In this commentary, I consider variability as an ordinary and irremediable feature related to the indexicality not only of transcripts but first of all of transcribing. In this sense, it is not just a characteristic of transcripts as texts, which can be assessed in a kind of philological comparison comparing formal features of autonomous and fixed textual objects, but a characteristic of transcribing as a situated practice. Practices are irremediably indexical, reflexively tied to the context of their production and to (...) the practical purposes of their accomplishment. Thus, a transcript is an evolving flexible object; it changes as the transcriber engages in listening and looking again at the tape, endlessly checking, revising, reformatting it. Transcribing relies in a fundamental way not only on the possibility of fixing the relevant details in a complex multilayered representation but also on the possibility of manipulating them, playing them again and again, at different paces, positions, fragments, while transcribing their finely tuned coordination, their synchronization, the fine articulation between different projections and sequential implicativenesses. These manipulations are one of the ways in which transcribing is accomplished as a situated practice. (shrink)

Biobanks are precariously situated at the intersection of science, genetics, genomics, society, ethics, the law and politics. This multi-disciplinarity has given rise to a new discourse in health research involving diverse stakeholders. Each stakeholder is embedded in a unique context and articulates his/her biobanking activities differently. To researchers, biobanks carry enormous transformative potential in terms of advancing scientific discovery and knowledge. However, in the context of power asymmetries in Africa and a distrust in science born out of historical exploitation, researchers (...) must balance the scientific imperative of collecting, storing and sharing high quality biological samples with obligations to donors/participants, communities, international collaborators, regulatory and ethics authorities. To date, researcher perspectives on biobanking in South Africa have not been explored and documented. In-depth qualitative interviews were conducted with a purposive sample of 21 researchers – 8 in the Western Cape, 3 in Gauteng and 10 in Kwa-Zulu Natal. Interviews lasted approximately 40–60 min and were audiotaped with consent. Thematic analysis of the transcribed interviews was conducted by the co-authors. Researchers articulated serious concerns over standardised regulatory approaches that failed to consider the heterogeneity of biobanks. Given that biobanks differ considerably, guidelines and RECs need to stratify risk accordingly and governance processes and structures must be flexible. While RECs were regarded as an important component of the governance structure researchers expressed concern about their expertise in biobanking. Operational management of biobanks was regarded as an ethical imperative and a pre-requisite to building trust during consent processes. While broad general consent was preferred, tiered consent was thought to be more consistent with respect for autonomy and building trust. Material Transfer Agreements were often lacking when biosamples were exported and this was perceived to impact negatively on trust. On the other hand, researchers believed that authentic community engagement would help to build trust. Building trust will best be achieved via a system of governance structures and processes that precede the establishment of a biobank and monitor progress from the point of sample collection through to future use, including export. Such governance structures must be robust and must include comprehensive national legislation, policy and contextualised guidelines. Currently such governance infrastructure appears to be lacking in many African countries including South Africa. Capacity development of all stakeholders including REC members will enhance expeditious and efficient review of biobanking protocols which in turn will reinforce trust in the researcher-donor relationship. Science translation and community engagement in biobanking is integral to the success of biobanking in South Africa. (shrink)

Engagement with genomic medicine and research has increased globally during the past few decades, including rapid developments in Sri Lanka. Genomic research is carried out in Sri Lanka on a variety of scales and with different aims and perspectives. However, there are concerns about participants' understanding of genomic research, including the validity of informed consent. This article reports a qualitative study aiming to explore the understanding, knowledge, and attitudes of the Sri Lankan public towards genomic medicine and to inform the (...) development of an effective and appropriate process for informed consent in that setting. Purposive sampling was employed. Participants were recruited from a sub-group of the public in Colombo, Sri Lanka who had either consented or refused to donate genetic material for a biobank. Data were collected using face-to-face semi-structured interviews. Interview data were transcribed verbatim and translated into English. Conventional content analysis was used. The analysis developed three key themes: a) ‘Scientific literacy’ describes an apparent lack of scientific knowledge that seems to affect a participant’s ability to understand the research, b) ‘Motivation’ describes narratives about why participants chose (not) to take part in the research, despite not understanding it, and c) ‘Trust’ describes how trust served to mitigate the apparent ethical deficit created by not being fully informed. In this article, we argue that informed trust is likely an acceptable basis for consent, particularly in settings where scientific literacy might be low. However, researchers must work to be worthy of that trust and ensure that misconceptions are actively addressed. (shrink)

All the conserved detailed results of evolution stored in DNA must be read, transcribed, and translated via an RNAmediated process. This is required for the development and growth of each individual cell. Thus, all known living organisms fundamentally depend on these RNA-mediated processes. In most cases, they are interconnected with other RNAs and their associated protein complexes and function in a strictly coordinated hierarchy of temporal and spatial steps (i.e., an RNA network). Clearly, all cellular life as we know (...) it could not function without these key agents of DNA replication, namely rRNA, tRNA, and mRNA. Thus, any definition of life that lacks RNA functions and their networks misses an essential requirement for RNA agents that inherently regulate and coordinate (communicate to) cells, tissues, organs, and organisms. The precellular evolution of RNAs occurred at the core of the emergence of cellular life and the question remained of how both precellular and cellular levels are interconnected historically and functionally. RNA-networks andRNA-communication can interconnect these levels.With the reemergence of virology in evolution, it became clear that communicating viruses and subviral infectious genetic parasites are bridging these two levels by invading, integrating, coadapting, exapting, and recombining constituent parts in host genomes for cellular requirements in gene regulation and coordination aims. Therefore, a 21st century understanding of life is of an inherently social process based on communicating RNA networks, in which viruses and cells continuously interact. (shrink)

I examine all the occasions on which Aquinas uses a particular example, which goes back to Plato's Republic, to shed light on the controversial subject of the immutability of natural law. Aquinas usually transcribes it as depositum gladius non debet restitui furioso, although some variations also occur. We shall first look at the context in which Plato situates this idea, then go on to examine the occasions on which Aquinas draws on it: in the Summa, when discussing the question as (...) to whether the natural law is the same for everyone; in his Commentary on the Nicomachean Ethics, when he explains in what sense natural law may change, and in what sense it remains the same; and finally, where he examines the virtues of gnome and epieikeia, also in the Summa. (shrink)

This article documents experiences of Glasgow Improvisers Orchestra’s virtual, synchronous improvisation sessions during COVID-19 pandemic via interviews with 29 participants. Sessions included an international, gender balanced, and cross generational group of over 70 musicians all of whom were living under conditions of social distancing. All sessions were recorded using Zoom software. After 3 months of twice weekly improvisation sessions, 29 interviews with participants were undertaken, recorded, transcribed, and analyzed. Key themes include how the sessions provided opportunities for artistic development, (...) enhanced mood, reduced feelings of isolation, and sustained and developed community. Particular attention is placed upon how improvisation as a universal, real time, social, and collaborative process facilitates interaction, allowing the technological affordances of software (latencies, sound quality, and gallery/speaker view) and hardware (laptop, tablet, instruments, microphones, headphones, and objects in room) to become emergent properties of artistic collaborations. The extent to which this process affects new perceptual and conceptual breakthroughs for practitioners is discussed as is the crucial and innovative relationship between audio and visual elements. Analysis of edited films of the sessions highlight artistic and theoretical and conceptual issues discussed. Emphasis is given to how the domestic environment merges with technologies to createThe Theatre of Home. (shrink)

BackgroundDespite the recognition that developing artificial intelligence (AI) that is trustworthy is necessary for public acceptability and the successful implementation of AI in healthcare contexts, perspectives from key stakeholders are often absent from discourse on the ethical design, development, and deployment of AI. This study explores the perspectives of birth parents and mothers on the introduction of AI-based cardiotocography (CTG) in the context of intrapartum care, focusing on issues pertaining to trust and trustworthiness.MethodsSeventeen semi-structured interviews were conducted with birth parents (...) and mothers based on a speculative case study. Interviewees were based in England and were pregnant and/or had given birth in the last two years. Thematic analysis was used to analyze transcribed interviews with the use of NVivo. Major recurring themes acted as the basis for identifying the values most important to this population group for evaluating the trustworthiness of AI.ResultsThree themes pertaining to the perceived trustworthiness of AI emerged from interviews: (1) trustworthy AI-developing institutions, (2) trustworthy data from which AI is built, and (3) trustworthy decisions made with the assistance of AI. We found that birth parents and mothers trusted public institutions over private companies to develop AI, that they evaluated the trustworthiness of data by how representative it is of all population groups, and that they perceived trustworthy decisions as being mediated by humans even when supported by AI.ConclusionsThe ethical values that underscore birth parents and mothers’ perceptions of trustworthy AI include fairness and reliability, as well as practices like patient-centered care, the promotion of publicly funded healthcare, holistic care, and personalized medicine. Ultimately, these are also the ethical values that people want to protect in the healthcare system. Therefore, trustworthy AI is best understood not as a list of design features but in relation to how it undermines or promotes the ethical values that matter most to its end users. An ethical commitment to these values when creating AI in healthcare contexts opens up new challenges and possibilities for the design and deployment of AI. (shrink)

Background Encounters of moral distress have long-term consequences on healthcare workers’ physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. Research Objective The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic (...) medical center. Participants & Research Context Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. Research Design Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine’s National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. Ethical Considerations Ethics approval was obtained from the university and medical center institutional review boards. Findings Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. Conclusion Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being. (shrink)

As in the Arab and Persian literatures, many works have been written on the education and teaching of tajwīd, which provides the correct reading of the Qurʼān in Islamic Turkish Literature. Works on this subject were written generally as prose. Besides, some of these works were written in verse style because of practical benefits in education. In this context, the work named Ẓafar written by S̲h̲umnulu Ḥilmī Efendi (d. 1200/1785-86), which is one of the poetical tajwīds that has not been (...) studied enough, is one of the works that can be evaluated under a separate title within religious literaty genres such as forty hadith, ʻaqāʼidnāme and s̲h̲urūt al-ṣalāt (pillars or prayer). This study primarily deals with Ḥilmī Efendi’s tajwīd of verse in Turkish, named Ẓafar, with form and content analysis. The aim of the study is to give information about Ḥilmī Efendi, based on his works and to reveal the text of the work named Ẓafar, which has been transcribed. The importance of the study stems from the fact that it will introduce the first Turkish tajwīd written in verse as far as it has been identified and the master of qırāʼat poet author who can be accepted as the founder of this genre.Summary: During the formation of Islamic sciences such as tafsīr, hadīth, kalām, fiḳh, and ḳırāʼat many works related to these sciences were written in Arabic, Persian, and Kurdish languages. After Turks met with Islam, works were written in verse and prose style to learn the al-Ḳurʼān, the hadīth and the sciences that would help to understand these two sources in order to live a true faith and worship life. On the other hand, as a result of the writing of verse works, some literary genres emerged in Turkish Islamic literature. This issue has also been appeared in the science of tajwīd, which is defined as “a set of rules for the correct pronunciation of the letters with all their qualities” and which ensures the Ḳurʼān to be read properly. As a matter of fact, the writing of both prose and verse tajwīd works defined as a religious-literary genre is an indication of this phenomenon. For instance, Tuḥfe-i Şerīfī (S̲h̲erīfī d. 1260/1844) and Naẓmuʼl-Ehem (S̲h̲eyhī d. 1235/1819-20) are examples of verse tajwīd works. In this context, one of the verse tajwīds is Ẓafar, which is defined by his own writer, S̲h̲umnulu Ḥilmī Efendi, as the first work written in this type.The author of the work, Ḥilmī Efendi, lived in Vardar Yenicesi (Giannitsa) for a long time and died in Hijāz in 1200 (1785-86), is one of the 18th century authors and an specialist in the field. In the work named Osmanli Müellifleri (Bursalı Meḥmed Ṭāhir, 1333 / Ottoman Authors) it is stated that he has works named Manẓūm Tajwīd (Ẓafar) and Manẓūm S̲h̲urūt-ı ṣalāt (Naẓm-ı nefīs) and that he wrote death dates with poetry on the gravestones of the grandchildren of G̲h̲āzī Evrenos Bey (d. 820/1417) and an Arabic khatim prayer. Information about Ḥilmī Efendi's personality, educational life, and scientific level could not be found. One of the works of Ḥilmī Efendi is Naẓm-ı nefīs, which was written in 1190/1776-77, and is in the form of S̲h̲urūt-ı ṣalāt. In this work of 125 couplets except for the title of “Tertīb-i Secāvend-i Ḥurūf” (fāʻilātün fāʻilātün fāʻilün) the author used the meter of the fāʻilātün fāʻilātün fāʻilātün fāʻilün and preferred the masnavī as a form of verse. The work consists of a introduction of 9 couplets, a main part of 24 couplets, an addition and conclusion of 3 couplets.Another work of Ḥilmī Efendi is the work called Ẓafar in the form of verse tajwīd, which he wrote on the request of some of his friends and which is the main subject of this study. There is no record of the writing date of this work. This study also includes the transcribed text of the work. However, when considering the period the author lived in and the time of his other work Naẓm-ı nefīs (1190/1776-77) it is estimated that Ẓafar was written after the second half of the 18th century. However no manuscript copy of Ẓafar could be found. Therefore, for the text to be transcribed in this study, the oldest dated and printed copy with Arabic diacritics of the work (Istanbul: Dār at-tıbāʻa al-āmire, 1265) was taken as basis. In this copy, the work was incorrectly named as Tajwīd-i Manẓūm. Also, there are some typographical errors in the headlines or text; these errors were tried to be corrected. It consists of 71 couplets; an introduction and 25 main titles. Ẓafar, written was written in half, full and rich rhyme. In some places, as well as rhyme, redif (repeated voice) created with an appendix or a word was used. The work has a clear, intriguing and narrative language and expression.Traditionally, the author starts his work by praising God, salawat, prayer, followed by a statement about the importance and the provisions of the learning tajwīd. Then the author gives informations about some tajwīd subjects such as ḥarf-i med, sebeb-i med, medd-i muttaṣıl, medd-i munfaṣıl, and so forth.The author bases on the Ḥafṣ narration of the ḳırāʼat of the ʻĀṣım probably because of taking into account the readers. Another point that draws attention in the work is that the tajwīd issues are explained shorter and clearer compared to other verse tajwīds. There are also no secondary topics such as ţūl, tevaṣṣut, ḳaṣr, ḥarf-i muḫaffefe, kelime-i müṡaḳḳale or istiʻāẕe-basmala, states of tā-i teʼnīṡ. To provide an easy memoration Ḥilmī Efendi does not apply the method of formulations of letters corresponding to the bases such as ikhfā, iẓhār as in many other tajwīd Works. Instead, he writes the letters of a specific rule one by one. Additionally, he does not give many examples from Qurʾān verses to consolidate the rules, and sometimes refers only to the surahs. With his work called Ẓafar, the author follows and represents the tradition of religious-literary works in general, and in particular, the tradition of the verse tajwīd. In some verse types of tajwīd works, for example, only subjects of ḳatʻ and vaṣl are discussed, however, in Ẓafar, most rules of tajwīd are included.It can also be said that the work has a special place and importance due to the possibility of being the first text (constituent text) written in verse tajwīd. On the other hand, when considering the conditions of the period and the fact that it was published more than once, it can be stated that Ẓafar was used as a material in educational activities and raised attention. (shrink)

The formation of mature large rRNAs from larger primary transcripts is very different in bacterial and mammalian cells. In both, cotranscription can help to assure the coordinated production of various rRNA species. However, in bacteria, processing is ordered, initiated by cleavages at double‐stranded stems which enclose the mature sequences; several cleavages are required to produce each mature terminus; and the final steps occur in polysomes, apparently linked to continued protein synthesis. In mouse cells, in contrast, cleavages generate nearly all mature (...) termini stochastically and directly, with no evidence for double‐stranded stems as cleavage signals; and processing occurs in the nucleolus, long before any new rRNA chains arrive in polysomes. Spacer sequences also serve different potnetial functions at the evolutionary extremes. In bacteria, transcribed spacer sequences are associated with different secondary structures in the pre‐rRNA compared to the mature rRNA, and these may promote ribosome formation. In mammalian cells, analyses are too premature to assign any comparable function to transcribed spacer sequences, but the non‐transcribed spacers are probably critical in the organization and replication of nucleoli, functions that are absent from bacteria. (shrink)

There appear to be only four troubadour songs which have not been edited at least diplomatically at one time or another. They were unknown until first discussed in 1935 by the Catalan musicologist Higini Anglès in his monumental treatise, La música a Catalunya. He described the sources, transcribed three of the four melodies with the first stanzas of the texts, and included photographs, which unfortunately are almost illegible. Despite his promise that the texts would soon be edited by a (...) colleague, no edition ever appeared, and I propose now to publish this difficult and surprising material for the first time. I argue that all four songs are refrain songs, probably recorded directly from performance. (shrink)

BackgroundBiobanks have recently been established in several low- and middle-income countries in the Arab region of the Middle East. We aimed to explore the views of biobank managers regarding the challenges, ethical issues, and governance arrangements of their biobanks.MethodsIn-depth semi-structured qualitative interviews were conducted with a purposive sample of eight biobank managers from Egypt, Jordan, and Sudan. Interviews were performed either face-to-face, by phone, or via Zoom and lasted approximately 45–75 min. After verbal consent, interviews were recorded and then (...) class='Hi'>transcribed. The authors performed a thematic analysis of the transcripts independently and then integrated the themes via a consensus process.ResultsBiobank managers discussed the main challenges in establishing their biobanks. These included the staff’s lack of experience and training, limited funds, deficit awareness of biobanks, obtaining funding from different sources. Only four reported they were active in distributing biospecimens and health data to researchers. Six biobanks used a broad consent model, one used tiered consent, and another allowed participants to opt-out of being recontacted. Five managers avoided partnerships with pharmaceutical companies due to concerns with unfavorable reactions from the community. Five managers did not have clear policies for returning research results to the donors. Five expressed challenges with sample and data sharing with international collaborators; all five used material transfer agreements. The biobank managers revealed variable governance arrangements and activities with community involving awareness and educational efforts rather than active engagement. Several expressed the importance of transparency with the operations of their biobanks and gaining the trust of their stakeholders.ConclusionManagers of biobanks in LMICs in the Arab Middle East encounter financial, operational, and social challenges toward their sustainability efforts. Discussions with key stakeholders are warranted to manage ethical issues involving informed consent, privacy, data sharing, and the return of results. We recommend that biobank managers in the Arab Middle East form collaborative networks within the region and internationally, develop trusting governance relationships with their stakeholders, and pursue engagement activities with their communities to enhance trust. (shrink)

Background: Visual technologies are central to youth culture and are often the preferred communication means of adolescents. Although these tools can be beneficial in fostering relations, adolescents’ use of visual technologies and social media also raises ethical concerns. Aims: We explored how school public health nurses identify and resolve the ethical challenges involved in the use of visual technologies in health dialogues with adolescents. Research design: This is a qualitative study utilizing data from focus group discussions. Participants and research context: (...) We conducted focus group discussions using two semi-structured discussion guides with seven groups of public health nurses (n = 40) working in Norwegian school health services. The data were collected during January and October 2016. Discussions were audio recorded, transcribed, and coded into themes and subthemes using systematic text condensation. Ethical considerations: The leader of the public health nursing service who agreed to provide access for the study and the Norwegian Center for Research Data that reviewed and approved the study. All participants gave informed consent. Findings: In adolescents’ use of visual materials with public health nurses, ethical concerns were raised regarding suicide ideations, socially unacceptable content, violation of privacy, and presentations of possible child neglect. The nurses utilized their professional knowledge and experience when identifying and navigating these ethical dilemmas; they resolved ethical uncertainties through peer discussion and collaboration with fellow nurses and other professionals. Discussion: We discussed the findings in light of Annemarie Mol’s interpretation of the ethics of care. Mol expands the notion of ethical care to include the action of technologies. Conclusion: Although the increasing use of visual technologies offered benefits, school nurses faced ethical challenges in health dialogues with adolescents. To address and navigate these ethical issues, they relied on their experience and caring practices based on their professional ethics. Uncertainties were resolved through peer dialogue and guidance. (shrink)

This paper describes the perspectives of stakeholders within the North American dairy industry on key issues affecting the welfare of dairy cattle. Five heterogeneous focus groups were held during a dairy cattle welfare meeting in Guelph, Canada in October 2012. Each group contained between 7 and 10 participants and consisted of a mix of dairy producers, veterinarians, academics, students, and dairy industry specialists. The 1-h facilitated discussions were audio-recorded and transcribed verbatim. Content analysis of the resulting transcripts showed that (...) participants across all stakeholder categories identified lameness as the most important welfare issue facing dairy cattle. Other prominent issues of concern included cow comfort, disease, on-farm mortality, stockmanship, painful procedures, injuries, cull cow management, calf management, and restriction of behavioural freedoms. Participants typically gave several reasons for why they considered issues problematic. Underlying reasons were grouped according to animal-centered concerns [at both the individual and at the herd level ] and industry-centered concerns . This analysis identified areas of shared concern among diverse stakeholder groups, which should aid in the development of standards and policies that satisfy stakeholders within and external to the dairy industry. (shrink)

Background: Nursing students, during their study, experience significant changes on their journey to become nurses. A major change that they experience is the development of their moral competency. Objective: The purpose of this study is to explore the process of moral development in Iranian nursing students. Research design: A constructivist grounded theory method was adopted. Twenty-five in-depth, semi-structured, face-to-face intensive interviews with 22 participants were conducted from September 2013 to October 2014. All interviews were audio-taped, transcribed, and analyzed using (...) writing memos and the constant comparative method. Participants and research context: The setting was three major nursing schools within Tehran, the capital of Iran. Nineteen nursing students and three lecturers participated in the study. Ethical considerations: The study was approved by the Tehran University of Medical Sciences Committee for Medical Research Ethics (92/D/130/1781). It was explained to all participants that their responses would be treated with confidentiality and that they would not be identified in any way in the research and any publication ensuing from the research. All participants agreed to be interviewed and signed written consent forms agreeing to the recording and analyses of the interview data gathered. Findings: Findings indicated three levels of moral development along with the formation of professional identity. The three levels of moral development, getting to know the identity of nursing (moral transition), accepting nursing identity (moral reconstruction), and professional identity internalization (professional morality), were connected to the levels of professional identity formation. Discussion: The proposed model added a new insight to professionalism in nursing. Conclusion: From the findings, it was concluded that to enhance higher moral practice, nursing instructors should promote the professional identity of nursing students. Reinforcement of moral characteristics and professional identity within registered nurses occurs over a series of phases and, once fully integrated into the identity of nursing students, the moral characteristics that they acquire become part of their both professional and personal identities. (shrink)

Background: While numerous studies have shown the positive impact of free healthcare policies, the ethical issues raised by these policies in low-income countries have received little attention. In Burkina Faso, in July 2016, user fees were removed at healthcare facilities for children under 59 months of age and for “mothers”, i.e., for reproductive care. These eligibility criteria are, reportedly, sometimes difficult to comprehend or to enforce. The purpose of this study is twofold: 1) to understand the perceptions and practices of (...) health workers and beneficiaries regarding compliance with eligibility criteria for free care and 2) to explore the ethical tensions that have arisen and possible ways of resolving them. Methodology: In late 2018, a cross-sectional qualitative study was conducted in five rural communities in Boulsa, Burkina Faso. Semi-directed individual interviews were conducted with healthcare personnel (n=10) and mothers of young children (n=10) who were purposefully selected with the assistance of community health workers. Interviews were recorded and transcribed. A thematic content analysis was conducted on all materials. Themes were identified, discussed and reformulated between team members. Results: The study reveals the presence of practices to circumvent strict compliance with the eligibility criteria for free access. Common circumventing practices include hiding the exact age of children aged 60 months or older and using eligible persons for stockpiling drugs or for receiving a free consultation for the benefit of other household members. These practices result from ethical and economic tensions experienced by the beneficiaries. But they also raise ethical dilemmas for healthcare providers since they have to enforce compliance with the eligibility criteria while realizing the financially precarious position of the households. Informal mechanisms are introduced at the community level to reconcile the healthcare providers’ dissonance. Conclusion: The implementation of the user fee abolition policy in Burkina Faso is being carried out through local reinvention mechanisms to overcome ethical tensions related to the compliance with the eligibility criteria. (shrink)

BackgroundThe COVID-19 pandemic introduced new challenges to provide care and educate junior doctors (resident physicians). We sought to understand the positive and negative experiences of first-year resident physicians and describe potential ethical issues from their stories.MethodWe used narrative inquiry (NI) methodology and applied a semistructured interview guide with questions pertaining to ethical principles and both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio recorded and transcribed. Three members of the research team coded transcripts in (...) duplicate to elicit themes. Discrepancies were resolved through discussion to attain consensus. A composite story with threads was constructed.Results11 residents participated across several programmes. Three main themes emerged from the participants’ stories: (1) complexities in navigating intersecting healthcare and medical education systems, (2) balancing public health and the public good versus the individual and (3) fair health systems planning/healthcare delivery. Within these themes, participants’ journeys through the first wave were elicited through the threads of (1) engage us, (2) because we see the need for the duty to treat and (3) we are all in this together.DiscussionCases of the ethical issues that took place during the COVID-19 pandemic may serve as a foundation on which ethics teaching and future pandemic planning can take place. Principles of clinical ethics and their limitations, when applied to public health issues, could help in contrasting clinical ethics with public health ethics.ConclusionEfforts to understand how resident physicians can navigate public health emergencies along with the ethical issues that arise could benefit both residency education and healthcare systems. (shrink)

Context In France, a new payment for performance (P4P) scheme for primary care physicians was introduced in 2009 through the ‘Contract for Improving Individual Practice’ programme. Its objective was to reduce healthcare expenditures while enhancing improvement in guidelines' observance. Nevertheless, in all countries where the scheme was implemented, it raised several concerns in the domain of professional ethics. Objective To draw out in France the ethical tensions arising in the general practitioner's (GP) profession linked to the introduction of P4P. Method (...) Qualitative research using two focus groups: first one with a sample of GPs who joined P4P and second one with those who did not. All collective interviews were recorded and fully transcribed. An inductive analysis of thematic content with construction of categories was conducted. All the data were triangulated. Results All participants agreed that conflicts of interest were a real issue, leading to the resurgence of doctor's dirigisme, which could be detrimental for patient's autonomy. GPs who did not join P4P believed that the scheme would lead to patient's selection while those who joined P4P did not. The level of the maximal bonus of the P4P was considered low by all GPs. This was considered as an offense by non-participating GPs, whereas for participating ones, this low level minimised the risk of patient's selection. Conclusion This work identified several areas of ethical tension, some being different from those previously described in other countries. The authors discuss the potential impact of institutional contexts and variability of implementation processes on shaping these differences. (shrink)

In the current research, using methods of oral history of philosophy, oral communication (in particular, interviews) is considered only as a technical phase in preparing the final text. The author claims that the primary audio or video recordings of such an interview, an "oral draft," should be considered independent material. After all, the written text does not reflect the interlocutors' intonations; comparing the source material and the final text may become important for future researchers. After the transcribed and agreed (...) text of the interview took its final shape, it should be analyzed by the interlocutors and supplemented with a commentary. This commentary aims to (1) clarify vague points of the text and (2) record the further opinions of the interviewer and interviewee. Therefore, the purpose of an interview that uses an oral history of philosophy should be an audio/video recording, a final text, and a commentary. (shrink)

A central figure in Western history and American political thought, Thomas Paine continues to provoke debate among politicians, activists, and scholars. People of all ideological stripes are inspired by his trenchant defense of the rights and good sense of ordinary individuals, and his penetrating critiques of arbitrary power. This volume contains Paine’s explosive Common Sense in its entirety, including the oft-ignored Appendix, as well as selections from his other major writings: The American Crisis, Rights of Man, and The Age of (...) Reason. It also contains several of Paine’s shorter essays. All the documents have been transcribed directly from the originals, making this edition the most reliable one available. Essays by Ian Shapiro, Jonathan Clark, Jane Calvert, and Eileen Hunt Botting bring Paine into sharp focus, illuminating his place in the tumultuous decades surrounding the American and French Revolutions and his larger historical legacy. (shrink)

Important to the essays here is the possibility of using logos without the negative, restricting and violent aspects of logos. In this respect I speak about affirmation and about tragic awareness rather than about the tragic itself or tragic conflict, as I read texts of a literary democracy that is already here, texts by Don DeLillo, Tomas Transtromer, John Ashbery and Thanasis Valtinos, or see arrangements by Lo Snofall. Indeed it is all about arrangements, about knowing how to affirm and (...) doing it rather than using language and its codes in order to transcribe, however accurate this might be. Arrangements say yes, since they do not raise any absolute boundaries. The arrangement is a logos without logos: it is a cosmos, where affirming is a tragically aware cosmetics. Cosmos is neither the world nor any ordering or embellishment of this world, but an openness as the incalculable accumulation of arrangements that say yes in their awareness that they do not amount to an ontology. (shrink)

Research on the relation between sound and meaning in language has reported substantial evidence for implicit associations between articulatory–acoustic characteristics of phonemes and emotions. In the present study, we specifically tested the relation between the acoustic properties of a text and its emotional tone as perceived by readers. To this end, we asked participants to assess the emotional tone of single stanzas extracted from a large variety of poems. The selected stanzas had either an extremely high, a neutral, or an (...) extremely low average formant dispersion. To assess the average formant dispersion per stanza, all words were phonetically transcribed and the distance between the first and second formant per vowel was calculated. Building on a long tradition of research on associations between sound frequency on the one hand and non‐acoustic concepts such as size, strength, or happiness on the other hand, we hypothesized that stanzas with an extremely high average formant dispersion would be rated lower on items referring to Potency (dominance) and higher on items referring to Activity (arousal) and Evaluation (emotional valence). The results confirmed our hypotheses for the dimensions of Potency and Evaluation, but not for the dimension of Activity. We conclude that, at least in poetic language, extreme values of acoustic features of vowels are a significant predictor for the emotional tone of a text. (shrink)

In his essay "Imagination," George Santayana writes, "There are books in which the footnotes, or the comments scrawled by some reader's hand in the margins, may be more interesting than the text." Santayana himself was an inveterate maker of notes in the margins of his books, writing comments that illuminate, contest, or interestingly expand the author's thought. These volumes offer a selection of Santayana's marginalia, transcribed from books in his personal library. These notes give the reader an unusual perspective (...) on Santayana's life and work. He is by turns critical, approving, literary, slangy, frivolous, and even spiteful. The notes show his humor, his occasional outcry at a writer's folly, his concern for the niceties of English prose and the placing of Greek accent marks. These two volumes list alphabetically by author all the books extant that belonged to Santayana, reproducing a selection of his annotations intended to be of use to the reader or student of Santayana's thought, his art, and his life. Each entry includes a headnote with the author's name, the title of the work, brief publication information, and the library location of the book. Not all marginalia from a given text is included; the notes have been selected for content and style. [cut last sentence; cut entire paragraph if nec.] Santayana, often living in solitude, spent a great deal of his time talking to, and talking back to, a wonderful miscellany of writers, from Spinoza to Kant to J. S. Mill to Bertrand Russell. These notes document those conversations. (shrink)

IntroductionFrontline healthcare workers have faced significant plight during the ongoing Coronavirus disease 2019 pandemic. Studies have shown their vulnerabilities to depression, anxiety disorders, post-traumatic stress, and insomnia. In a developing country like India, with a rising caseload, resource limitations, and stigma, the adversities faced by the physicians are more significant. We attempted to hear their “voices” to understand their adversities and conceptualize their resilience framework.MethodsA qualitative approach was used with a constructivist paradigm. After an initial pilot, a socio-demographically heterogeneous population (...) of 172 physicians working in COVID-designated centers were purposively sampled from all over India. Following in-depth virtual interviews using a pre-formed semi-structured guide, the data was transcribed and translated verbatim. The interview was focused on their challenges, needs, and processes of coping and support. Charmaz’s grounded theory was used for analysis supplemented by NVivo 10 software.ResultsFear of infection, uncertainty, stigma, guilt, and social isolation emerged as the main challenges. Simultaneously, their “unmet needs” were flexible work policies, administrative measures for better medical protection, the sensitivity of media toward the image of HCW, effective risk communication for their health, and finally, social inclusion. Their resilience “framework” emerged as a process while navigating these adversities and consisted of three facets: forming a “resilient identity,” managing the resilience, and working through the socio-occupational distress. The role of mental well-being, social network, peer support, problem negotiation, and self-care emerged as the key coping strategies.ConclusionThe study findings support the global call for better psychosocial health and quality of life of the frontline HCWs. Their “unheard voices” explored in the study can anchor subsequent resilience-enhancing interventions and policies. Guidelines focusing on the psychological wellbeing of frontline HCWs need to be grounded in their unmet needs and lived experiences. (shrink)

The decision-making environment in intensive care units (ICUs) is influenced by the transformation of intensive care medicine, the staffing situation and the increasing importance of patient autonomy. Normative implications of time in intensive care, which affect all three areas, have so far barely been considered. The study explores patterns of decision making concerning the continuation, withdrawal and withholding of therapies in intensive care. A triangulation of qualitative data collection methods was chosen. Data were collected through non-participant observation on a surgical (...) ICU at an academic medical centre followed by semi-structured interviews with nurses and physicians. The transcribed interviews and observation notes were coded and analysed using qualitative content analysis according to Mayring. Three themes related to time emerged regarding the escalation or de-escalation of therapies: influence of time on prognosis, time as a scarce resource and timing in regards to decision making. The study also reveals the ambivalence of time as a norm for decision making. The challenge of dealing with time-related efforts in ICU care results from the tension between the need to wait to optimise patient care, which must be balanced against the significant time pressure which is characteristic of the ICU setting. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Perjury and Pardon, Volume 1 by Jacques DerridaRalph ShainDERRIDA, Jacques. Perjury and Pardon, Volume 1. Translated by David Wills. Edited by Ginette Michaud and Nicholas Cotton. Chicago: The University of Chicago Press, 2022. 368 pp. Cloth, $45.00This is the translation of a volume in the posthumously published series of Derrida's lecture courses. The most important of these are the early Heidegger: The Question of Being and History (1964–65) (...) and Theory and Practice (1975–76), no parts of which were published by Derrida. Substantial portions of the first volume of the lectures on Perjury and Pardon were published as separate essays, so the main question concerning this book is what it adds to the published portions.For those readers who are familiar with Derrida's most famous work and are curious about his deconstructive ethics ("ethics beyond ethics") and have not read any of the essays drawn from this book (such as "To Forgive: the Unforgiveable and the Imprescriptible," "Literature in Secret," and "Typewriter Ribbon"), this is a good place to approach the topic. One will find here many of Derrida's classic moves, such as the deconstruction of texts, concepts, and traditions. One will find conditions of possibility that are also conditions of impossibility, concepts that are contaminated from within by their opposites, and appeals to the experience of the impossible and to the distinction between a general and restricted economy.One will also find here those points that seem to be Derrida's weakest, such as the insistence on the privacy of the mental, a rather wobbly treatment of the separation between intending and causality, and the [End Page 545] claim, important for Derrida's "poetico-performative" theory of truth, that all constatives depend on a prior performative—a promise to tell the truth, always already contaminated by failure and hence a "perjury." (The first and third of these are also found in Derrida's published work.)The topics in this book are helpful in situating Derrida vis-à-vis other thinkers, especially those in the Frankfurt School. Derrida's concept of an impossible, paradoxical pardon might be compared with Adorno's concept of utopian moments. The promise of truth implicit in every constative might be compared with Habermas's quasi-transcendental ideal speech situation.Even if one has read one or more of the published portions, if one is unsure how they fit together, these lectures will allow one to see how they cohere. In the third session Derrida provides an outline of the project, which he qualifies with the comment that "I am aware of the grossly schematic character of this outline." Grossly schematic, yes, but grossly schematic outlines are very helpful. Here's the gist of the outline: "stubbornly tracking down in the Biblio-Koranic tradition a logic of economy, an economy, a sublime ruse which... comes to contradict and undermine a demand for finite-infinite forgiveness, forgiveness without condition, the aneconomic forgiveness that is nevertheless at the heart of this same thinking... showing that on the supposed Greek side, the aneconomic notion of forgiveness comes to organize the aneconomic logic and 'syngnomic' rationality of a so-called Greek culture." In short, the concept of forgiveness that is derived from the monotheistic traditions of forgiveness claims not to be pragmatic or goal oriented, but Derrida shows that it is, whereas the Greek concept that is the closest equivalent, and is supposed to be entirely pragmatic, has moments that exceed any limited economy. (If this still sounds opaque, see Derrida's essay on Bataille and general economy in Writing and Difference.)Even those who are well versed in deconstructive ethics and have read the published parts of this book may still find it quite interesting. Derrida's verbal elucidations of the typescript are transcribed from recordings and placed in footnotes. There are quite a few of these, and some of them are interesting. The editorial apparatus will allow one to confirm that one has indeed read all of the published parts, which one should not take for granted since a couple of them are in relatively obscure venues. The readings of texts are of variable interest, but even in the... (shrink)

Media guidelines on safe suicide-related reporting are within the suicide prevention armamentarium. However, implementation issues beleaguer real-world practice. This study evaluated the perspectives of the Malaysian media community, persons with lived experience of suicidal behavior, and mental health professionals on suicide-related reporting in terms of the impact, strategies, challenges, and the implementation of guidelines on safe reporting. Three focus group discussions of purposively sampled Malaysian media practitioners, PLE, and MHP were audio-recorded, transcribed, coded and thematically analyzed. Inclusion criteria were: (...) English fluency, no clinical depression or suicidal ideation, no recent previous suicide attempts or suicide bereavement. Three major themes emerged: Unsafe Reporting; Impact; and Safe Reporting. Most described current reporting as unsafe by being potentially triggering to media users and may contribute to contagion effect. Positive impacts identified included raised awareness toward suicide and its prevention. Unsafe reporting was attributed to inadequate awareness, knowledge, and guidance, lack of empathy and accountability, job-related factors, popularity-seeking, lack of monitoring and governance, and information source with unsafe content. Majority agreed on how suicide stories should be framed to produce a safe report. The media community diverged on how detailed a suicide story should be. Safe reporting challenges included difficulties in balancing beneficial versus harmful details, social media ubiquity and its citizen reporters. Participants suggested these safe reporting strategies: stakeholder engagement, educational approaches, improving governance and surveillance, and guidelines revision. Most acknowledged the relevance of guidelines but were unaware of the existence of local guidelines. Implementation challenges included the dilemma in balancing media industry needs vis-à-vis safe reporting requirements, stakeholder engagement difficulties and social media regulation. There is poor awareness regarding safe suicide-related reporting across all groups. PLE and MHP were negatively impacted by current unsafe messaging which aggravated trauma and grief reactions. Postvention support gaps for mental health professionals were highlighted. Safe reporting promotion strategies should include stakeholder engagement to increase awareness on minimizing Werther and maximizing Papageno effects. Strategic re-examination and dissemination of local media guidelines to address new media issues, and effective surveillance mechanisms, are crucial in sustainable improvement of safe reporting practices. (shrink)

The _Analects_ is a compendium of the sayings of Confucius (551-479 b.c.e.), transcribed and passed down by his disciples. How it came to be transformed by Zhu Xi (1130-1200) into one of the most philosophically significant texts in the Confucian tradition is the subject of this book. Scholarly attention in China had long been devoted to the _Analects._ By the time of Zhu Xi, a rich history of commentary had grown up around it. But Zhu, claiming that the _Analects_ (...) was one of the authoritative texts in the canon and should be read before all others, gave it a still more privileged status in the tradition. He spent decades preparing an extended interlinear commentary on it. Sustained by a newer, more elaborate language of metaphysics, Zhu's commentary on the _Analects_ marked a significant shift in the philosophical orientation of Confucianism--a shift that redefined the Confucian tradition for the next eight centuries, not only in China, but in Japan and Korea well. Gardner's translations and analysis of Zhu Xi's commentary on the _Analects_ show one of China's great thinkers in an interesting and complex act of philosophical negotiation. Through an interlinear, line-by-line "dialogue" with Confucius, Zhu effected a reconciliation of the teachings of the Master, commentary by later exegetes, and contemporary philosophical concerns of Song-dynasty scholars. By comparing Zhu's reading of the _Analects_ with the earlier standard reading by He Yan (190-249), Gardner illuminates what is dramatically new in Zhu Xi's interpretation of the _Analects._ A pioneering study of Zhu Xi's reading of the _Analects,_ this book demonstrates how commentary is both informed by a text and informs future readings, and highlights the importance of interlinear commentary as a genre in Chinese philosophy. (shrink)

There is a growing interest in aggregating more biomedical and patient data into large health data sets for research and public benefits. However, collecting and processing patient data raises new ethical issues regarding patient’s rights, social justice and trust in public institutions. The aim of this empirical study is to gain an in-depth understanding of the awareness of possible ethical risks and corresponding obligations among those who are involved in projects using patient data, i.e. healthcare professionals, regulators and policy makers. (...) We used a qualitative design to examine Swiss healthcare stakeholders’ experiences and perceptions of ethical challenges with regard to patient data in real-life settings where clinical registries are sponsored, created and/or used. A semi-structured interview was carried out with 22 participants between July 2014 and January 2015. The interviews were audio-recorded, transcribed, coded and analysed using a thematic method derived from Grounded Theory. All interviewees were concerned as a matter of priority with the needs of legal and operating norms for the collection and use of data, whereas less interest was shown in issues regarding patient agency, the need for reciprocity, and shared governance in the management and use of clinical registries’ patient data. This observed asymmetry highlights a possible tension between public and research interests on the one hand, and the recognition of patients’ rights and citizens’ involvement on the other. The advocation of further health-related data sharing on the grounds of research and public interest, without due regard for the perspective of patients and donors, could run the risk of fostering distrust towards healthcare data collections. Ultimately, this could diminish the expected social benefits. However, rather than setting patient rights against public interest, new ethical approaches could strengthen both concurrently. On a normative level, this study thus provides material from which to develop further ethical reflection towards a more cooperative approach involving patients and citizens in the governance of their health-related big data. (shrink)

The four talks collected here transcribe lectures delivered to an audience of children between the ages of ten and fourteen, under the auspices of the little dialogues series at the Montreuil's center for the dramatic arts. Modeled on Walter Benjamin's Aufklrung for Kinderradio talks, this series aims to awaken its young audience to pressing philosophical concerns. Each talk in God, Justice, Love, Beauty explores what is at stake in these topics as essential moments in human experience. (Indeed, the book argues (...) that they are constitutive of human experience.) Following each, Nancy's audience is given a chance to engage with him in a process of philosophical questioning; the texts of these touching and probing exchanges are included in the volume. Despite the fact that these lectures were delivered to an audience of children, the intellectual level they achieve-while remaining easily comprehensible-is astounding. No attempt is made to simplify Nancy's positions or to resolve the complexities that arise in the course of the talks or the question periods that follow. The work of opening performed here is fully in keeping with the strategy of Nancy's philosophy as a whole. Thus, for readers unfamiliar with his work, God, Justice, Love, Beauty will function as an excellent introduction to Nancy's larger corpus. As varied as the individual talks are, they share the motif of incalculability or the immeasurable. Broadly speaking, one could say that the various ways in which Nancy approaches this motif exemplify his deconstructive approach to think of human existence. As well, those treatments exemplify his conviction that the task of thinking is to develop original ways of communicating the incalculable.God, Justice, Love, Beauty is thus a skillful reminder that philosophy is important to all of us. The book is also a model of intellectual generosity and openness. Seamlessly moving from Schwarzenegger to Plato, from Kant, Roland Barthes, and Caravaggio to Caillou, Harry Potter, and the pages of Gala magazine, Nancy's wide-ranging references bear witness to his commitment to think of culturein its broadest sense. (shrink)

Cognitive enhancement (CE) covers a broad spectrum of methods, including behavioral techniques, nootropic drugs, and neuromodulation interventions. However, research on their use in children has almost exclusively been carried out in high-income countries with limited understanding of how experts working with children view their use in low- and middle- income countries (LMICs). This study examines perceptions on cognitive enhancement, their techniques, neuroethical issues about their use from an LMICs perspective.Seven Indian experts were purposively sampled for their expertise in bioethics, child (...) development and child education. In-depth interviews were conducted using a semi-structured topic guide to examine (1) understanding of CE, (2) which approaches were viewed as cognitive enhancers, (3) attitudes toward different CE techniques and (4) neuroethical issues related to CE use within the Indian context. All interviews were audio recorded and transcribed before thematic analysis.Findings indicate Indian experts view cognitive enhancement as a holistic positive impact on overall functioning and well-being, rather than improvement in specific cognitive abilities. Exogenous agents, and neuromodulation were viewed with skepticism, whereas behavioral approaches were viewed more favorably. Neuroethical concerns included equitable access to CE, limited scientific evidence and over-reliance on technology to address societal problems. This highlights the need for more contextually relevant neuroethics research in LMICs. (shrink)

BackgroundOpen peer review practices are increasing in medicine and life sciences, but in social sciences and humanities they are still rare. We aimed to map out how editors of respected SSH journals perceive open peer review, how they balance policy, ethics, and pragmatism in the review processes they oversee, and how they view their own power in the process.MethodsWe conducted 12 pre-registered semi-structured interviews with editors of respected SSH journals. Interviews consisted of 21 questions and lasted an average of 67 (...) min. Interviews were transcribed, descriptively coded, and organized into code families.ResultsSSH editors saw anonymized peer review benefits to outweigh those of open peer review. They considered anonymized peer review the “gold standard” that authors and editors are expected to follow to respect institutional policies; moreover, anonymized review was also perceived as ethically superior due to the protection it provides, and more pragmatic due to eased seeking of reviewers. Finally, editors acknowledged their power in the publication process and reported strategies for keeping their work as unbiased as possible.ConclusionsEditors of SSH journals preferred the benefits of anonymized peer review over open peer and acknowledged the power they hold in the publication process during which authors are almost completely disclosed to editorial bodies. We recommend journals to communicate the transparency elements of their manuscript review processes by listing all bodies who contributed to the decision on every review stage. (shrink)

Due to improvements in medicine, the figures of patients with disorders of consciousness (DoC) are increasing. Diagnostics of DoC and prognostication of rehabilitation outcome is challenging but necessary to evaluate recovery potential and to decide on treatment options. Such decisions should be made by doctors and patients’ surrogates based on medico-ethical principles. Meeting information needs and communicating effectively with caregivers as the patients´ most common surrogate-decision makers is crucial, and challenging when novel tech-nologies are introduced. This qualitative study aims to (...) explore information needs of informal DoC caregivers, how they manage the obtained information and their perceptions and experiences with caregiver-physician communication in facilities that implemented innovative neurodiagnostics studies. In 2021, we conducted semi-structured interviews with nine caregivers of clinically stable DoC patients in two rehabilitation centers in Italy and Germany. Participants were selected based on consecutive purposeful sampling. Caregivers were recruited at the facilities after written informed consent. All interviews were recorded, transcribed verbatim and translated. For analysis, we used reflexive thematic analysis according to Braun & Clarke (2006). Caregivers experienced the conversations emotionally, generally based on the value of the information provided. They reported to seek positive information, comfort and empathy with-in the communication of results of examinations. They needed detailed information to gain a deep understanding and a clear picture of their loved-one’s condition. The results suggest a mismatch between the perspectives of caregivers and the perspectives of medical profession-als, and stress the need for more elaborate approaches to the communication of results of neu-rodiagnostics studies. (shrink)

BackgroundAdolescents living with human immunodeficiency virus (HIV) experience challenges, including lack of involvement in their care as well nondisclosure of HIV status, which leads to poor adherence to antiretroviral therapy (ART). Parents have authority over their children, but during adolescence there is an increasing desire for independence. The aim of the study was to explore adolescents’ experience of challenges identified by adolescents ages 10–19 years attending HIV care and treatment at Temeke Regional Referral Hospital in Tanzania. MethodsAn exploratory descriptive qualitative (...) design was employed in the HIV Care and Treatment Centre (CTC) in the Out-Patient Department at the Temeke Regional Referral Hospital in Tanzania with adolescents living with HIV who were 10–19 years of age. A total of 22 adolescents participated in semi-structured face-to-face interviews after parental consent and adolescent assent were obtained. Participants were interviewed about their participation in decisions to be tested for HIV and enrolled in the CTC, concerns surrounding disclosure of their HIV status to the adolescent or to others, stigma and discrimination, and the effect of these challenges on their adherence to medication. All interviews were audio-taped, transcribed verbatim in Swahili, and back-translated to English. Data analysis included both inductive and deductive thematic analysis.ResultsQualitative themes identified included lack of participation in decisions about HIV testing, challenges to enrollment in care and treatment; issues around disclosure of HIV status, such as delays in disclosure to the adolescent and disclosure to other persons and benefits and harms of such disclosures; and factors supporting and interfering with adherence to ART, such as parental support, organizational (clinic) support and problems, and self-stigmatization and shame.ConclusionLack of adolescents’ involvement in their care decision making and delayed disclosure of HIV status to the adolescent were identified concerns, leading to poor adherence to ART among adolescents. Disclosure to others, especially teachers, helped adolescents at school to take their medication properly. Disclosure to others led to stigma and discrimination for some adolescents. More research is needed to better understand the role of disclosure and its benefits and challenges for HIV-positive adolescents in Tanzania. (shrink)

Digital sweatshops represent exploitative digital workplaces where individuals are compelled to work long hours under high demands for minimal compensation. This study employs in-depth, semi-structured interviews with digital workers to explore digital sweatshop operations’ challenges and adverse aspects, mainly focusing on ethical considerations. The collected data were transcribed and analyzed using grounded theory methodology. The findings highlight three key themes: conditions mitigating factors, organisational factors, and work environment factors, all of which contribute to the persistence of digital sweatshops. The (...) study advocates for comprehensive labour laws, education and advocacy for digital employees, mental health support, transparency and accountability, skill development, career advancement, and ethical business practices. These recommendations are intended to help governments and organizations create a fair and ethical digital workplace, prioritizing workers’ rights and well-being. (shrink)

BackgroundIn Australia, the peer review process for competitive funding is usually conducted by a peer review group in conjunction with prior assessment from external assessors. This process is quite mysterious to those outside it. The purpose of this research was to throw light on grant review panels (sometimes called the ‘black box’) through an examination of the impact of panel procedures, panel composition and panel dynamics on the decision-making in the grant review process. A further purpose was to compare experience (...) of a simplified review process with more conventional processes used in assessing grant proposals in Australia.MethodsThis project was one aspect of a larger study into the costs and benefits of a simplified peer review process. The Queensland University of Technology (QUT)-simplified process was compared with the National Health and Medical Research Council’s (NHMRC) more complex process. Grant review panellists involved in both processes were interviewed about their experience of the decision-making process that assesses the excellence of an application. All interviews were recorded and transcribed. Each transcription was de-identified and returned to the respondent for review. Final transcripts were read repeatedly and coded, and similar codes were amalgamated into categories that were used to build themes. Final themes were shared with the research team for feedback.ResultsTwo major themes arose from the research: (1) assessing grant proposals and (2) factors influencing the fairness, integrity and objectivity of review. Issues such as the quality of writing in a grant proposal, comparison of the two review methods, the purpose and use of the rebuttal, assessing the financial value of funded projects, the importance of the experience of the panel membership and the role of track record and the impact of group dynamics on the review process were all discussed. The research also examined the influence of research culture on decision-making in grant review panels. One of the aims of this study was to compare a simplified review process with more conventional processes. Generally, participants were supportive of the simplified process.ConclusionsTransparency in the grant review process will result in better appreciation of the outcome. Despite the provision of clear guidelines for peer review, reviewing processes are likely to be subjective to the extent that different reviewers apply different rules. The peer review process will come under more scrutiny as funding for research becomes even more competitive. There is justification for further research on the process, especially of a kind that taps more deeply into the ‘black box’ of peer review. (shrink)

PurposeContinuous patient-reported outcomes to identify and address patients’ needs represent an important addition to current routine care. The aim of this study was to identify and determine important dimensions of health-related quality of life in routine oncological care.MethodsIn a cross-sectional qualitative study, interviews and focus groups were carried out and recorded. The interviewees were asked for their evaluation on HrQoL in general and specifically regarding cancer treatment. The material was transcribed and analyzed using qualitative content analysis based on Mayring. (...) The results were reviewed in an expert discussion.ResultsInterviews with patients and clinicians, as well as five focus groups with clinicians were conducted. Initially, nine deductive and two inductive categories on HrQoL were built. Four categories were excluded following the qualitative content analysis because they were hardly or not at all mentioned by participants. Following on from the analysis of the expert discussion, one dimension was added, and two further categories were excluded. The resulting system consisted of six dimensions: emotional health, physical ailments, autonomy, social functionality, dignity, and resources.ConclusionThe identified dimensions of HrQoL in routine oncological care were found to differ from those used in existing HrQoL measurements for patients. Further research is needed to test and evaluate the presented structure in a larger sample of cancer patients to further assess its psychometric properties. (shrink)

Nearly every edition of Aeschylus published between 1782 and 1852 contained readings from what were called ‘Askew's collations’ or the ‘Askew MSS.’—usually referred to as Ask. A, Ask. B, Ask. C, Ask. D, Ask. a, Colb. 1, and Colb. 2. These MSS., which were very briefly described, were stated in these editions to be Paris MSS. which had been collated by Askew. Blomfield, however, discovered that Askew had transcribed all the collations from a note-book that had belonged to Needham, (...) and Pierron accused Askew of deliberate plagiarism and unscrupulous dishonesty. The late Prof. H. W. Smyth in a recent note on the subject attempted to identify the ‘Askew MSS.’, and maintained the charge of plagiarism; but his conclusions were based on inadequate evidence, and were consequently partly incorrect. A full study of all the available evidence, a summary of which I give below, not only clears Askew's name of any plagiarism, but also establishes the identity of the MSS. (shrink)

Twelve retired nurses were asked to narrate a care situation in which it had been difficult for them as nurses to know what was the right and good thing to do. The transcribed interviews were examined by content analyses. Physicians were the central coactors in the nurses’ stories. Colleagues were seldom mentioned. Other ward staff were mainly called ‘the girls’. The patient was central and referred to with respect. All the nurses focused on experiential learning. Guiding ethical principles are (...) listed. (shrink)

In his essay "Imagination," George Santayana writes, "There are books in which the footnotes, or the comments scrawled by some reader's hand in the margins, may be more interesting than the text." Santayana himself was an inveterate maker of notes in the margins of his books, writing comments that illuminate, contest, or interestingly expand the author's thought. These volumes offer a selection of Santayana's marginalia, transcribed from books in his personal library. These notes give the reader an unusual perspective (...) on Santayana's life and work. He is by turns critical, approving, literary, slangy, frivolous, and even spiteful. The notes show his humor, his occasional outcry at a writer's folly, his concern for the niceties of English prose and the placing of Greek accent marks. These two volumes list alphabetically by author all the books extant that belonged to Santayana, reproducing a selection of his annotations intended to be of use to the reader or student of Santayana's thought, his art, and his life. Each entry includes a headnote with the author's name, the title of the work, brief publication information, and the library location of the book. Not all marginalia from a given text is included; the notes have been selected for content and style. [cut last sentence; cut entire paragraph if nec.] Santayana, often living in solitude, spent a great deal of his time talking to, and talking back to, a wonderful miscellany of writers, from Spinoza to Kant to J. S. Mill to Bertrand Russell. These notes document those conversations. (shrink)

This paper completes a small but long desiderated act of restitution to the Euripidean scholarship of J. J. Scaliger.In 1694 Joshua Barnes published at Cambridge a complete edition of Euripides; he included either in his text or notes a number of conjectures transcribed from marginalia in a copy of W. Canter's Euripides owned successively by Scaliger, his pupil Daniel Heinsius, to whom Scaliger bequeathed the book, and Jan Rutgers. The book passed to the Bodleian Library at Oxford ; in (...) the early nineteenth century P. Elmsley re-examined it for his editions of Medea and Bacchae, and complained that Barnes had not only failed to report all Scaliger's conjectures but frequently disguised the source of those he had noted or even silently appropriated them to himself. (shrink)

Background Thirst and dry mouth are common symptoms in terminally ill patients. In their day-to-day practice, palliative care physicians regularly encounter ethical dilemmas, especially regarding artificial hydration. Few studies have focused on thirst and the ethical dilemmas palliative care physicians encounter in relation to this, leading to a knowledge gap in this area. Aim The aim of this study was to explore palliative care physicians’ experiences of ethical challenges in relation to thirst in terminally ill patients. Methods A qualitative interview (...) study with an inductive approach was conducted. Sixteen physicians working in four different specialised palliative care units and one geriatric care unit in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. Results When presented with an ethical challenge relating to thirst, physicians attempted to balance benefits and harms while emphasizing respect for the patient’s autonomy. The ethical challenges in this study were: Starting, continuing or discontinuing drips; lack of evidence and traditions create doubt; and lack of interest and time may result in patient suffering. Conclusions All physicians in this study reported that “Starting, continuing or discontinuing drips” was the main ethical challenge they encountered, where some were so accustomed to the decision that they had a standard answer ready to offer patients and families. Physicians reported that drips were a symbol of thirst quenching, life and survival but were not necessary in end-of-life care. Others questioned the traditions regarding thirst and emphasised drips in particular. (shrink)

AbstractBackgroundEthical challenges constitute an inseparable part of daily decision-making processes in all areas of healthcare. In prehospital emergency medicine, decision-making commonly takes place in everyday life, under time pressure, with limited information about a patient and with few possibilities of consultation with colleagues. This paper explores the ethical challenges experienced by prehospital emergency personnel. MethodsThe study was grounded in the tradition of action research related to interventions in health care. Ethical challenges were explored in three focus groups, each attended by (...) emergency medical technicians, paramedics, and prehospital anaesthesiologists. The participants, 15 in total, were recruited through an internal information network of the emergency services. Focus groups were audio-recorded and transcribed verbatim.ResultsThe participants described ethical challenges arising when clinical guidelines, legal requirements, and clinicians’ professional and personal value systems conflicted and complicated decision-making processes. The challenges centred around treatment at the end of life, intoxicated and non-compliant patients, children as patients—and their guardians, and the collaboration with relatives in various capacities. Other challenges concerned guarding the safety of oneself, colleagues and bystanders, prioritising scarce resources, and staying loyal to colleagues with different value systems. Finally, challenges arose when summoned to situations where other professionals had failed to make a decision or take action when attending to patients whose legitimate needs were not met by the appropriate medical or social services, and when working alongside representatives of authorities with different roles, responsibilities and tasks.ConclusionFrom the perspective of the prehospital emergency personnel, ethical challenges arise in three interrelated contexts: when caring for patients, in the prehospital emergency unit, and during external collaboration. Value conflicts may be identified within these contexts as well as across them. A proposed model of analysis integrating the above contexts can assist in shedding light on ethical challenges and value conflicts in other health care settings. The model emphasises that ethical challenges are experienced from a particular professional perspective, in the context of the task at hand, and in a particular, the organisational setting that includes work schedules, medical guidelines, legal requirements, as well as professional and personal value systems. (shrink)

Background There is ongoing debate regarding whether and under which circumstances secondary findings (SF) should be offered in the pediatric context. Although studies have examined patient perspectives on receiving SF, little research has been conducted examining the experiences of clinicians offering SF to parents of newborns receiving genomic sequencing for a recently diagnosed medical condition.Methods To address this, we conducted qualitative interviews exploring the views and experiences of 12 clinicians who offered SF to parents of infants who had diagnostic exome (...) sequencing (ES) to identify the cause of their hearing loss. Interviews explored clinicians’ accounts of parents’ choices and decision-making about receiving SF, their views on whether and when to offer SF, their experiences returning SF, and any ethical challenges they encountered. Interviews were audio-recorded, transcribed and analyzed using inductive content analysis.Results Clinicians reported parents who declined all SF often felt finding out about future conditions unrelated to their child’s hearing loss may be unhelpful, or even harmful, or were overwhelmed by their child’s diagnosis. Clinicians also reported that some parents chose SF because they felt obliged to, even if they did not want to receive them. They explained that while some parents experienced decision-making regarding SF as positive, for others, this process was challenging or distressing. While clinicians generally agreed SF should be offered, mainly to promote parental choice, most felt SF should be offered after disclosing diagnostic results, primarily to avoid overwhelming parents. Clinicians encountered several ethical challenges, including balancing parental autonomy with non-maleficence, wanting to report or not report certain SF, and questioning whether parents can make an autonomous choice regarding SF.Conclusions Our findings, which are novel as they relate to parents of young infants with a recent diagnosis of hearing loss, add new insights into clinicians’ and parents’ decision-making regarding SF in pediatrics. (shrink)

‘One thing, however, seems certain: the manuscripts should be completely deciphered and transcribed, and studied as a group, as an individual manuscript, as an individual page (in many cases!), and then put in chronological order.For example: yesterday I carefully examined the results of the page by page transcription of the manuscripts of Daybreak. I drew a sort of diagram of all the aphorisms in Daybreak following their appearance in the different manuscripts. Two things came out of this, which are (...) basically the two sides of the same coin, that is: 1) the evolution of Daybreak, and 2) the exact chronology of each manuscript. (shrink)

ObjectiveTo compare techniques for computing clustering and switching scores in terms of agreement, correlation, and empirical value as predictors of incident cognitive impairment.MethodsWe transcribed animal and letter F fluency recordings on 640 cases of ICI and matched controls from a national epidemiological study, amending each transcription with word timings. We then calculated clustering and switching scores, as well as scores indexing speed of responses, using techniques described in the literature. We evaluated agreement among the techniques with Cohen’s κ and (...) calculated correlations among the scores. After fitting a base model with raw scores, repetitions, and intrusions, we fit a series of Bayesian logistic regression models adding either clustering and switching scores or speed scores, comparing the models in terms of several metrics. We partitioned the ICI cases into acute and progressive cases and repeated the regression analysis for each group.ResultsFor animal fluency, we found that models with speed scores derived using the slope difference algorithm achieved the best values of the Watanabe–Akaike Information Criterion, but with good net reclassification improvement only for the progressive group. For letter fluency, different models excelled for prediction of acute and progressive cases. For acute cases, NRI was best for speed scores derived from a network model, while for progressive cases, the best model used clustering and switching scores derived from the same network model. Combining variables from the best animal and letter F models led to marginal improvements in model fit and NRI only for the all-cases and acute-cases analyses.ConclusionSpeed scores improve a base model for predicting progressive cognitive impairment from animal fluency. Letter fluency scores may provide complementary information. (shrink)

This contribution explores in detail the presence and the context of two quotations of the philosopher and theologian Abū Ḥāmid al-Ġazālī (Algazel for the Latin world) in Albert the Great’s late Summa theologiae sive de mirabili scientia Dei. The two quotations, which concern the notion of the soul as “abridged letter” or “copy” [nusḫa muḫtaṣara, chartula brevis] on which all pieces of knowledge are potentially transcribed, occur in two significant textual points of Albert’s Summa. Two different aspects of al-Ġazālī’s (...) simile are addressed in the article: the consideration of the soul as a book, which has extremely wide biblical and literary echoes, and the consideration of the soul as a place, also with regard to the already Aristotelian, and then Albertinian notion of locus intelligibilium. The feature the two passages by Albert share is the acknowledgment of Algazel as a source of primary importance, capable of corroborating with his authority both a Christian theological doctrine and the littera itself of Aristotle’s De anima, in a culturally momentous philosophical-theological, and Islamic-Christian, cooperation. Thanks to a focused analysis on further contexts of reception of the same Ġazālīan image, which bear witness to its peculiar memorability and its differentiated usages, the article argues in conclusion in favour of a more attentive and in-depth study of philosophical similes such as the one here discussed. (shrink)

Examining discourse markers (Schiffrin, 1987) in two transcribed discussions of controversial issues in an undergraduate 'critical thinking' class, we note frequent uses of 'I'm just saying' and related metadiscursive expressions (I'm/we're saying, I'm/we're not saying, etc.). Our central claim is that these 'saying' expressions are pragmatic devices by which speakers claim 'all along' to have held a consistent argumentative standpoint, one that continues through the discussion unless changed for good reasons. Through close analysis of a series of discourse examples, (...) we show how these discourse markers are used to display continuity, deflect counterarguments, and acknowledge the force of counterarguments while preserving continuity. In a concluding section we reflect critically on the use of these continuity markers with regard to four pragmatic functions that they potentially serve: to specify and clarify argumentative standpoints, to acknowledge a presumption of standpoint continuity, to acknowledge a normative expectation that discussion participants should have standpoints, and to avoid overt disagreement while saving face. (shrink)