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)

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)

A central feature of our waking mental experience is that our attention naturally toggles back and forth between “external” and “internal” stimuli. In the midst of an externally demanding task, attention can involuntarily shift internally with no clear reason how or why thoughts momentarily shifted inward. In the case of external attention, we are typically exploring and encoding aspects of our external world, whereas internal attention often involves searching for and retrieving potentially relevant information from our memory networks. Cognitive science (...) has traditionally focused on understanding forms of internal and external attention separately, leaving a mystery about what sparks the seemingly automatic shifts between the two. Specifically, what shifts attentional focus from being outward‐directed to being inward‐directed? We present a candidate mechanism: Familiarity‐detection. (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.

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)

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.

Agricultural intensification and extensification are standard responses to ecological and economic vulnerability among smallholder communities. Climate change has exacerbated this vulnerability and thrown the complexity of and critical need for managing a healthy natural resource base while increasing on-farm productivity into sharp light. Sustainable intensification is one of many mechanisms for accomplishing this balancing act. This study examines the adoption of sustainable intensification practices, namely input packages focused on tef row planting—designed to boost yield and promote more efficient use of (...) inputs. This study utilized a mix methods approach to survey 115 smallholder farmers in the South Wollo zone of the Amhara region in Ethiopia. This study found that cash and capital, more so than contact with the AIS, influenced farmers’ decisions to adopt row planting input packages. Khat production was an important source of cash for inputs and was more likely to be available to farmers with irrigation schemes. Long-term, farmers who cultivate khat may not successfully engage in SI, as khat replaces traditional food crop production in the region. Yet, for farmers who do not grow khat, long-term investment in SI practices is unlikely unless access to affordable credit options is improved. (shrink)

BackgroundCRISPR-Cas9, a technology enabling modification of the human genome, is developing rapidly. There have been calls for public debate to discuss its ethics, societal implications, and governance. So far, however, little is known about public attitudes on CRISPR-Cas9. This study contributes to a better understanding of public perspectives by exploring the various holistic perspectives Dutch citizens have on CRISPR-Cas9.MethodsThis study used Q methodology to identify different perspectives of Dutch citizens (N = 30) on the use of CRISPR-Cas9. The Q-sort method (...) aims at segmenting audiences based on the structural characteristics of their perspectives. Participants individually ranked 32 statements about CRISPR-Cas9 and discussed their rankings in small groups. By-person factor analysis was performed using PQMethod. Participants’ contributions to the discussions were used to further make sense of the audience segments identified.ResultsFive perspectives on CRISPR-Cas9 were identified: (1) pragmatic optimism (2) concerned scepticism; (3) normative optimism; (4) enthusiastic support; and (5) benevolent generalism. Each perspective represents a unique position motivated by different ranking rationales. Sorting rationales included improving health, preventing negative impacts on society, and fear of a slippery slope. Overall, there is broad, but not universal support for medical uses of CRISPR-Cas9.ConclusionsResearch on CRISPR-Cas9 should prioritise the broadly supported applications of the technology. Research and public debates on CRISPR-Cas9, its uses, its broader implications, and the governance of CRISPR-Cas9 are recommended. A discourse that includes all perspectives can contribute to the embedding of future uses of CRISPR-Cas9 in society. This study shows that Q methodology followed by group discussions enables citizens to contribute meaningfully to discourses about research. (shrink)

Ansel Adams, Robert Adams, Carlos Almaraz, Robert Arneson, John Baldessari, Lewis Baltz, Robert Bechtle, Jeff Brouws, Laurie Brown, Angela Buenning, Darlene Campbell, Mark Campbell, Gary Carlos, Fandra Chang, Stephane Couturier, Robert Dawson, Joe Deal, Richard Diebenkorn, John Divola, Beth Yarnelle Edwards, Kota Ezawa, William A. Garnett, Jeff Gillette, Joe Goode, Todd Hido, David Hockney, Salomon Huerta, Robert Isaacs, Thomas Lawson, Jean Lowe, Alex MacLean, Richard Meisinger, Jr., Richard Misrach, Rick Monzon, Barrie Mottishaw, Martin Mull, Deborah Oropallo, Bill Owens, Rondal Partridge, (...) John Register, Ed Ruscha, Peter Saul, Mary Snowden, Joel Sternfeld, Larry Sultan, Rudy Vanderlans, Camilo Jose Vergara, Henry Wessel, Amir Zaki. (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 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)

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 edition aims to make Margaret Cavendish’s most mature philosophical work more accessible to students and scholars of the period. _Grounds of Natural Philosophy_ is important not only because it is Cavendish’s final articulation of her metaphysics but also because it succinctly outlines her fundamental views on “the nature of nature”—or the base substance and mechanics of all natural matter—and vividly demonstrates her probabilistic approach to philosophical enquiry. Moreover, _Grounds_ spends considerable time discussing the human body, including the functions of (...) the mind, a topic of growing interest to both historians of philosophy and literary scholars. This Broadview Edition opens to modern readers a vibrant, unique, and provocative voice of the past that challenges our standard view of seventeenth-century English philosophy. (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)

This paper outlines a strategy for teaching an Introduction to Philosophy anthology. The author argues that students in introductory philosophy courses are unable to comprehend primary sources in philosophy anthologies because of the distance and foreignness of the text. A course relying on lectures as the primary mode of engagement with texts results in mere exposition and does not facilitate a critical engagement with primary texts for students. The author suggests that teachers in introductory courses should integrate weekly and monthly (...) writing assignments into the curriculum to help facilitate a critical engagement with primary texts. The writing assignments provide students with constant feedback on their own thoughts and allow educators to assess how well students read and comprehend primary sources before the course lectures. The writing assignments also encourage more classroom discussion because students are able to think through their objections and critiques and to feel more comfortable talking in class. (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)

Developments in neuroscience over the last few decades have shown an increasing interest in examining art and culture as a means of acquiring a greater understanding of the human brain. By the same token, our knowledge of the brain can be tremendously helpful in the study of cultural output, not only in terms of how culture works in a biological sense but why it remains so indispensable and integral to the well-being of individuals and societies. In Self Comes to Mind, (...) neuroscientist Antonio Damasio describes the development of culture as a form of homeostasis that regulates our social environments and engages the very same neurological mechanisms that manage our internal bodily environments. These mechanisms are... (shrink)

If capitalism is being increasingly understood as performative and processual, and if these understandings are being folded into capitalism's production of itself, what place does gender have in performing the commercial world? This article argues that the significance of gender as genre or type has been overlooked in the recent literature on the performance of the market or market relations. While the role of economic theories and management practices in making markets has been examined, and the place of women in (...) organizations has been explored, little attention has been paid to how gender as a productive process marks the creation and maintenance of market relations. Using material from a recent ethnographic study of the advertising industry, I examine how advertising practitioners incorporate vitalist understandings of market relations and of knowledge-producing activities into their practices. Framed as `creativity' and `innovation', these discursive practices perform what practitioners understand as a reproductive function in commercial life. (shrink)

This essay offers a preliminary account of the ways in which alterations to the landscape of fourteenth- and fifteenth-century Sukhothai and Chiang Mai figured within the micro-politics of these city-states. I show how landscape alterations inspired by Lanka and mainland South Asia served the consolidation and projection of royal power within the context of local and regional competition, and how such alterations formed part of strategic royal engagement with Buddhist monastic lineages.

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)

Euthanasia advocates have recently begun counseling people to create advance directives calling for oral food and water to be withheld if the person reaches a certain stage of dementia. The author shows that these directives are in fact requests for euthanasia, and they leave vulnerable people subject to poor-quality care. Both surrogate decision makers and Catholic institutions have a moral obligation not to implement such directives, and surrogates, rather than withdrawing as proxies, have a moral obligation to advocate for the (...) life and proper care of the incompetent person. Finally, the author argues that society is morally culpable if it does not strongly resist euthanasia in all its forms. National Catholic Bioethics Quarterly 16.3 : 421–434. (shrink)

IT IS NO LONGER UNUSUAL to find ethical or moral relativism defended, yet there remains some uneasiness about the position, even among its defenders. Richard Brandt, for example, who offers a version he finds "somewhat plausible," admits that he and most other philosophers "have an anti-relativist predilection, at least when we come to moral issues which are important.".

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)

Déjà vu is the striking sense that the present situation feels familiar, alongside the realization that it has to be new. According to the Gestalt familiarity hypothesis, déjà vu results when the configuration of elements within a scene maps onto a configuration previously seen, but the previous scene fails to come to mind. We examined this using virtual reality technology. When a new immersive VR scene resembled a previously-viewed scene in its configuration but people failed to recall the previously-viewed scene, (...) familiarity ratings and reports of déjà vu were indeed higher than for completely novel scenes. People also exhibited the contrasting sense of newness and of familiarity that is characteristic of déjà vu. Familiarity ratings and déjà vu reports among scenes recognized as new increased with increasing feature-match of a scene to one stored in memory, suggesting that feature-matching can produce familiarity and déjà vu when recall fails. (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)

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)

This paper explores the notion of practical wisdom asan alternative to current formulations of criticalthinking. The practical realm is that ofill-structured problems that emerge from life aslived; it is a realm of legitimate uncertainty andambiguity that requires an ethical responsiveness orpractical wisdom. The death of a child is a case inpoint. The author identifies and examines threeaspects of practical wisdom – the ethical claims ofpartiality, a yielding responsiveness and the play ofthought – and juxtaposes them with aspects of criticalthinking. The (...) work of Martha Nussbaum and RichardPaul are interwoven throughout the discussion. Theauthor concludes that the discourse of criticalthinking is in danger of lapsing into a form of moralescapism wherein all we are rationally responsible foris thinking correctly. Practical wisdom, on theother hand, recognizes that thinking is not simply anintellectual cognitive act of an individual but adance between the life of a child and the love of anelder, a conversation between what is and what couldbe, an openness to passionate sorrow and surprise, aplay between understanding and perception. As such,practical wisdom provides a more likely account ofliving in good faith with oneself and others. (shrink)