Machine ethics via logic programming

Machine ethics is an interdisciplinary field of inquiry that emerges from the need of imbuing autonomous agents with the capacity of moral decision-making. While some approaches provide implementations in Logic Programming (LP) systems, they have not exploited LP-based reasoning features that appear essential for moral reasoning. This PhD thesis aims at investigating further the appropriateness of LP, notably a combination of LP-based reasoning features, including techniques available in LP systems, to machine ethics. Moral facets, as studied in moral philosophy and psychology, that are amenable to computational modeling are identified, and mapped to appropriate LP concepts for representing and reasoning about them. The main contributions of the thesis are twofold. First, novel approaches are proposed for employing tabling in contextual abduction and updating – individually and combined – plus a LP approach of counterfactual reasoning; the latter being implemented on top of the aforementioned combined abduction and updating technique with tabling. They are all important to model various issues of the aforementioned moral facets. Second, a variety of LP-based reasoning features are applied to model the identified moral facets, through moral examples taken off-the-shelf from the morality literature. These applications include: (1) Modeling moral permissibility according to the Doctrines of Double Effect (DDE) and Triple Effect (DTE), demonstrating deontological and utilitarian judgments via integrity constraints (in abduction) and preferences over abductive scenarios; (2) Modeling moral reasoning under uncertainty of actions, via abduction and probabilistic LP; (3) Modeling moral updating (that allows other – possibly overriding – moral rules to be adopted by an agent, on top of those it currently follows) via the integration of tabling in contextual abduction and updating; and (4) Modeling moral permissibility and its justification via counterfactuals, where counterfactuals are used for formulating DDE.

How to improve consumer decision skills in children? A case study of an intervention with institutionalized children

The aim of this study is to assess the institutionalized children’s skills as consumers but also to assess how we can improve their knowledge through an intervention. The sample was composed of two subgroups (38 institutionalized children and 36 non-institutionalized children). In order to assess children’s knowledge, a questionnaire and an interview were used. The method used as intervention was a 30-minute class. Results suggested that institutionalized children have lower levels of knowledge regarding consumption-related practices and lower levels of accuracy at estimating prices than non-institutionalized children. However, results also showed that the attitudes of institutionalized children towards advertising and making decisions based on price/quantity evaluation or based on the use of the same strategy in different situations are not significantly different from the non-institutionalized children. Regarding the intervention, it was possible to conclude that one class is not the best method to improve children’s knowledge. Institutionalized children need a longer and more practical intervention.

A description of the Australian early psychosis intervention model and a proposal to establish a Pilot Early Intervention Program in Santa Cruz de la Sierra, Bolívia

RESUMO: Em 2011, a Associação Psiquiátrica Mundial lançou um programa de bolsas de investigação para psiquiatras em início de carreira a partir de países de renda baixa ou média-baixa, no âmbito deste programa, o autor foi selecionado para uma bolsa de pesquisa no Centre for Youth Mental Health/Orygen Youth Health Research Centre da Universidade de Melbourne. Orygen, é a principal organização de pesquisa e tradução do conhecimento do mundo com foco em problemas de saúde mental em pessoas jovens. O estágio foi baseado em Prevenção e Intervenção Precoce Psychosis Centre (EPPIC), que faz parte do Orygen. EPPIC fornece programa de tratamento abrangente e integrada, baseada na comunidade para o primeiro episódio de psicose. Esta dissertação descreve o modelo EPPIC, e seus componentes essenciais e fatores que são necessários para uma implementação de serviço direito. Além disso, uma proposta de criação de um programa-piloto de intervenção psicose precoce é discutido. Este programa inclui um programa de extensão inovadora que combina princípios comerciais sólidos, com metas sociais, a fim de combater especificamente a maior barreira para o tratamento da psicose precoce na Bolívia: o estigma da doença mental. Ao utilizar uma equipe de tratamento móvel, multidisciplinar, que enfatiza os papéis dos gerentes do caso treinados focada em fornecer indivíduo intensiva e apoio familiar no lar, este programa irá prestar cuidados culturalmente apropriados que irá alavancar contribuições de um suprimento limitado de psiquiatras e mudar longe da dependência um sistema médico fragmentado. ---------------------------- ABSTRACT: In 2011, the World Psychiatric Association launched a programme of research fellowships for early-career psychiatrists from low- or lower-middle income countries, within this programme, the author was selected to a research fellowship at the Centre for Youth Mental Health/Orygen Youth Health Research Centre at University of Melbourne. Orygen, is the world’s leading research and knowledge translation organization focusing on mental ill-health in young people. The traineeship was based on Early Psychosis Prevention and Intervention Centre (EPPIC), which is part of Orygen. EPPIC provides comprehensive, integrated, community-based treatment program for first-episode psychosis. This dissertation describes the EPPIC model, and its core components and factors which are necessary to a right service implementation. Additionally, a proposal to establish a pilot early psychosis intervention programme is discussed. This programme includes an innovative outreach programme that combines sound business principals with social goals in order to specifically target the largest barrier to early psychosis treatment in Bolivia: the stigma of mental illness. By utilizing a mobile, multidisciplinary treatment team that emphasizes the roles of trained case managers focused on providing intensive individual and family support in the home, this programme will provide culturally appropriate care that will leverage contributions from a limited supply of psychiatrists and shift dependence away from a fragmented medical system.

Protocol for the psychotherapeutic group intervention for facilitating posttraumatic growth in nonmetastatic breast cancer patients

Breast cancer can be perceived as a traumatic event with disturbing effects on psychological domains such as depression, anxiety, and Posttraumatic Stress Disorder. In contrast, growing evidence has shown that posttraumatic growth can occur as a result of coping with breast cancer. Challenging the assumptive world, deliberate rumination, and emotional disclosure are recognized as strong predictors of posttraumatic growth. Group interventions may also increase social support, distress disclosure, and posttraumatic growth. The aim of this study is to evaluate how group-based interventions can facilitate posttraumatic growth and promote improved psychosocial adjustment to breast cancer. This article describes the study protocol and the applied research methods.

Essays in health economics: Volume-Outcome Effect, upcoding behaviour and the evaluation of a short-term intervention program

Evidence in the literature suggests a negative relationship between volume of medical procedures and mortality rates in the health care sector. In general, high-volume hospitals appear to achieve lower mortality rates, although considerable variation exists. However, most studies focus on US hospitals, which face different incentives than hospitals in a National Health Service (NHS). In order to add to the literature, this study aims to understand what happens in a NHS. Results reveal a statistically significant correlation between volume of procedures and better outcomes for the following medical procedures: cerebral infarction, respiratory infections, circulatory disorders with AMI, bowel procedures, cirrhosis, and hip and femur procedures. The effect is explained with the practice-makes-perfect hypothesis through static effects of scale with little evidence of learning-by-doing. The centralization of those medical procedures is recommended given that this policy would save a considerable number of lives (reduction of 12% in deaths for cerebral infarction).

Appreciating the power of words and imaginative organizing: A triadic model of ethics practiced in everyday conversations

This thesis provides an alternative framework to analyze power and ethics practiced in everyday conversations, which constitute processes of organizing. Drawing upon narrative frameworks, the analyses of messages posted on an online message board demonstrate people’s imaginative capacity to create relevant stories, in respect of their precise grasp of factual understandings, contextual relevance and evaluative/moral appropriateness, by appropriating others’ words. Based on the empirical analyses, the thesis indicates that studies on power and ethics in organizations can be re-oriented towards appreciating irremediable power imbalances by offering alternative ways of member’s denoting experiences of power.

The World Health Organization Multi-Professional Patient Safety Curriculum : implementation of key modules and its impact on patient safety knowledge, skills, and attitudes of medical students at the University of Algarve

ABSTRACT - Objectives: We attempted to show how the implementation of the key elements of the World Health Organization Patient Safety Curriculum Guide Multi-professional Edition in an undergraduate curriculum affected the knowledge, skills, and attitudes towards patient safety in a graduate entry Portuguese Medical School. Methods: After receiving formal recognition by the WHO as a Complementary Test Site and approval of the organizational ethics committee , the validated pre-course questionnaires measuring the knowledge, skills, and attitudes to patient safety were administered to the 2nd and3rd year students pursuing a four-year course (N = 46). The key modules of the curriculum were implemented over the academic year by employing a variety of learning strategies including expert lecturers, small group problem-based teaching sessions, and Simulation Laboratory sessions. The identical questionnaires were then administered and the impact was measured. The Curriculum Guide was evaluated as a health education tool in this context. Results: A significant number of the respondents, 47 % (n = 22), reported having received some form of prior patient safety training. The effect on Patient Safety Knowledge was assessed by using the percentage of correct pre- and post-course answers to construct 2 × 2 contingency tables and by applying Fishers’ test (two-tailed). No significant differences were detected (p < 0.05). To assess the effect of the intervention on Patient Safety skills and attitudes, the mean and standard deviation were calculated for the pre and post-course responses, and independent samples were subjected to Mann-Whitney’s test. The attitudinal survey indicated a very high baseline incidence of desirable attitudes and skills toward patient safety. Significant changes were detected (p < 0.05) regarding what should happen if an error is made (p = 0.016), the role of healthcare organizations in error reporting (p = 0.006), and the extent of medical error (p = 0.005). Conclusions: The implementation of selected modules of the WHO Patient Safety Curriculum was associated with a number of positive changes regarding patient safety skills and attitudes, with a baseline incidence of highly desirable patient safety attitudes, but no measureable change on the patient safety knowledge, at the University of Algarve Medical School. The significance of these results is discussed along with implications and suggestions for future research.

Distúrbios osteomioarticulares : lombalgia e escoliose : prevalência e fatores associados : um estudo analítico e transversal em adolescentes da região do Algarve

RESUMO - Introdução: Os distúrbios osteomioarticulares envolvem diversas condições donde se destacam a lombalgia e a escoliose, a primeira considerando o fato que a sua prevalência tem vindo a aumentar em adolescentes consistindo num problema crescente de saúde pública que envolve custos indiretos e a escoliose pela ausência de estudos nacionais. Diversos fatores físicos, genéticos, mecânicos, comportamentais e ambientais podem estar envolvidos na patogénese das lombalgias e escolioses. O ambiente escolar, incluindo as posturas adotadas pelos alunos e o transporte das mochilas escolares, e alguns hábitos de estilos de vida constituem fatores que podem contribuir para o desenvolvimento destes distúrbios osteomioarticulares. Este estudo também aborda o estado ponderal, nomeadamente o excesso de peso e a obesidade, pois este é referido frequentemente como um potencial fator de risco destes distúrbios osteomioarticulares (apesar de ainda apresentar controvérsia na literatura), além de ser, por si só, atualmente considerado como um dos mais graves problemas de saúde pública a nível mundial. Objetivos do estudo: (1) determinar a prevalência pontual, anual e ao longo da vida de lombalgia, assim como a prevalência de escoliose em adolescentes da região do Algarve; (2) identificar os fatores associados ao desenvolvimento destes distúrbios osteomioarticulares; (3) determinar a prevalência de excesso de peso e de obesidade e explorar a sua eventual associação com a prevalência de lombalgia e escoliose em adolescentes; (4) comparar os resultados obtidos nos diferentes métodos antropométricos (Índice de massa corporal - IMC, medição das pregas cutâneas e circunferência abdominal) e verificar a sua concordância. Material e métodos: O desenho deste estudo foi de natureza observacional, analítico e transversal. O estudo foi aprovado pela Comissão de Ética da Administração Regional de Saúde do Algarve, pela Direção Regional de Educação do Algarve, pela Direção-Geral de Inovação e de Desenvolvimento Curricular, Ministério da Educação e Ciência, e pelas Direções dos Agrupamentos de Escolas que participaram do projeto. A amostra incluiu 966 adolescentes da região do Algarve, sul de Portugal, com idades compreendidas entre os 10 e 16 anos (12,24±1,53 anos), sendo 437 (45,2%) do sexo masculino e 529 (54,8%) do feminino. O método de amostragem foi aleatório estratificado, com base nos concelhos da região do Algarve, assumindo que poderia existir heterogeneidades geográficas. Os instrumentos de medida foram aplicados num único momento (2011/2012) e incluíram o Questionário de Lombalgia e Hábitos Posturais para caracterizar a presença de lombalgia e os hábitos posturais adotados pelos alunos em casa e na escola, o escoliómetro para avaliar a presença de escoliose, a balança, o estadiómetro (sendo posteriormente calculado o IMC), o adipómetro e a fita métrica. A análise dos dados incluiu técnicas de estatística descritiva, gráficas e analíticas aplicadas à todas as variáveis em estudo. Para determinar a associação entre as variáveis do estudo foi utilizada a estatística inferencial, nomeadamente o teste de independência do Qui-quadrado. Para analisar as correlações entre as medidas obtidas com os métodos antropométricos (na sua forma quantitativa), foi utilizado o coeficiente de Spearman. A influência das diversas variáveis na presença de lombalgia foi aferida através de regressões logísticas binárias, sendo os resultados apresentados como odds ratios brutos e ajustados e respetivos intervalos de confiança. Resultados: O presente estudo revelou uma elevada prevalência de lombalgia (anual: 47,2%; pontual: 15,7%; ao longo da vida: 62,1%). As raparigas apresentaram 2,05 de probabilidade de apresentar lombalgia comparativamente aos rapazes (IC 95%: 1,58-2,65; p<0,001), assim como os alunos com idades mais avançadas (13-16 anos) comparativamente aos mais novos (10-12 anos) que tiveram 1,54 de chances (IC 95%: 1,19-1,99; p=0,001). Os alunos que indicaram adotar uma postura de sentado com a coluna vertebral posicionada incorretamente apresentaram 2,49 de probabilidade de revelar lombalgia (IC 95%: 1,91-3,24; p<0,001), os alunos que afirmaram se posicionar de forma inadequada para assistir televisão ou jogar videojogos tiveram a probabilidade de 2,01 (IC 95%: 1,55- 2,61; p<0,001) e aqueles que adotaram a postura de pé incorretamente tiveram 3,39 de chance de apresentar lombalgia (IC 95%: 2,19-5,23; p<0,001). A escoliose esteve presente em 41 (4,2%) alunos. As raparigas apresentaram a maior prevalência (4,5% versus 3,9%) do que os rapazes e o mesmo foi observado nas raparigas que apresentaram a menarca tardia (8,6% versus 3,3%) e os que foram classificados como magros (7,1%), não sendo no entanto estas diferenças estatisticamente significativas. Relativamente à prevalência de excesso de peso e obesidade, os valores variaram de 31,6%, 61,4% e 41,1% de acordo com a medição do IMC, pregas cutâneas e circunferência abdominal, respetivamente. Os valores obtidos com a avaliação dos três métodos antropométricos apresentaram um elevado alto grau de correlação entre o IMC e as pregas cutâneas (p<0,001; r=0,712), entre o IMC e circunferência abdominal (p<0,001; r=0,884) e entre a circunferência abdominal e as pregas cutâneas (p<0,001; r=0,701). Conclusões: O presente estudo revelou valores de prevalência de lombalgia semelhante a estudos anteriores sendo que os alunos com idade mais avançada, ou do sexo feminino ou aqueles que adotavam a postura sentada e de pé de forma inadequada ou os que transportavam indevidamente a mochila escolar apresentaram a maior prevalência. Quanto à presença de escoliose, observou-se uma baixa prevalência não sendo verificada nenhuma associação significativa com os fatores analisados. Relativamente ao estado ponderal, verificou-se uma elevada prevalência de excesso de peso e obesidade, com a utilização dos três métodos antropométricos: IMC, medição das pregas cutâneas e circunferência abdominal, tendo sido verificado um elevado grau de correlação entre estes três métodos antropométricos. Este estudo contribuiu para determinar a magnitude destes distúrbios osteomiarticulares nesta população específica, assim como seus possíveis fatores associados. De acordo os resultados obtidos no presente estudo, torna-se necessário ações de intervenção nas escolas, envolvendo não somente os alunos, mas toda a comunidade escolar, com o objetivo de prevenção destes distúrbios osteomioarticulares através da promoção de hábitos de vida saudável.

Reinvigorating and redesigning early intervention in psychosis services for young people in Auckland

RESUMO: Auckland tem sido pioneira na implementação de modelos de Intervenção Precoce em Psicose. No entanto, esta organização do serviço não mudou nos últimos 19 anos. Segundo os dados obtidos da utilização do serviço, no período de 1996 -2012 foram atendidos 997 doentes, que tinham um número médio de 89 contactos (IQR: 36-184), com uma duração média de 62 horas de contactos (IQR: 24-136). Estes doentes passaram um número médio de 338 dias (IQR: 93-757) em contacto com o programa. 517 doentes (52%) não necessitaram de internamento no hospital, e os que foram internados, ficaram uma mediana de 124 dias no hospital (IQR: 40-380). Os doentes asiáticos tiveram um aumento de 50% de probabilidade de serem internados no hospital. Este relatório inclui 15 recomendações para orientar as reformas para o serviço e, nomeadamente, delinear a importância de uma visão organizacional e dos seus componentes-chave. As recomendações incluem o reforço da gestão e da liderança numa estrutura de equipe mais integrada, com recursos dedicados a melhorar a consciencialização da comunidade, a educação e deteção precoce, bem como a capacidade de receber referenciações diretas. Os Indicadores Chave de Desempenho devem ser estabelecidos, mas os Exames de Estado Mental em risco, devem ser removidos. Auckland deve manter a faixa etária alvo atual. A duração do serviço deve ser aumentada para um mínimo de três anos, com a opção de aumentá-la para cinco anos. A proporção de gestor de cuidados para os doentes deve ser preconizada em 1:15, enquanto o pessoal de apoio não-clínico deve ser aumentado. Os psiquiatras devem ter uma carga de trabalho de cerca de 80 doentes por equivalente de tempo completo. Um serviço local de prestação de cuidados deve ser desenvolvido com, nomeadamente, intervenções culturais para responder às necessidades da população multicultural de Auckland. A capacidade de investigação deve ser incorporada no Serviço de Intervenção Precoce em Psicoses. Qualquer alteração deverá envolver contacto com todas as partes interessadas, e a Administração Regional de Saúde deve comprometer-se em tempo, recursos humanos e políticos para apoiar e facilitar a mudança do sistema, investindo de forma significativa para melhor servir a comunidade Auckland.----------------------------------- ABSTRACT: Auckland has been pioneering in the adoption of Early Intervention in Psychosis models but the design of the service has not changed in 19 years. In service utilisation data from 997 patients seen from 1996 -2012, patients had a median number of 89 contacts (IQR: 36-184), with a median duration of 62 hours of contact (IQR: 24-136). Patients spent a median number of 338 days (IQR: 93-757) in contact with the program. 517 patients (52%) did not require admission to hospital, and those who did spent a median of 124 days in hospital (IQR: 40-380). Asian patients had a 50% increased chance of being admitted to hospital. This report includes 15 recommendations to guide reforms to the service, including outlining the importance of vision and key components. It recommends strengthened managerial leadership and a more integrated team structure with dedicated resources for improved community awareness, education and early detection as well as the capacity to take direct referrals. Key Performance Indicators (KPIs) should be established but At Risk Mental States should be excluded. Auckland should maintain the current target age range. The duration of service should be increased to a minimum of three years, with the option to extend this to five years. The ratio of care co-ordinator to patients should be capped at 1:15 whilst non-clinical supporting staff should be increased. Psychiatrists should have a caseload of about 80 per FTE. A local Service Delivery framework should be developed, as should cultural interventions to meet the needs of the multicultural population of Auckland. Research capacity should be incorporated into the fabric of Early Intervention in Psychosis Services. Any changes should involve consultation with all stakeholders, and the DHB should commit to investing time, human and political resources to support and facilitate meaningful system change to best serve the Auckland community.

Social impact bond feasibility study AEIPS intervention

AEIPS is a Portuguese social organization promoting the integration of people with mental health illnesses and/or substance abuse in the community through the intervention model Housing First. The philosophy of Housing First aims at lifting people out of their homelessness status by providing instant access to individualized and permanent housing as well as support services. Housing First projects from all over the world have proved very positive results in terms of residential stability and community integration of its participants. This feasibility study evaluates the suitability of using a Social Impact Bond to fund the Housing First intervention of AEIPS in Portugal.

Psychological intervention in Portuguese college students: effects of two career self-management seminars

This article describes the evaluation of a psychological intervention—the Career Self-Management Seminar, Version A, for undergraduate students, and Version B for postgraduate students—developed to support Portuguese college students in career exploration, goal setting, design and implementation of action plans, and decision-making. A total of 120 participants from CSMS-A (experimental group, n = 58; control group, n = 62) and 98 from CSMS-B (experimental group, n = 62; control group, n = 36) were assessed by the Career Exploration Survey according to a pretest and posttest plan. Results demonstrate a significant increase in most of the cognitive, behavioral, and affective career exploration dimensions among the CSMS-A and CSMS-B experimental groups.

Mothers' beliefs concerning severity and need for intervention in child maltreatment

Dissertação de mestrado integrado em Psicologia Clínica e da Saúde

A atuação profissional no campo do lazer: reflexões sobre aspectos éticos

Esse estudo tem como objetivo refletir sobre a atuação profissional no âmbito da lazer, abordando a intervenção sob ponto de vista da ética. Partimos da premissa que os valores e relações estabelecidos na sociedade moderna, lócus das práticas de lazer, interferem na interpretação e organização de modos de vida. Aproximando a ação do profissional de Educação Física com o campo do lazer, apontamos para uma atuação influenciada pela conduta ética e política na direção da mediação. Considerando as reflexões sobre ética e atuação profissional, podemos inferir que a área de Educação Física se consolida por exercer o papel social significativo aos processos educativos do lazer. A atuação profissional no lazer possibilita através da mediação na prática a educação para novos olhares e sensibilidades necessários à construção de uma sociedade igualitária e democrática.

Intervention program on adolescent’s creativity representations and academic motivation

Creativity and its promotion are widespread concerns in education. However, few efforts have been made to implement intervention programs designed to promote creativity and other related aspects (e.g., academic motivation). The Future Problem Solving Program International (FPSPI), aimed for training creativity representations and creative problem solving skills in young people, has been one of the most implemented programs. This intervention’s materials and activities were adapted for Portuguese students, and a longitudinal study was conducted. The program was implemented during four months, in weekly sessions, by thirteen teachers. Teachers received previous training for the program and during the program’s implementation. Intervention participants included 77 Basic and Secondary Education students, and control participants included 78 equivalent students. Pretest-posttest measures of academic motivation and creativity representations were collected. Results suggest a significant increase, in the intervention group, in motivation and the appropriate representations of creativity. Practical implications and future research perspectives are presented.