The current study examines patterns of attachment/self-protective strategies and rates of unresolved loss/trauma in children and adolescents presenting to a multidisciplinary gender service. Fifty-seven children and adolescents (8.42–15.92 years; 24 birth-assigned males and 33 birth-assigned females) presenting with gender dysphoria participated in structured attachment interviews coded using dynamic-maturational model (DMM) discourse analysis. The children with gender dysphoria were compared to age- and sex-matched children from the community (non-clinical group) and a group of school-age children with mixed psychiatric disorders (mixed psychiatric (...) group). Information about adverse childhood experiences (ACEs), mental health diagnoses, and global level of functioning was also collected. In contrast to children in the non-clinical group, who were classified primarily into the normative attachment patterns (A1-2, B1-5, and C1-2) and who had low rates of unresolved loss/trauma, children with gender dysphoria were mostly classified into the high-risk attachment patterns (A3-4, A5-6, C3-4, C5-6, and A/C) (χ2= 52.66;p< 0.001) and had a high rate of unresolved loss/trauma (χ2= 18.64;p< 0.001). Comorbid psychiatric diagnoses (n= 50; 87.7%) and a history of self-harm, suicidal ideation, or symptoms of distress were also common. Global level of functioning was impaired (range 25–95/100; mean = 54.88;SD= 15.40; median = 55.00). There were no differences between children with gender dysphoria and children with mixed psychiatric disorders on attachment patterns (χ2= 2.43;p= 0.30) and rates of unresolved loss and trauma (χ2= 0.70;p= 0.40).Post hocanalyses showed that lower SES, family constellation (a non-traditional family unit), ACEs—including maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence)—increased the likelihood of the child being classified into a high risk attachment pattern. Akin to children with other forms of psychological distress, children with gender dysphoria present in the context of multiple interacting risk factors that include at-risk attachment, unresolved loss/trauma, family conflict and loss of family cohesion, and exposure to multiple ACEs. (shrink)

BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...) objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)

The United States National Preparedness System has evolved significantly in the recent past. These changes have affected the system structures and goals for disaster response. At the same time, actors such as private businesses have become increasingly involved in disaster efforts. In this paper, we begin to fill the gap in the cross-sector literature regarding interactions that have systemic impacts by investigating how the simultaneous processes of systemic change and intensifying cross-sector interaction worked and interacted in the context of the (...) preparedness system. We examine these inter-linkages through a qualitative study in the setting of Hurricane Sandy. Drawing from systems theory, we develop a grounded model that provides an explanation for the system change and highlights how cross-sector interaction relates to the changes observed in the system. (shrink)

Detecting contract cheating in written submissions can be difficult beyond direct plagiarism detectable via technology. Successfully identifying potential cases of contract cheating in written work such as essays and reports is largely dependent on the experience of assessors and knowledge of student. It is further dependent on their familiarity with the patterns and clues evident in sections of body text and reference materials to identify irregularities. Consequently, some knowledge of what the patterns and clues look like is required. This paper (...) documents how to identify some of the patterns and clues observed in essay and report submissions. Effective assessment design with specific contextual requirements make irregularities easier to detect and interpret. The irregularities identified were confirmed as instances of contract cheating through conversations held with postgraduate students. An essential element of the conversations was the evidence presented for discussion. Irregularities were noted on a pro-forma specifically developed for this purpose. Patterns identified include misrepresented bibliographic data, inappropriate references, irrelevant material and generalised text that did not address the assessment question or grading criteria. The validated patterns formed the basis of identifying potential instances of contract cheating in later submissions. Timely conversations with students before the end of semester are essential to determining whether the patterns and clues link to poor knowledge of academic writing conventions or classified as contract cheating necessitating the application of appropriate penalties under institutional policies and procedures. (shrink)

Research on emotion perception in schizophrenia has focused primarily on the perception of static faces displaying different emotion signals or expressions. However, perception of emotion in daily life relies on much more than just the face. In this article, we review the role of context in emotion perception among people with and without schizophrenia. We argue that not only is context central to the perception of emotion, it in fact helps to construct the perception. Implications for future research on emotion (...) perception are discussed. (shrink)

How should nursing knowledge advance? This exploration contextualizes its evolution past and present. In addressing how it evolved in the past, a probable historical evolution of its development draws on the perspectives of Frank & Gills's World System Theory, Kuhn's treatise on Scientific Revolutions, and Foucault's notions of Discontinuities in scientific knowledge development. By describing plausible scenarios of how nursing knowledge evolved, I create a case for why nursing knowledge developers should adopt a post‐structural stance in prioritizing their research agenda(s). (...) Further, by adopting a post‐structural stance, I create a case on how nurses can advance their disciplinary knowledge using an engaging post‐colonial strategy. Given an interrupted history caused by influence(s) constraining nursing's knowledge development by power structures external, and internal, to nursing, knowledge development can evolve in the future by drawing on post‐structural interpretation, and post‐colonial strategy. The post‐structural writings of Deleuze & Guattari's understanding of ‘Nomadology’ as a subtle means to resist being constrained by existing knowledge development structures, might be a useful stance to understanding the urgency of why nursing knowledge should advance addressing the structural influences on its development. Furthermore, Bhabha's post‐colonial elucidation of ‘Hybridity’ as an equally discreet means to change the culture of those constraining structures is an appropriate strategy to enact how nursing knowledge developers can engage with existing power structures, and simultaneously influence that engagement. Taken together, ‘post‐structural stance’ and ‘post‐colonial strategy’ can refocus nursing scholarship to learn from its past, in order to develop relevant disciplinary knowledge in its future. (shrink)

Precarious Others: Valuing Singularity -- Alienation and Exclusion: Appreciating Proximity -- Shamed and Shaming: Honouring Students -- Destitute and Dying: Preserving Dignity -- Fears and Frustrations: Acknowledging Desire -- Revitalizing Teaching as Vocation.

This survey set out to explore occupational health professionals' courses of action with respect to privacy in a situation of dual loyalty between employees and employers. A postal questionnaire was sent to randomly selected potential respondents. The overall response rate was 64%: 140 nurses and 94 physicians returned the questionnaire. Eight imaginary cases involving an ethical dilemma of privacy were presented to the respondents. Six different courses of action were constructed within the set alternatives proposed. The study indicated that privacy (...) as an absolute value is not in the interest of either employees or employers. It also showed that, where dual loyalty is concerned, the most valid course of action in dealing with sensitive subjects such as drug and work community problems, sexual harassment and sick leave is to rely on tripartite co-operation. If they maintain their professional independence and impartiality, health professionals are well placed to succeed in this challenging task; if not, there are bound to be severe violations of privacy. (shrink)

The demand for science trainees to have appropriate responsible conduct of research instruction continues to increase the attention shown by federal agencies and graduate school programs to the development of effective ethics curriculums. However, it is important to consider that the main learning environment for science graduate students and post-doctoral research fellows is within a laboratory setting. Here we discuss an internal laboratory program of weekly 15-minute ethics discussions implemented and used over the last 3 years in addition to the (...) graduate school’s program of scientific integrity training. During this time, the environment and culture within our laboratory has changed to place greater emphasis on the ethical implications of our own research and the research we evaluate. We still struggle with how to accurately assess this behavioral change; although, we present preliminary survey results on the evaluation and impact of this style of curriculum for ethics instruction in our laboratory. (shrink)

A decade ago, conventional wisdom in the medical establishment was that physicians treating chronic pain with opioid analgesics were at a substantial risk of being sanctioned for overprescribing by state medical regulatory boards. Dozens of articles written since have alluded to this risk as an obstacle to effective pain re1ief. In the early 1990s, a number of high profile cases in which physicians were disciplined by regulatory boards for overprescribing to patients with chronic pain were reported in the press. Although (...) the board actions in many of these cases were eventually overturned by state judiciaries, the publicity heightened practitioners’. sensitivity to the regulatory risks associated with prescribing opioids.A review of the available data on state medical board actions nationwide for the period from 1990 to 1996 reveals that the perception of regulatory risk far exceeds the reality. Indeed, relatively few of the disciplinary actions taken for overprescribing by state medical boards in any given year directly concern the treatment of chronic pain—malignant or nonmalignant—in patients. (shrink)

" With more than one hundred photographs, many from the collection of the Getty Museum, Railroad Vision illustrates the parallel histories of railroads and photography-from a photograph of George Stephenson's steam engine Locomotion, to ...

In lieu of an abstract, here is a brief excerpt of the content:Maurice Blondel on the Practice of Supernatural ReligionAnne M. CarpenterIntroductionMaurice Blondel attended daily Mass to the very end of his life.1 This essay is, in a way, a meditation on this fact. But it is more nearly a confrontation with Blondel's philosophical argument in defense of human action's capacity for affirming the infinite, for "containing" the infinite in its affirmation of the infinite, an affirmation achieved in action's finitude. (...) That is, this is an essay on Blondel's argument for a supernatural religion that can be literally practiced. Much like Blondel's larger philosophical works, this essay spends its time exploring the coordinating ground of supernatural religion, which is the natural world split open in two directions: in its very existence, which is a supposition of what absolutely outstrips its power; in its very action, which in ecstasy takes the shape of a desire for a reversal that it cannot offer itself. So the natural world presupposes the supernatural and desires the supernatural while remaining, of its own power, natural. Blondel makes a theoretical distinction in the universe that, concretely, is a natural–supernatural one committed to a single destiny. This theory and this concreteness cohere in order to make the literal practice of religion both possible and necessary, terms that this essay explains. [End Page 1305]Action: The Problem of Theory and PracticeBlondel's later writing in the 1930s expands on an important paradox that appears in the very early L'Action (1893). That paradox has to do with a distinction between theory—that is, the world of ideas and reflection—and practice, by which Blondel means the concrete world of human action, a world that for Blondel is an expansive range or "body" of action. It is true, after all, that an idea is not a deed. And yet no deed is without its idea, without the mediatory power of the act of consciousness, nor without the mediation of this consciousness's rationality—a further synthesizing act within consciousness—even when the deed contradicts reason. "Hence," says Blondel, "it is because we find in our acts a kind of creative sovereignty that we have a consciousness of ourselves and reason; it is because we are reasonable and conscious of ourselves that we judge ourselves capable of voluntary initiative."2 The paradox, at one angle, is this leap or gap, this difference nevertheless sustained by a mediation, where ideas and deeds are non-identical yet inseparable. At another angle, it is a paradox that a "science of practice" has to straddle, since it studies (as science) what it is not: concrete action (practice). Blondel, whether young or of his latter days, is after the possibility of such a science. He is also after the bond between reasoning and acting. In this section, I also seek that bond, and I make use of Blondel's early and later works together to give a sense not of Blondel's development, but of the Gestalt of his life's work with respect to the bond between thought and action.3The bond first requires the rejection of monism. Though Blondel's stance toward theologies of his day tends to be more well-known among theologians, and therefore filtered through questions of nature and grace and carried through to a rejection of a two-tiered conception of the universe, still, his nearer interlocutors are often monists: modern philosophers and the modern sciences, and their strange compatriots in history, the spiritual movements of the fin de siècle, involving spiritualisms of various kinds, recollected in our popular imagination today in visions of crystal balls and séance tables. The positivism of the modern sciences and of modern (French) philosophy poses a totally self-contained "nature" that can be explained [End Page 1306] without religion, in a form of what English speakers might call "secularism," but which is more accurately filtered through French Republican desires for laïcité.4 While Blondel was writing, there were not only these political and scientific and philosophical trends, but also the semi-pantheistic, variously agnostic religious movements that dominated privileged circles in Europe at the time. These are a kind of... (shrink)

Nolan, Ann MC In the past fifty years there has been a stream of commentary on the documents of Vatican II. Have we not had so much commentary, so much interpretation, that further commentary is unnecessary? Fifty years on, one might ponder how to interpret the sixteen documents for the church of our times, indeed to wonder whether they continue to have any relevance at all. Faced with this thought, we could turn to one scholar whose works span almost the (...) whole of this fifty-year period, yet whose thought in relation to the documents has not remained static: the renaissance historian John O'Malley SJ. (shrink)

We propose that IAM and déjà vu may not share a placement on the same gradient, per se, but the mechanism of cue familiarity detection, and a major differentiating factor between the two metacognitive experiences is whether the resulting inward directed search of memory yields retrieved content or not. Déjà vu may manifest when contentless familiarity detection is inexplicable by the experiencer.

Research on emotion and psychopathology has blossomed due in part to the translation of affective science theory and methods to the study of diverse disorders. This translational approach has helped the field to hone in more precisely on the nature of emotion deficits to identify antecedent causes and maintaining processes, and to develop promising new interventions. The future of emotion research in psychopathology will benefit from three inter-related areas, including an emphasis on emotion difficulties that cut across traditional diagnostic boundaries (...) (i.e., a transdiagnostic approach), the explicit linking of emotion and cognition in behavioral and neuroimaging studies in psychopathology, and continued translation of the latest conceptualizations of emotion to the study of psychopathology. (shrink)

Inattentional Blindness occurs when observers engaged in resource-consuming tasks fail to see unexpected stimuli that appear in their visual field. Eye movements were recorded in a dynamic IB task where participants tracked targets amongst distractors. During the task, an unexpected stimulus crossed the screen for several seconds. Individuals who failed to report the unexpected stimulus were deemed to be IB. Being IB was associated with making more fixations and longer gaze times on distractor stimuli, being less likely to fixate the (...) unexpected stimulus, and having lower working memory capacity than those who were not IB. Noticing the unexpected stimulus was not contingent upon fixating it, suggesting that some individuals processed the unexpected stimulus via covert attention. The findings support earlier research on working memory and IB. In addition, IBs were less efficient attentional allocators than those who were not IB, as reflected in their eye tracking of irrelevant distractors. (shrink)

The distinction between stakeholders and shareholders frequently employed in business ethics can illuminate challenges faced by a bioethics advisory panel. I use the distinction to reflect back on the work of an advisory panel on which I served, a panel on US transplant policy. The panel hearings were akin to a shareholders’ meeting, with many stakeholders absent. In addition to ‘hearing out’ the shareholders who were present, the panel had duties to absent stakeholders to insure their interests were included in (...) public discussion. While panel efforts to include stakeholder perspectives rightfully framed its report, such duties should have framed its operating procedures more robustly. The stakeholder/shareholder distinction also offers a critical prism on the actual evolution of organ allocation policy, which the panel failed to influence. Current policy embodies a compromise among shareholders that obscures major stakeholder interests. This results in under‐attention to likely medical benefit of transplant, compared to other allocation criteria. Recognition of duties to stakeholders amidst pressures of shareholders complicates the notion of ‘consensus’ for an advisory panel. Consensus framed on terms defined only by shareholders, not stakeholders, may be an inadequate measure of public interest. (shrink)

This paper engages with debates around transformations in the production and circulation of images and the changes in modes of perception that these offer. Paul Virilio has argued that technological developments have produced a shift in the site of meaning‐production from the material reference space of the image to the time of visual contact by the viewer. I consider what significance these temporalities have in relation to social difference, and I develop debates around the performative to consider how the viewer (...) is constituted in visual performativity. This focus on time and performativity opens up questions of how vision may constitute the agency, intention and responsibility of the viewer. Drawing on an example of visual irony in advertising, I explore how the temporal suspension of meanings allows for a suspension of the terms of intent and responsibility. This visual performative accesses and reworks the terms of social difference and privilege in what I have called ‘retroactive intentionality’. (shrink)

This study was designed to compare the natural free form communication that takes place when a person interacts with robotic entities versus live animals. One hundred and eleven participants interacted with one of four entities: an AIBO robotic dog, Legobot, Dog or Cat. It was found that participants tended to rate the Dog as more capable than the other entities, and often spoke to it more than the robotic entities. However, participants were not positively biased toward live entities, as the (...) Cat often was thought of and spoken to similarly to the AIBO robot. Results are consistent with a model in which both appearance and interactivity lead to the development of beliefs about a live or robotic entity in an interaction. Keywords: Human-robot interaction; human-animal interaction; AIBO; free form communication; attributions; human-entity interaction. (shrink)

Traditional theistic proofs are often understood as evidence intended to compel belief in a divinity. John Clayton explores the surprisingly varied applications of such proofs in the work of philosophers and theologians from several periods and traditions, thinkers as varied as Ramanuja, al-Ghazali, Anselm, and Jefferson. He shows how the gradual disembedding of theistic proofs from their diverse and local religious contexts is concurrent with the development of natural theologies and atheism as social and intellectual options in early modern Europe (...) and America. Clayton offers a fresh reading of the early modern history of philosophy and theology, arguing that awareness of such history, and the local uses of theistic argument, offer important ways of managing religious and cultural difference in the public sphere. He argues for the importance of historically grounded philosophy of religion to the field of religious studies and public debate on religious pluralism and cultural diversity. (shrink)

Recently, we reported that melanoma risk in redheads is linked not only to pale skin, but also to the synthesis of the pigment – called pheomelanin – that gives red hair its color. We demonstrated that pheomelanin synthesis is associated with increased oxidative stress in the skin, yet we have not uncovered the chemical pathway between the molecule pheomelanin and the DNA damage that drives melanoma formation. Here, we hypothesize two possible pathways. On one hand, pheomelanin might generate reactive oxygen (...) species (ROS) that directly or indirectly cause oxidative DNA damage. On the other hand, pheomelanin synthesis might consume cellular antioxidant stores and make the cell nucleus more vulnerable to other endogenous ROS. Uncovering the mechanistic pathway between pheomelanin and oxidative DNA damage will be an important step in developing strategies to lower melanoma risk in redheads. (shrink)

Background: ICU patients’ family members are in a new, uncertain, and vulnerable situation due to the patient’s critical illness and complete dependence on the ICU nurses and physicians. Family members’ feeling of being cared for is closely linked to clinicians’ attitudes and behavior. Aim: To explore ICU nurses’ and physicians’ bedside interaction with critically ill ICU patients´ families and discuss this in light of the ethics of care. Research design: A qualitative study using participant observation, focus groups, and thematic narrative (...) analysis. Participants and research context: Data were gathered from July 2017 to August 2019, in four ICUs in Norway through 270 h of fieldwork and seven focus groups with ICU nurses and physicians. Ethical considerations: The Regional Committee for Medical and Health Research Ethics and the Norwegian Centre for Research Data approved the study. Findings: Quality of ICU family care depends on nurses’ and physicians’ attitudes, behavior, and personality traits. Three main themes were identified: being attentive, an active approach, and degree of tolerance. Discussion: The findings are discussed in light of the ethics of care and empirical research from the intensive care environment. Conclusions: This study shows that attentive, active, and tolerant clinicians represent a culture of ethical care that gives families greater freedom of action and active participation in patient care. Clinicians must not bear sole responsibility for this culture; it must have a firm basis in the hospital and ICU and be established through training, interprofessional reflection, and support of clinicians. (shrink)

We examine the influences of social capital, source credibility, and fairness perceptions on the judgments of experienced compensation committee members who are considering a proposal to reduce management’s performance targets in the middle of a compensation cycle due to difficult circumstances. Eighty-nine U.S. public company CC members participated in a 2 × 2 experiment with social capital and source credibility each manipulated as low or high, and outcome fairness to management, process fairness to shareholders, and outcome fairness to shareholders included (...) as measured variables. While social capital and source credibility are not significant, we find that outcome fairness to the CEO and outcome fairness to shareholders are significantly related to CC members’ support for reducing performance targets during a compensation cycle. In addition, we find that more experienced CC members are less supportive of changing the performance targets. The significant interactions include one between outcome fairness to shareholders and process fairness to shareholders, which suggests that CC member support for the proposal relies on both process and outcome fairness being present. Finally, the participants’ qualitative responses reflect arguments both for and against adjusting performance targets. Overall, the results highlight the important roles of fairness and director experience in boardroom decisions and provide important insights into factors affecting CC judgments. (shrink)

Ethicists differ considerably in their reasons for using empirical data. This paper presents a brief overview of four traditional approaches to the use of empirical data: “the prescriptive applied ethicists,” “the theorists,” “the critical applied ethicists,” and “the particularists.” The main aim of this paper is to introduce a fifth approach of more recent date (i.e. “integrated empirical ethics”) and to offer some methodological directives for research in integrated empirical ethics. All five approaches are presented in a table for heuristic (...) purposes. The table consists of eight columns: “view on distinction descriptive-prescriptive sciences,” “location of moral authority,” “central goal(s),” “types of normativity,” “use of empirical data,” “method,” “interaction empirical data and moral theory,” and “cooperation with descriptive sciences.” Ethicists can use the table in order to identify their own approach. Reflection on these issues prior to starting research in empirical ethics should lead to harmonization of the different scientific disciplines and effective planning of the final research design. Integrated empirical ethics (IEE) refers to studies in which ethicists and descriptive scientists cooperate together continuously and intensively. Both disciplines try to integrate moral theory and empirical data in order to reach a normative conclusion with respect to a specific social practice. IEE is not wholly prescriptive or wholly descriptive since IEE assumes an interdepence between facts and values and between the empirical and the normative. The paper ends with three suggestions for consideration on some of the future challenges of integrated empirical ethics. (shrink)

A translator and her science consultant, who have worked together on many books, consider the problems of translating primary and secondary texts in science. Various problems encountered in translating an ongoing documentary edition in the history of science are discussed using the collected works of Albert Einstein as a test case. For instance, each language has its own preferred sentence structure; moreover, not every historical term finds a perfect equivalent in modern usage, and historical accuracy is contextually bounded.

John Haught has awarded the debates between religion (Christianity in particular) and science a central place in his ongoing corpus of work. Seeking to encourage and enhance the conversation, Haught both critiques current positions and offers his own perspective as a potential ground for continuing the discussion in a fruitful manner. This essay considers Haught's primary criticisms of the voices on both sides of the debate which his work connotes as polarizing or conflating the debate. It also extrudes from Haught's (...) work themes that provide alternative visions. The essay concludes with two questions for further consideration. (shrink)