements so that midcourse corrections/attention can be made. Finally, the tool is used at the program end to show overall maturity of resident judgment and overall impact of program. A “resume enhancer” is created to be used with internship applications. Perhaps most significantly, the tool becomes a “platform” for vital communication relating to the entire residency program. By promoting better understanding of residents and by increasing resident self-understanding, task accomplishment and personal interactions are notably enhanced.

Segmental arterial mapping during pediatric robot-assisted laparoscopic heminephrectomy: A descriptive series

The incidence of innocent moiety injury during heminephrectomy is estimated to be 4-5%. This complication can have long-term consequences for the child. Selective arterial mapping (SAM) with indocyanine green (ICG)-aided near infrared fluorescence (NIRF) imaging using the Firefly™ system on the da Vinci(®) surgical robotic console has proven to be valuable in robotic partial nephrectomy for adult renal tumors. However, there is nothing in the literature for using this technique in pediatric robot-assisted laparoscopic heminephrectomy (RALHN). To present a descriptive series of children who had SAM RALHN using ICG-aided NIRF imaging. To determine the feasibility of using ICG-aided NIRF SAM during RALHN, and to study if real-time delineation of the selective arterial anatomy of the upper and lower moieties would be helpful or change the immediate outcomes of the surgery. A descriptive series of six children who received RALHN at the present institution. Selective arterial mapping was performed safely without toxicity or vascular complications; it did not extend the operative time and did not change the complexity of the operation. As shown in the summary table below, SAM added value by increasing safety of the operation. The individual operation cost increase of using SAM was only related to the single-use vial of ICG. Inadvertent injury to the innocent moiety in pediatric heminephrectomy is seldom noted intraoperatively, and many times only becomes evident postoperatively when there is acute ischemia or a chronic reduction in renal function. Although there is no replacement for good surgical technique and judgment, SAM during RALHN is a useful real-time way of alerting the surgeon to unexpected anatomy, and possible unintended or occult injury to the innocent moiety that could have devastating short-term and long-term consequences to the child, despite immediate recovery from surgery. This report achieved its aim of reporting the feasibility of SAM on a small descriptive series of children who had RALHN.

Development of a Simple Clinical Risk Score for Early Prediction of Severe Dengue in Adult Patients.

We aimed to develop and validate a risk score to aid in the early identification of laboratory-confirmed dengue patients at high risk of severe dengue (SD) (i.e. severe plasma leakage with shock or respiratory distress, or severe bleeding or organ impairment). We retrospectively analyzed data of 1184 non-SD patients at hospital presentation and 69 SD patients before SD onset. We fit a logistic regression model using 85% of the population and converted the model coefficients to a numeric risk score. Subsequently, we validated the score using the remaining 15% of patients. Using the derivation cohort, two scoring algorithms for predicting SD were developed: models 1 (dengue illness ≤4 days) and 2 (dengue illness >4 days). In model 1, we identified four variables: age ≥65 years, minor gastrointestinal bleeding, leukocytosis, and platelet count ≥100×109 cells/L. Model 1 (ranging from −2 to +6 points) showed good discrimination between SD and non-SD, with an area under the receiver operating characteristic curve (AUC) of 0.848 (95% confidence interval [CI], 0.771–0.924). The optimal cutoff value for model 1 was 1 point, with a sensitivity and specificity for predicting SD of 70.3% and 90.6%, respectively. In model 2 (ranging from 0 to +3 points), significant predictors were age ≥65 years and leukocytosis. Model 2 showed an AUC of 0.859 (95% CI, 0.756–0.963), with an optimal cutoff value of 1 point (sensitivity, 80.3%; specificity, 85.8%). The median interval from hospital presentation to SD was 1 day. This finding underscores the importance of close monitoring, timely resuscitation of shock including intravenous fluid adjustment and early correction of dengue-related complications to prevent the progressive dengue severity. In the validation data, AUCs of 0.904 (95% CI, 0.825–0.983) and 0.917 (95% CI, 0.833–1.0) in models 1 and 2, respectively, were achieved. The observed SD rates (in both cohorts) were <3% for patients with a score <1 point, but >50% for those with a score of ≥2 points, irrespective of the day of illness onset, suggesting that our simple risk score can be easily implemented in resource-limited countries for early prediction of dengue patients at risk of SD provided that they have rapid dengue confirmed tests. For patients with other acute febrile illnesses or bacterial infections usually have SD risk score of >1. Thus, these scoring algorithms cannot totally replace good clinical judgement of the physician, and most importantly, early differentiating dengue from other febrile illnesses is critical for appropriate monitoring and management.

Sistema de formación continua para la alfabetización digital de los docentes de la escuela de hotelería y turismo de Cienfuegos

From the transformations that ICT has caused in all spheres of society, great importance has been attributed to the digital literacy of teachers in schools of hospitality and tourism, both internationally and in our territory. However, this formation has not been addressed repeatedly and systemically, that is, courses and training are planned, but isolated and disconnected, without considering development possibilities such as collaborative learning among teachers. The aim of this work is to develop a continuous improvement system for the digital literacy of teachers, so that the teacher can receive continuous organized training, with a collaborative approach, in line with the rapid advancement of ICT. This system was evaluated by 14 experts who found it suitable to fulfill its purpose. In addition, we discuss one of the training activities undertaken, collaborative mentoring. Finally, the implementation of the system until 2015 is assessed with highlighs on the good judgment of teachers as regards organization and implementation.

The relationship between plasma D-dimer and coronary slow flow in patients with acute coronary syndrome after percutaneous coronary intervention

Objective To study the correlation between the risk factors of coronary slow flow phenomenon (CSF) and the level of plasma D-dimer in patients with ACS (acute coronary syndrome) after emergency percutaneous coronary intervention (PCI). Methods A total of 297 patients with ACS after PCI were enrolled for retrospective analysis. All patients were divided into CSF group and control group in the light of corrected thrombolysis in myocardial infarction (TIMI) frame count method (cTFC). Multivariate analysis for evaluating clinical predictors of CSF was carried out using Logistic regression test and Pearson analysis to find the correlation between plasma D-dimer and cTFC. The predictive value of D-dimer level in the occurrence of coronary slow flow was determined by using receiver operating characteristic (POC) curve analysis. Results CSF was observed in 59 cases (19.8%). The plasma D-dimer was significantly higher in the coronary slow flow group compared with the control group (P< 0.05). Multivariate regression analysis and Logistic regression test showed that the level of plasma D-dimer (OR=1.276, 95%CI: 1.132-3.224, P=0.012), thrombus score (OR=1.108, 95%CI: 1.085-2.103, P=0.018)and target lesion length of culprit vessel(OR=1.436, 95%CI: 0.635-1.382, P=0.037)were the risk factors of CSF. Correlation analysis showed that plasma D-dimer were positively associated with CSF. Receiver operating characteristic (ROC) curve analysis showed that D-dimer cutoff point at 515.3 ng/ml had a good judgment significance (AUC 0.783, OR=1.502, 95%CI: 1.324-2.531, P=0.005). Conclusions The increased D-dimer level is a risk factor and plays an important role in the ACS patients with the CSF phenomenon, thereby predicting no-reflow phenomenon after primary PCI in these patients. Key words: D-dimer; Coronary slow flow; Acute coronary syndrome; Percutaneous coronary intervention; Risk factors; Prognosis

Is 60 the New 80 in Hypertension?

Since the release of the "2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)", much controversy has ensued over the appropriate systolic blood pressure goal for those over the age of 60years. This guideline suggested liberalizing the target for this population to <150mmHg, moving away from previous guidelines suggesting a target of <140mmHg. While some national quality measures have accepted the new relaxed blood pressure goal, the American Heart Association and American College of Cardiology have not. Recently published data show that millions of adults over 60years of age would be classified as controlled using a threshold of <150mmHg, but not with a target of <140mmHg. In addition, emerging randomized trial evidence suggests that targeting a systolic blood pressure well below 140mmHg is beneficial in older adults. In light of the improved health and vitality of older adults, and the steady decline in cardiovascular and cerebrovascular mortality over recent decades, we do not think it is in good judgment to liberalize the treatment target in adults less than 80 years of age.

Under The Law: When is enough enough?

A review of what seems to be pervasive racial harassment against three African-American students in a rural Texas school district finds that districts are protected by a high bar for plaintiffs. Given the noxious behavior, the court sided with the school district in a suit for money damages, holding that the district’s weak response upon learning of the behaviors meant that it did not intentionally subject its students to them. This standard does provide protection for the district. It does not put attorneys and courts in the position of second-guessing educators’ academic and disciplinary decisions. But it may not provide the protection children need or deserve. Students must rely on the good judgment of administrators and boards for real protection from harassment.

تخصيص علة القياس بين المجيزين والمانعين، دراســــــة أصـــــــــولية مــقارنة

مستخلص البحث: هدفت الدراسة إلى إبراز جانب من جهود علماء الأمة في خدمة مصادر التشريع بصفة عامة والقياس بصفة خاصة ، فالبحث عبارة عن تدقيق علمي لأقوال علماء الأمـــة من أصوليين وفقهاء مدعومة بأدلة وبراهين حول تخصيص علة القياس من حيث الجواز والمنع . واتبع الباحث في هذه الدراسة المنهج الوصف التحليلي الذي يقوم على جمع الأقوال من مصادرها الأصلية ، وذکر أدلة کل قول ومناقشتها وترجيح ما تسنده الحجج والبراهين . وتوصلت الدراسة إلى أن صنيع علماء الأمة جواز تخصيص العلة هو الصواب إلا أنه يقوم على ضوابط وشروط تتفاوت بين عالم وآخر حرصا منهم على ضبط الإجتهاد في الأحکام. Abstract: The study aimed to highlight the efforts of the Nation's Scholars in the service of legislation sources in general and particularly in measurement case , the quest is for checking Scion telic statements of Nation's Scholars hem the Fundamentalists and Modern izers supported by evidence about the acceptance or prohibition of the measurement . The researcher in this research has adopted the descriptive only Tikal method which is based on the collection of sayings of the original sources , Said the evidence of all that was said and dismissed the likelihood that attributed by arguments and evidence. The study concluded that the fact which the Nation's scholars find is the exact cause which differs from one scholar to another in the area of good and acceptable judgment

A high-risk, high-grade proximal left anterior descending coronary artery stenosis in a patient with a zero calcium score

A 58-year-old man with intermediate risk for obstructive coronary artery disease presents with atypical CP. A cardiac computedtomographic angiogram with calcium scoring was obtained. Despite a zero calcium score he was found to have a high risk, critical,proximal left anterior descending artery (LAD) stenosis. During the post-scan monitoring period, he developed unstable anginasymptoms. He was admitted and ruled out for infarction. Invasive coronary angiography confirmed his severe LAD stenosis and adrug eluting stent was placed in the proximal LAD. This case nicely illustrates the cardiac computed tomographic angiographycharacteristics of a high risk coronary stenosis. In addition, it emphasizes that while a zero calcium score is associated with agood prognosis, it is not tantamount to the absence of coronary artery disease and good clinical judgment must be employedwhen caring for symptomatic patients, despite a zero calcium score.

Q&amp;A: Rating Facial Numbness

QUESTION: A man fell and sustained facial fractures that required surgery. He was left without residual deformity, disfigurement, scar, or other ratable conditions. Per the AMA Guides Sixth Edition, Chapter 11, Ear, Nose, Throat and Related Structures, there is no ratable impairment. However, he does have a residual small area of numbness over his right upper lip noticed occasionally when touching the spot or chewing. There is no interference with activities of daily living (ADLs) and no facial neuralgia. Would I rate him per Table 13-20, Criteria for Rating Miscellaneous Peripheral Nerves (6th ed, 344) as class 1 with “sensory loss only in an anatomic distribution” and 1% whole person permanent impairment? However, the trigeminal nerve is not listed in Table 13-20.ANSWER: Table 13-20 does not list the trigeminal nerve; however you could consider this by analogy. You could reference Table 13-19, Criteria for Rating Trigeminal or Glossopharyngeal Neuralgia (6th ed, 343) which states if there is “no neuralgia” the rating is 0%. Section 13.11b, Trigeminal and Glossopharyngeal Neuralgia (6th ed, 343) states “Both atypical, episodic facial pain and typical, neuralgic pain may be evaluated (Table 13-19) if they have occurred for months and interfere with ADLs.” However, he does not have interference with ADLs therefore technically this would not be ratable. Section 13.11b does state you should evaluate by “pain, temperature, and touch” and therefore you could rate by analogy at the low end of class 1 in Table 13-19 at 1% whole person permanent impairment. Even if the sensory loss were not present, some people may complain minimally of discomfort when outdoors in cold weather.You need to use good judgment and determine whether it is more appropriate to conclude there is no ratable impairment or 1% whole person permanent impairment and in the latter case rate by analogy.

Session 314 - Developing Your Clinician/Educator Career

Abstract Opportunities for professional development and mentorship are vital for junior and mid-level faculty members to succeed in academic medicine. Too often, those opportunities are of short supply at institutions. In this special 2-hour, interactive workshop affiliated with the Teaching and Training Committee, learners will be exposed to several areas of professional development. Dr. Brandon Yarns will discuss providing formative feedback using the Feedback with Good Judgment Model. Dr. Scalmati will briefly address the importance of setting the stage for feedback by the establishment of clear expectations, with a description of its role in both the context of a rotation and individual tasks, and the definition ofthe concept of a “feedback bank”. The second part of her presentation will consist of a practical exercise prepared by faculty involving the audience in a role play of feedback skills. Dr. Santos will discuss the need to present oneself effectively in the academic world and the value of effective CV. Finally, Dr. Popeo will discuss how strategic thinking about one's career and the judicious use of the words “yes” and “no.”

Rethinking the training of intelligence analysts

Despite intense scrutiny and promised fixes resulting from intelligence ‘transformation’ efforts, erroneous analytic assessments persist and continue to dominate news coverage of the US intelligence community. Existing analytic training teaches analysts about common cognitive biases and then aims to correct them with structured analytic techniques. On its face, this approach is eminently reasonable; on close inspection, incomplete and imbalanced. Current training is anchored in a mid-twentieth century understanding of psychology that focuses on checking over-confidence and rigidity but ignores the problems of under-confidence and excessive volatility. Moreover it has never been validated against objective benchmarks of good judgment. We propose a new approach: (a) adopting scientifically validated content and regularly testing training to avoid institutionalizing new dogmas; (b) incentivizing analysts to view training guidelines as means to the end of improved accuracy, not an end in itself.

Relationships are building blocks to social justice: Cases of biblical justice and African Ubuntu

The entire Bible is full of themes calling humans to live justly with one another and fear God who is the author of justice. The first book of the Bible, Genesis, carries the story of God’s relationship with his people. Their relationship is bound by social justice and mutual love in reciprocity. This article argues that African Ubuntu has an affinity with the Bible’s message of justice and mutual caring for one another. Ubuntu presupposes that humans were created in God’s image and indicates that characteristics such as kindness, charity, equality, love of one’s neighbours and voluntarily dispensing justice to others are present in human life. God created humans to be bound to one another in caring love, coexistence and total dependence. In today’s world, social justice requires good judgement from those who are in privileged positions to implement it.

On the Randomisation Gallery:Random Reflections on a Popular Method in Medical Research

Objective: Randomized controlled trials (RCTs) and meta-analysis are increasingly utilized methods in medicine. There is, however, substantial critique on both from the theoretical as well as from the practical side. Methods: Seven points on RCTs and three on meta-analysis were choosen to summarize the current critique. Studies critically reviewing the quality of meta-analyses in various fields of medicine were narratively reviewed. Results: The typical RCT is short, performed on a small group of selected patients without severe comorbidity. It is expensive and favors drugs over other forms of therapies. Furthermore, neither patients nor doctors much like RCTs, they feel restricted in their choice of treatments. Finally, it can be problematic to obtain informed consent in disorders affecting decision making, e.g. acute psychosis severe depression or dementia. The evaluation of existing meta-analyses varied between acceptable and poor, good judgments were not often found. Conclusion: The current uncritical use of RCTs and meta-analyses in medicine is not appropriate. Doctors using meta-analyses simply thinking to gather information efficiently are often unaware that there is evidence for bias. Keywords: Randomized controlled trials; Meta-analysis; Quality assessment

All India Difficult Airway Association 2016 guidelines for the management of anticipated difficult extubation.

Extubation has an important role in optimal patient recovery in the perioperative period. The All India Difficult Airway Association (AIDAA) reiterates that extubation is as important as intubation and requires proper planning. AIDAA has formulated an algorithm based on the current evidence, member survey and expert opinion to incorporate all patients of difficult extubation for a successful extubation. The algorithm is not designed for a routine extubation in a normal airway without any associated comorbidity. Extubation remains an elective procedure, and hence, patient assessment including concerns related to airway needs to be done and an extubation strategy must be planned before extubation. Extubation planning would broadly be dependent on preventing reflex responses (haemodynamic and cardiovascular), presence of difficult airway at initial airway management, delayed recovery after the surgical intervention or airway difficulty due to pre-existing diseases. At times, maintaining a patent airway may become difficult either due to direct handling during initial airway management or due to surgical intervention. This also mandates a careful planning before extubation to avoid extubation failure. Certain long-standing diseases such as goitre or presence of obesity and obstructive sleep apnoea may have increased chances of airway collapse. These patients require planned extubation strategies for extubation. This would avoid airway collapse leading to airway obstruction and its sequelae. AIDAA suggests that the extubation plan would be based on assessment of the airway. Patients requiring suppression of haemodynamic responses would require awake extubation with pharmacological attenuation or extubation under deep anaesthesia using supraglottic devices as bridge. Patients with difficult airway (before surgery or after surgical intervention) or delayed recovery or difficulty due to pre-existing diseases would require step-wise approach. Oxygen supplementation should continue throughout the extubation procedure. A systematic approach as briefed in the algorithm needs to be complemented with good clinical judgement for an uneventful extubation.

Playing Political Philosophy

Ronald Beiner wants to have it both ways. We know this because, near the end of his book, he tells us that he is a “dualist,” someone for whom “philosophy and citizenship are defined by radically distinct purposes: the job of philosophy is to strive unconditionally for truth, and the job of citizenship is to strive for good and prudent judgment about the common purposes of civic life, and each should focus strictly on fulfilling its own appointed end without worrying too much about the other.” So there needs to be “a steady appreciation of the fundamental chasm between what we (as citizens) need in the world of practice and what we (as human beings) need from the world of theory” (224). This, however, would be abhorrent to most of the political philosophers Beiner covers. Because they are not dualists but monists; to them, theory and practice should be one.

Another Look at Respecting Patients’ Autonomous Choices – In India

Although medicine based on scientific principles is gaining ground, in India, the efforts to advance the ethical principle of respect for patients’ autonomous choices appear to lag behind. Illiteracy, poverty and inexperience in making autonomous choices were given as the reasons. When the same reasons were not impediments in choosing and participating in a representative form of government, why should they matter in making autonomous choices and participating in medical decisions – jointly with health-care practitioners?Autonomy or self-determination is a Human Right. Legally, it is upheld by most constitutions around the world; ethically, it continues to receive worldwide approbation. By the virtue of this right, health-care providers are obliged to breakdown medical information enabling patients – individually or collaboratively – to choose and authorise a course of action or entrust it to the good judgment of others. Inexperience or illiteracy, as India's grand experiment in democracy proves, may be overcome by reaching out to the patients: Taking time to talk with them (instead of speed-reading) or to the extended family members and including them in crucial conversations. It is obvious that the ideals of autonomic expression and full democratic participation are yet to be realised. Our immediate obligation, it seems, is to understand the reasons why we lag behind respecting patients’ autonomous choices; at the same time, institute reasonable controls which, when conjoined with our knowledge of its binding principles, would lead us to make apposite decisions were we to apply them uniformly. A few examples are as follows: (a) a signature-line in the consent form to capture family agreement to patient's choices, (b) mandatory International Conference on Harmonisation/Good Clinical Practice training for entire teamof health-care practitioners and Institutional Review Board (IRB)/Independent Ethics Committee (IEC) members involved in research on humans and (c) empower IRB/IEC to audit clinical trials and certify compliance with Indian Council On Medical Research standards. Anything less, than this, would seem to be unethical.

En

From an examination of the current textbooks and literature concerning judgment and decision-making models used in outdoor adventure leadership, it is easy to see that they are still deeply rooted in the classical decision-making theory. In this article, I will (a) outline the importance of good judgment and decision making in an outdoor adventure setting, (b) examine the current judgment and decision-making models and the theories that drive them, and (c) put forth a holistic model that incorporates current developments in judgment and decision-making theory.