Trust and responsibility in molecular tumour boards

Molecular tumour boards (MTBs) offer recommendations for potentially effective, but potentially burdensome, molecularly targeted treatments to a patient's treating physician. In this paper, we discuss the question of who is responsible for ensuring that there is an adequate evidence base for any treatments recommended to a patient. We argue that, given that treating oncologists cannot usually offer a robust evaluation of the evidence underlying an MTB's recommendation, members of the MTB are responsible for ensuring that the evidence level is adequate. We explore two models for how to share responsibility between MTB members. According to the first model, each MTB member, as well as the treating physician, should be held maximally and equally responsible for the recommendations. We argue that this insufficiently accounts for differences in roles and expertise of MTB members. We propose instead that responsibility is delegated via relationships of trust. We argue if these relationships of trust are to be instances of reasonable trust, (a) MTBs should offer a clinical representative to whom a treating physician may delegate the responsibility of ensuring there is sufficient evidence for treatment recommendations, (b) the relationships of trust between the representative and the other MTB members should be clearly defined, and (c) MTB members should be carefully selected. Treating oncologists retain a responsibility to consider general limitations of the evidence for targeted treatments in assessing whether the treatment recommendation offered by an MTB's representative is adequate for a given clinical situation.     

Economic Profits Enhance Trust,Perceived Integrity and Memory of Fairness in Interpersonal Judgment

Does money lead to trust in personality and intention of others? Humans have a strong tendency to judge the intention of others from their sequent behaviors. In general, people trust others who behave fairly, but not always. Here we show that judgments of both intentional aspects and memory of intentional behavior are automatically influenced by unintentional benefits from the behaviors of others. We conducted a reward-manipulated and repeated trust game by using real participants interacting with moving image partners on a computer screen. The participants assessed likability, trustworthiness, and perceived integrity of the partners in pre- and post-game questionnaires. The results of judgments of all three dimensions and the memory of frequency of each partner''s fair behavior (sharing) were strongly influenced by profitability in the trust game, even though all partners shared 75% of the profit and participants were told that profitability was randomly assigned to each partner. Furthermore, these effects were moderated by the gender of the participants: males were more sensitive to monetary profits than were females. The results reveal that humans automatically trust, approve the integrity of, and recall well the fair behavior of others who provide affectively positive outcomes such as monetary profits. We call this phenomenon the “affect ripple effect”.     

Commentary: Moving From Practice to Research,and Back

It is a widely accepted idea that knowledge from research needs to be better integrated into practice. Considerable energy is dedicated to strengthening the flow of research to practice. Less attention, however, has been paid to strengthening the ways researchers can learn from practice to improve their work. In this commentary, we draw on our work over the past decade to offer reflections on the nature and pace of practice, the gaps between practitioners’ needs and available research, and the importance of trust and relationships. Although there are no easy responses to these challenges, we can create a dialogue about them and begin to work collectively toward overcoming them.     

One falls,we all fall: How boys of color develop close peer mentoring relationships

The aim of this study was to investigate the processes involved in developing close peer mentoring relationships among African American and Latino male adolescents in a school-based, group peer mentoring program. Qualitative one-on-one in-depth interviews were conducted with six school staff members, who administer the program, and 26 program participants about their experiences in the mentoring program. Data analysis revealed five program processes that led to close mentoring relationships: (a) rapport-building activities, (b) safe space, (c) mutual support, (d) group identity, and (e) trust. These processes ultimately led to bonding and friendship among program members, which further solidified the previous processes. Implications and future directions are discussed.     

Collaborative fractal-based supply chain management based on a trust model for the automotive industry

In the supply chain of the automotive industry, where the procurement ratio of parts from partners is very high, the trustworthiness of partners should be considered during supply chain optimization. In this paper, to deal with the trust issue related to collaboration and reduce the computational load in production planning, we develop a collaborative fractal-based supply chain management framework for the automotive industry. In our framework, the relationships between the participants of a supply chain are modeled as a fractal. Each fractal has a goal model and generates a production plan of its participants based on the goal model. The goal model of each fractal is developed from an operational perspective to consider the trust value of participants during production planning. A fuzzy trust evaluation model is used to evaluate the trust value in terms of numerical value. To validate the developed framework in the automotive industry, simulations are conducted. The results of the simulations indicate that our framework can be useful in generating precise production plans.     

Applying Signaling Theory to Traditional Cultural Rituals

The branch of evolutionary theory known as signaling theory attempts to explain various forms of communication. Social scientists have explained many traditional rituals as forms of communication that promote cooperative social relationships among participants. Both evolutionists and social scientists have realized the importance of trust for the formation and maintenance of cooperative social relationships. These factors have led to attempts to apply signaling theory to traditional cultural rituals in various ways. This paper uses the traditional ritual of mumming in small Newfoundland fishing villages to evaluate alternative hypotheses about the connection between rituals, communication, trust, and cooperation. Mumming is found to be most consistent with the hypothesis that it is a ritual of trust wherein participants take a specific type of risk: the risk of harm at the hands of other participants. Individuals who take this risk actively signal their trust. Conversely, individuals who restrain themselves from inflicting harm on other participants actively signal their trustworthiness.

Placebo, meaning, and health

Placebos are boon and bane to medical theory and clinical practice. On the one hand, randomized controlled trials employ concealed allocations of placebo to control for effects not due to specific pharmacological mechanisms. As a result, nearly all of evidence-based medicine derives from principles and practices based on placebo. On the other hand, medical researchers and physicians have tended to ignore, minimize, or deride placebos and placebo effects, perhaps due to values emphasizing scientific understanding of mechanistic pathways. We argue that intention, expectation, culture, and meaning are central to placebo-effect phenomena and are substantive determinants of health. We introduce three dualities that are integral to placebo/meaning phenomena: body-mind, subconscious-conscious, and passive-active. These placebo-related dualities should be acknowledged, explored with research, and incorporated in theory. While we view consideration of placebo and meaning effects as essential to any adequate understanding of human health, we feel that lessons from this area of inquiry may already provide practical tools for astute clinicians. Toward this end, we list eight specific clinical actions: speak positively about treatments, provide encouragement, develop trust, provide reassurance, support relationships, respect uniqueness, explore values, and create ceremony. These clinical actions can empower patients to seek greater health and may provide a healthful sense of being cared for.     

Young children's selective trust in informants

Young children readily act on information from adults, setting aside their own prior convictions and even continuing to trust informants who make claims that are manifestly false. Such credulity is consistent with a long-standing philosophical and scientific conception of young children as prone to indiscriminate trust. Against this conception, we argue that children trust some informants more than others. In particular, they use two major heuristics. First, they keep track of the history of potential informants. Faced with conflicting claims, they endorse claims made by someone who has provided reliable care or reliable information in the past. Second, they monitor the cultural standing of potential informants. Faced with conflicting claims, children endorse claims made by someone who belongs to a consensus and whose behaviour abides by, rather than deviating from, the norms of their group. The first heuristic is likely to promote receptivity to information offered by familiar caregivers, whereas the second heuristic is likely to promote a broader receptivity to informants from the same culture.     

Affective Balance,Team Prosocial Efficacy and Team Trust: A Multilevel Analysis of Prosocial Behavior in Small Groups

Little research has focused on how individual- and team-level characteristics jointly influence, via interaction, how prosocially individuals behave in teams and few studies have considered the potential influence of team context on prosocial behavior. Using a multilevel perspective, we examined the relationships between individual (affective balance) and group (team prosocial efficacy and team trust) level variables and prosocial behavior towards team members. The participants were 123 students nested in 45 small teams. A series of multilevel random models was estimated using hierarchical linear and nonlinear modeling. Individuals were more likely to behave prosocially towards in-group members when they were feeling good. Furthermore, the relationship between positive affective balance and prosocial behavior was stronger in teams with higher team prosocial efficacy levels as well as in teams with higher team trust levels. Finally, the relevance of team trust had a stronger influence on behavior than team prosocial efficacy.     

Oxytocin is associated with human trustworthiness

Human beings exhibit substantial interpersonal trust-even with strangers. The neuroactive hormone oxytocin facilitates social recognition in animals, and we examine if oxytocin is related to trustworthiness between humans. This paper reports the results of an experiment to test this hypothesis, where trust and trustworthiness are measured using the sequential anonymous "trust game" with monetary payoffs. We find that oxytocin levels are higher in subjects who receive a monetary transfer that reflects an intention of trust relative to an unintentional monetary transfer of the same amount. In addition, higher oxytocin levels are associated with trustworthy behavior (the reciprocation of trust). Absent intentionality, both the oxytocin and behavioral responses are extinguished. We conclude that perceptions of intentions of trust affect levels of circulating oxytocin.     

Biased face recognition in the Faith Game

Several studies have indicated that people are able to memorize the face of a cheater more accurately than that of a noncheater, but some contradictory findings have also been reported. Because most previous studies focused on memory for the faces of cheaters who break social contracts, the consequence for the subjects of their cheating was unclear. In our study, participants were asked to decide whether they trusted persons depicted in photographs to give them money using two sessions of the Faith Game. The participants tended to not increase their trust in the individuals, depicted in photographs, who had altruistically given money to them previously. However, participants recognized nonaltruists who had not shared money and, during the second session, rescinded the trust that they had previously placed in them. This suggests that bias in face recognition is not restricted to the recognition level, as previous studies have suggested, but also operates at the behavioral level and functions to facilitate the avoidance of persons who have caused some disadvantage in a previous interaction, rather than to facilitate new relationships with altruists by enhancing recognition of their faces.     

ADEQUATE TRUST AVAILS,MISTAKEN TRUST MATTERS: ON THE MORAL RESPONSIBILITY OF DOCTORS AS PROXIES FOR PATIENTS' TRUST IN BIOBANK RESEARCH

In Sweden, most patients are recruited into biobank research by non‐researcher doctors. Patients' trust in doctors may therefore be important to their willingness to participate. We suggest a model of trust that makes sense of such transitions of trust between domains and distinguishes adequate trust from mistaken trust. The unique position of doctors implies, we argue, a Kantian imperfect duty to compensate for patients' mistaken trust. There are at least three kinds of mistaken trust, each of which requires a different set of countermeasures. First, trust is mistaken when necessary competence is lacking; the competence must be developed or the illusion dispelled. Second, trust is irrational whenever the patient is mistaken about his actual reasons for trusting. Care must therefore be taken to support the patient's reasoning and moral agency. Third, some patients inappropriately trust doctors to recommend only research that will benefit them directly. Such trust should be counteracted by nurturing a culture where patients expect to be asked occasionally to contribute to the common good.     

‘Wasting mbeng’: Adventure and Trust Amongst sub-Saharan Migrants in Morocco

This article examines how irregular migrants from Central and Western Africa stranded in Morocco forged tenuous but essential relationships in the face of hostile and violent border politics constraining their mobility and resulting in systematic infringement of their rights. I examine the basis of trust amongst migrants in Morocco, who called themselves ‘adventurers’ on a quest for the ‘objective’ (e.g. ‘finding their lives’, usually through getting into Europe). Although most of them had embarked on individual journeys, they regularly needed to cooperate in order to face arduous living conditions and attempt crossing the border into Spain. The article demonstrates how trust was entangled not only with hostile migration politics but with regular moral conundrums as migrants needed to manage a balance between collaborating with other migrants and reaching their own ‘objective’.     

Trust and Distrust in CPR Decisions

Trust is essential in human relationships including those within healthcare. Recent studies have raised concerns about patients’ declining levels of trust. This article will explore the role of trust in decision-making about cardiopulmonary resuscitation (CPR). In this research thirty-three senior doctors, junior doctors and division 1 nurses were interviewed about how decisions are made about providing CPR. Analysis of these interviews identified lack of trust as one cause for poor understanding of treatment decisions and lack of acceptance of medical judgement. Two key implications emerged from the analysis. First, before embarking on a discussion about CPR it is essential to establish trust between the doctor and the patient/family. Secondly, it is essential that the CPR discussion itself does not undermine trust and cause harm to the patient.     

Ebola separations: trust,crisis, and ‘social distancing’ in West Africa

The Ebola outbreak in West Africa involved the introduction of new forms of social and physical separation that aimed to curtail the spread of the disease. People changed the ways they lived to avoid contact with those who might be sick. A suite of governmental instruments was introduced, ranging from by-laws and public health campaigns to the use of specialist treatment centres and military force. These events transformed social connections and affected possibilities for trust in intimate, governmental, and therapeutic relations. Drawing upon fieldwork in Sierra Leone, Liberia, and Guinea, this article explores these forms of separation and social distance ethnographically, with a focus on material objects, touch, and spaces of separation. In doing so, we contribute to discussions on the constitution of trust and distance within social relations, and the ways in which separation can enable certain kinds of closeness. Our analysis offers insights for those seeking to understand the impact of the ongoing COVID-19 pandemic on the ways that people relate to, and care for, others.     

The Impact of Social Deprivation on Paranoia,Hallucinations, Mania and Depression: The Role of Discrimination Social Support,Stress and Trust

The negative implications of living in a socially unequal society are now well documented. However, there is poor understanding of the pathways from specific environmental risk to symptoms. Here we examine the associations between social deprivation, depression, and psychotic symptoms using the 2007 Adult Psychiatric Morbidity Survey, a cross-sectional dataset including 7,353 individuals. In addition we looked at the mediating role of stress, discrimination, trust and lack of social support. We found that the participants'' neighbourhood index of multiple deprivation (IMD) significantly predicted psychosis and depression. On inspection of specific psychotic symptoms, IMD predicted paranoia, but not hallucinations or hypomania. Stress and trust partially mediated the relationship between IMD and paranoid ideation. Stress, trust and a lack of social support fully mediated the relationship between IMD and depression. Future research should focus on the role deprivation and social inequalities plays in specific manifestations of psychopathology and investigate mechanisms to explain those associations that occur. Targeting the mediating mechanisms through appropriate psychological intervention may go some way to dampen the negative consequences of living in an unjust society; ameliorating economic injustice may improve population mental health.     

Structure and Sentiment in Serbian Cousinship

Analysis of survey and interview data from modern Belgrade shows an interplay between the structural alignments of traditional Serbian kinship and the more individual considerations of affective relationships between parents and their siblings. Cousin relationships are a perpetuation of parental sibling relationships but are markedly affected by structural factors. "Liking" appears to be a matter of loyalty, trust, and obligation and is strongest along agnatic lines; the greatest continuity of positive affect is between the close fraternal relationships in the parental generation and the close relationship between mutual father's brother's sons. The virifocality of the system is shown for other facets of kinship including possible warping of genealogical perception and recall.     

Trust: The Missing Dimension in the Food Retail Transition in Thailand

Thailand has experienced dramatic growth of large national and international modern food retailers, such as supermarkets, hypermarkets and convenience stores in large cities and regional centres in the last two decades. Nevertheless, Thai consumers continue to purchase perishables (fruits, vegetables and animal products) from fresh markets (wet markets, talat sot) contradicting predictions from analysts that modern food retail chains will rapidly replace fresh markets as the preferred venue for purchasing all types of foods. This paper examines trust in food retail systems as an under-explored dimension lying behind the continued patronage by Thais of fresh markets to purchase perishable items. It derives from a research program commenced in 2005 that includes fieldwork visits, interviews and questionnaires. In the context of the Thai food retail transition, we propose that trust affects relationships between consumers and (1) individual fresh market-based vendors, (2) the food products sold at fresh markets and (3) the food retail system more broadly. If fresh markets can be maintained in the face of sustained pressure from modern national and international food retailers, Thais will continue to use them. Meanwhile, trust is a relatively unrecognised dimension that is supporting the continued existence of traditional food retail formats.     

Poison de flèches de l'Indochine française

Through an examination of business relationships in the textile industry of Surat, a city in western India, this article evaluates different theories about the importance of social trust in economic development. The case study of Surat raises questions about models that posit a necessary expansion of broad civic ties or legal‐bureaucratic structures at the expense of close personal ties as a basis for industrial development. Surat's business people rely most strongly upon relationships to particular kins‐people, caste‐mates, and co‐religionists rather than broader civic bonds, formal legal controls, or bureaucratic systems as foundations for business trust. Although the expansion of the city's textile industry has created a greater need among the local population for impersonal, universalizing types of social trust, this article argues that these forms, show little sign of replacing personalized trust as the primary basis for local economic activity.     

Freeman Hospital: the will to survive.

The future looks uncertain for the Freeman Hospital trust in Newcastle upon Tyne. There are plans to rationalise the health service in Newcastle by shifting resources from secondary to primary care, and by providing more services locally for people who live in the region but outside Newcastle. These could reduce the level of contracts that purchasers place with the trust in the future. Staff at the trust say the service they provide is good value for money, but purchasers do not seem to take this into account. Instead of choosing from a "shopping list" of priced procedures, purchasers are forcing the trust to dovetail its prices to meet their budgets. There is also concern at the potential impact on the trust''s financial situation of reduced working hours for junior doctors and the Calman proposals on training.