Glucagon-like peptide-1 receptor agonists are effective for treating obesity, but the high cost of these medications endangers the financial viability of our health care system. To ensure that these drugs are available to Medicare beneficiaries, pharmaceutical manufacturers must lower their prices.

Background: The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought. Objectives: This study explored nurses’ care practices at the end (...) of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity. Research Design and context: Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated. Ethical Considerations: Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals. Findings: A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting. Discussion: Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members. Conclusion: Despite the avoidance of death talk and nurses’ lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values. (shrink)

The aim of this article is to explore the images of nursing that were presented in the media during the recent industrial action by nurses and midwives in the Republic of Ireland. Although both nurses and midwives took industrial strike action, the strike was referred to as ‘the nurses’ strike’ and both nurses and midwives were generally referred to by the generic term ‘nurses’. Data were gathered from the printed news media of The Irish Times over a period of one (...) month - 4 October to 4 November 1999 - which included the nine days of the strike. Although we limited the source of our data to just one newspaper, the findings do provide an image of how nurses and nursing care are viewed by both health professionals and the public. This image appeared to give a higher value to masculine cultural codes and the performance of technical skills, whereas acts associated with feminine cultural codes of caring were considered of lower value. (shrink)

This paper addresses the explanatory role of the concept of a motive for action in economics. The aim of the paper is to show the difficulty economists have to accommodate the motive of commitment into their explanatory and predictive framework, i.e. rational choice theory. One difficulty is that the economists’ explanation becomes analytic when assuming preferences of commitment. Another difficulty is that it is highly doubtful whether commitment can be represented by current frameworks while (pre-)serving the ‘folk-psychological’ idea of what (...) is commonly understood by the idea of a commitment. Both difficulties lead to the conclusion that, although motives do matter, conceptualizing the motive of commitment would cause trouble for rational choice theory. (shrink)

For many decades, access to human biological samples, such as cells, tissues, organs, blood, and sub-cellular materials such as DNA, for use in biomedical research, has been central in understanding the nature and transmission of diseases across the globe. However, the limitations of current ethical and regulatory frameworks in sub-Saharan Africa to govern the collection, export, storage and reuse of these samples have resulted in inconsistencies in practice and a number of ethical concerns for sample donors, researchers and research ethics (...) committees. This paper examines stakeholders’ perspectives of and responses to the ethical issues arising from these research practices. (shrink)

Motor development – traditionally studied in WEIRD populations – falls victim to assumptions of universality similar to other domains described by Henrich et al. However, cross-cultural research illustrates the extraordinary diversity that is normal in motor skill acquisition. Indeed, motor development provides an important domain for evaluating cultural challenges to a general behavioral science.

In this commentary on Osiurak and Reynaud's target article, we argue that action is largely missing in their account of the ascendance of human technological culture. We propose that an action-based developmental account can help to bridge the cognitive-sociocultural divide in explanations of the discovery, production, and cultural transmission of human tool use.

Faculty plagiarism and fraud are widely documented occurrences but little analysis has been conducted. This article addresses the question of why faculty plagiarism and fraud occurs and suggests approaches on how to develop an environment where faculty misconduct is socially inappropriate. The authors review relevant literature, primarily in business ethics and student cheating, developing action steps that could be applied to higher education. Based upon research in these areas, the authors posit some actions that would be appropriate in higher education (...) and suggest topics for continued study. (shrink)

Despite the burgeoning literature on professionalism in other health professions, psychology lags behind in the level of attention given to this core competency. In this article, we review definitions from other health professions and how they address professionalism. Next, we review how this competency evolved within health service psychology (HSP), and we propose a definition. We offer an approach for assessing professionalism within HSP. Consideration is given to strategies and methods for providing effective education and training in this multifaceted competency. (...) Finally, recommendations are made for creating a culture of professionalism within HSP and honoring psychology’s social contract with multiple publics. (shrink)

Gene therapies to treat sickle cell disease are in development and are expected to have high costs. The large eligible population size — by far, the largest for a gene therapy — poses daunting budget challenges and threatens to exacerbate health disparities for Black patients, who make up the vast majority of American sickle cell patients.

Director compensation can potentially represent an ethical minefield. When faced with supporting strategic decisions that can lead to an increase in director pay, directors may consider their own interests and not solely those of the shareholders to whom they are legally bound to represent. In such cases, directors essentially become agents, rather than those installed to protect principals (shareholders) from agents. Using acquisitions as a study context, we employ a matched-pair design and find a statistically significant difference in outside director (...) compensation between acquiring and control firms. Outside directors of acquiring firms earn more than twice as much as their counterparts in the matched-sample. (shrink)

Artificial intelligence systems advising healthcare professionals will be widely introduced into healthcare settings within the next 5–10 years. This paper considers how this will sit with tort/negligence based legal approaches to compensation for medical error. It argues that the introduction of AI systems will provide an additional argument pointing towards no-fault compensation as the better legal solution to compensation for medical error in modern health care systems. The paper falls into four parts. The first part rehearses the main arguments for (...) and against no-fault compensation. The second explains why it is likely that AI systems will be widely introduced. The third part analyses why it is difficult to fit AI systems into fault-based compensation systems while the final part suggests how no-fault compensation could provide a possible solution to such challenges. (shrink)

Drug Safety Communications are used by the Food and Drug Administration to inform health care providers, patients, caregivers, and the general public about safety issues related to FDA-approved drugs. To assess patient knowledge of the messaging contained in DSCs related to the sleep aids zolpidem and eszopiclone, we conducted a large, cross-sectional patient survey of 1,982 commercially insured patients selected by stratified random sampling from the Optum Research Database who had filled at least two prescriptions for either zolpidem or eszopiclone (...) between July 1, 2012 and June 30, 2013. Among the 594 respondents, two-thirds reported hearing generally about drug safety information prior to starting a new drug, with the remaining one-third “rarely” or “never” hearing such information. Providers and pharmacists were primary sources of drug safety information. Two-thirds of zolpidem users and half of eszopiclone users reported having heard about the related DSC messages, ability to accurately identify the major factual messages was limited. Respondents reacted to new drug safety information about their sleep aids by reporting that they would want to learn about alternative ways to help them sleep and seek out more information about the safety of their specific sleeping pill. Opportunities may exist for the FDA to work with providers and pharmacies to help ensure the DSC information is more widely received and is more fully understood by those taking the affected medications. (shrink)

The rapidly changing field of genetics affects society through advances in health-care and through implications of genetic research. This study addresses the impacts of new genetic discoveries and technologies on different segments of today's society. The book begins with a chapter on genetic complexity, and subsequent chapters discuss moral and ethical questions arising from today's genetics from the perspectives of health care professionals, the media, the general public, special interest groups and commercial interests.

ABSTRACT This article proposes rhetorical hegemony as a new materialist intervention into the production of alternative political economic futures. It problematizes contemporary theories of hegemony that assert affect as beyond rhetorical engagement, suggesting that these accounts fail to produce viable political economic alternatives because they use, but do not reinvent, the prevailing affective relations. Turning to and extending Foucault's middle and late work to forge a different model, the article discusses rhetorical hegemony as the entangled relationships between materiality and power. (...) In conversation with other contemporary theories, it argues for a practice of rhetorical hegemony that materially recapacitates energetic potential and, consequently, the milieu. The article ends by outlining the rhetorical, political, and intellectual implications of this shift. (shrink)

Severe staffing shortages have emerged as a prominent threat to maintaining usual standards of care during the COVID-2019 pandemic. In dire settings of crisis capacity, healthcare systems assume the ethical duty to maximise aggregate population-level benefit of existing resources. To this end, existing plans for rationing mechanical ventilators and intensive care unit beds in crisis capacity focus on selecting individual patients who are most likely to survive and prioritising these patients to receive scarce resources. However, staffing capacity is conceptually different (...) from availability of these types of discrete resources, and the existing strategy of identifying and prioritising patients with the best prognosis cannot be readily adapted to fit this real-world scenario. We propose that two alternative approaches to staffing resource allocation offer a better conceptual fit: (1)prioritise the worst off: restrict access to acute care services and hospital admission for patients at relatively low clinical risk and (2)prioritise staff interventions with high near-term value: universally restrict selected interventions and treatments that require substantial staff time and/or energy but offer minimal near-term patient benefit. These strategies—while potentially resulting in care that deviates from usual standards–support the goal of maximising the aggregate benefit of scarce resources in crisis capacity settings triggered by staffing shortages. This ethical framework offers a foundation to support institutional leaders in developing operationalisable crisis capacity policies that promote fairness and support healthcare workers. (shrink)

This paper addresses three factors that have contributed to shifts in decision making in health care. First, the notion of patient autonomy, which has changed due to the rise of patient-centred approaches in contemporary health care and the re-conceptualization of the physician-patient relationship. Second, the understanding of patient autonomy has broadened to better engage patient participation. Third, the need to develop cross-cultural health care ethics. Our paper shows that the shift in the West from the individual to the relational self (...) indicates an important change in the understanding of autonomy through the lens of culture. Practices that recognize the notion of the relational self allow for a more balanced view of autonomy and a richer conception of moral agency. (shrink)

We examined the course of caregiver motherese and the course of the infant’s response based on home movies from two single cases: a boy with typical development and a boy with autistic development. We first blindly assessed infant CG interaction using the Observer computer-based coding procedure, then analyzed speech CG production using a computerized algorithm. Finally we fused the two procedures and filtered for co-occurrence. In this exploratory study we found that the course of CG parentese differed based on gender (...) and child status. The course of an infant’s response to CG vocalization differed according to the type of speech and child status. Mothers spent more time interacting with infants, and fathers appeared to interact with their child preferentially between 12 and 18 months in the TD boy, but not in the AD boy. The TD boy responded equally well to motherese compared to other speech after 1 year of age. For the AD boy, the responses to both types of speech were lower than in the boy with TD and decreased from the second to the third semester. Keywords: Autism; motherese; early interaction; computational methods. (shrink)

Anyone preparing to work through Catherine Wilson's important 1989 book, Leibniz's Metaphysics, would be well advised to go back for another look at Bertrand Russell's Critical Exposition of the Philosophy of Leibniz, for it is this book that provides the foil and the context for much that Wilson has to say. In particular, the preface to Russell's first edition stresses the very points regarding both methodology and content on which Wilson will disagree most vigorously with her predecessor.

This study of the metaphysics of G. W. Leibniz gives a clear picture of his philosophical development within the general scheme of seventeenth-century natural philosophy. Catherine Wilson examines the shifts in Leibniz's thinking as he confronted the major philosophical problems of his era. Beginning with his interest in artificial languages and calculi for proof and discovery, the author proceeds to an examination of Leibniz's early theories of matter and motion, to the phenomenalistic turn in his theory of substance and (...) his subsequent de-emphasis of logical determinism, and finally to his doctrines of harmony and optimization. Specific attention is given to Leibniz's understanding of Descartes and his successors, Malebranche and Spinoza, and the English philosophers Newton, Cudworth, and Locke. Wilson analyzes Leibniz's complex response to the new mechanical philosophy, his discontent with the foundations on which it rested, and his return to the past to locate the resources for reconstructing it. She argues that the continuum-problem is the key to an understanding not only of Leibniz's monadology but also of his views on the substantiality of the self and the impossibility of external causal influence. A final chapter considers the problem of Leibniz-reception in the post-Kantian era, and the difficulty of coming to terms with a metaphysics that is not only philosophically "critical" but, at the same time, "compensatory.". (shrink)

BackgroundThe proper and ethical inclusion of PWLHIV and their young children in research is paramount to ensure valid evidence is generated to optimize treatment and care. Little empirical data exists to inform ethical considerations deemed most critical to these populations. Our study aimed to systematically review the empiric literature regarding ethical considerations for research participation of PWLHIV and their young children.MethodsWe conducted this systematic review in partnership with a medical librarian. A search strategy was designed and performed within the following (...) electronic databases: Ovid MEDLINE, Embase and CINAHL. We screened titles and abstracts using the following inclusion criteria: (1) a study population of PWLHIV or children under 5 years of age; and (2) collection of qualitative or quantitative data regarding ethics of research participation. Excluded were reviews, commentaries, policy statements, clinical care-related ethics concerns, abstracts, case studies, or studies unrelated to HIV research. Studies were appraised for quality, data were extracted, and studies were qualitatively analyzed using a principle-based ethical framework within the Belmont Report.ResultsOf the 7470 titles identified, 538 full-text articles were reviewed for eligibility and only three articles met full criteria for inclusion within this review. While we allowed for inclusion of studies involving young children born to mothers with HIV, only articles focused on PWLHIV were identified. Within the results of these studies, four themes emerged: (1) adequacy of informed consent; (2) consideration of paternal involvement; (3) balancing risks; and (4) access to research and treatment. A strength of this review is that it included perspectives of international research investigators, community leaders, and male partners. However, only two studies collected empiric data from PWLHIV regarding their experiences participating in researchConclusionResearchers and funding agencies should be aware of these considerations and appreciate the value of and critical need for formative research to ensure clinical trials involving PWLHIV promote ethical, well-informed research participation and, ultimately, improve care outcomes. More research is needed to create a comprehensive ethical framework for researchers when conducting studies with PWLHIV. (shrink)

Catherine Zuckert examines the work of five key philosophical figures from the nineteenth and twentieth centuries through the lens of their own decidedly postmodern readings of Plato. She argues that Nietzsche, Heidegger, Gadamer, Strauss, and Derrida, convinced that modern rationalism had exhausted its possibilities, all turned to Plato in order to rediscover the original character of philosophy and to reconceive the Western tradition as a whole. Zuckert's artful juxtaposition of these seemingly disparate bodies of thought furnishes a synoptic view, (...) not merely of these individual thinkers, but of the broad postmodern landscape as well. The result is a brilliantly conceived work that offers an innovative perspective on the relation between the Western philosophical tradition and the evolving postmodern enterprise. (shrink)

This study of the metaphysics of G. W. Leibniz gives a clear picture of his philosophical development within the general scheme of seventeenth-century natural philosophy. Catherine Wilson examines the shifts in Leibniz's thinking as he confronted the major philosophical problems of his era. Beginning with his interest in artificial languages and calculi for proof and discovery, the author proceeds to an examination of Leibniz’s early theories of matter and motion, to the phenomenalistic turn in his theory of substance and (...) his subsequent de-emphasis of logical determinism, and finally to his doctrines of harmony and optimization. Specific attention is given to Leibniz’s understanding of Descartes and his successors, Malebranche and Spinoza, and the English philosophers Newton, Cudworth, and Locke. Wilson analyzes Leibniz’s complex response to the new mechanical philosophy, his discontent with the foundations on which it rested, and his return to the past to locate the resources for reconstructing it. She argues that the continuum-problem is the key to an understanding not only of Leibniz’s monadology but also of his views on the substantiality of the self and the impossibility of external causal influence. A final chapter considers the problem of Leibniz-reception in the post-Kantian era, and the difficulty of coming to terms with a metaphysics that is not only philosophically "critical" but, at the same time, “compensatory.” Originally published in 2050. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

Societal problems are not solved by individualistic interventions, but nor are systemic approaches optimal given their neglect of the social psychology underpinning group dynamics. This impasse can be addressed through agroup-level analysis (a “g-frame”) that social identity theorizing affords. Using a g-frame can make policy interventions more adaptive, inclusive, and engaging.

Book synopsis: The feminist movement has challenged many of the unstated assumptions on which ethics as a branch of philosophy has always rested - assumptions about human nature, moral agency, citizenship and kinship. The twenty-six readings in this book express the discontent of a succession of fiercely articulate women writers, from Mary Wollstonecraft to the present day, with the masculine bias of `morality'. The editors have contributed an overall introduction, which discusses ethics, feminism and feminist themes in ethics, and have (...) provided introductions to each of the readings, designed to situate in their historical and intellectual context. They have also compiled two lists for further reading: `Ethics: a Feminist Bibliography' and `The Male Tradition'. Ethics: A Feminist Reader is an essential resource for students and teachers of philosophy, political theory and women's studies. For anyone with a stake in progressive sexual politics it is an inspirational guide. (shrink)

Do the nonverbal signals used to make social judgements differ depending on the type of judgement being made and what other nonverbal signals are visible? Experiment 1 investigated how nonverbal signals across three channels (face: angry/fearful, posture: expanded/contracted, lean: forward/backward), when viewed together, were used for judgements of emotion, threat, and status. Experiment 2 replicated Experiment 1 and explored how use of the body channels differed in making social judgements when the face channel was obscured. Both experiments found facial anger (...) linked to high anger, threat, and status ratings; facial fear was linked to low ratings. Expanded body posture increased threat and status judgements, while backward lean decreased anger and threat. With the face channel blocked (Experiment 2B), the influence of body posture increased across emotion, threat, and status judgements, while body lean was more consistent. Findings demonstrate that despite the face’s importance across types of social judgements, the body channels differentially contribute to judgements of emotion, threat and status. Further, they are differentially affected by the absence of facial information. How much face and body-related channels are used in social judgements is moderated by the type of judgement being made and the availability of other (particularly facial) channel information. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:You Mean It’s Not My Fault:Learning about Lipedema, a Fat DisorderCatherine A. Seo“As a surgeon there is nothing more I can do for you. You need to lose 75 pounds before I can even consider repairing the damage done.” Implied and not directly stated, “… Because it’s your fault.” I sat listening, dumbfounded. I was at one of the top teaching hospitals in the country, face to face with (...) a respected Harvard Medical School trained surgeon who came highly recommended.I had seemingly irreversible damage that was leading to permanent immobility. I was experiencing excessive and uncontrollable swelling in my extremities. I was in unrelenting pain that prevented me from sleeping through the night.The surgeon looked down at the floor avoiding my gaze and—after never before mentioning weight as a possible contraindication to surgery during any of our interactions associated with five surgeries, in over two years, including at least 25 consultations, pre-op, post-op, or follow-up visits stated—in essence, “I can’t help you. You are too fat. It’s your fault.” Not until now, this moment, a couple of months after “the-surgery-gone-wrong-that-ended-in-terrible-complications,” I was being told that it was my fault.He then looked down at his pager that had conveniently buzzed within minutes after he delivered this news, and then walked out of the examining room leaving me to fend for myself in dealing with serious and life-changing complications. Susan1*, his Nurse Practitioner, printed out and handed me a standard listing of BMI calculations, marched me into the common hallway to weigh me, pointed out my BMI >30, reinforced the message that he would do nothing to remedy this horrific situation unless I lost 75 pounds, and then sent me on my way.I stood outside the hospital in shock. This just wasn’t happening, and it couldn’t be happening to me. I had grown to trust this surgeon, and I was struggling to comprehend what had just happened. As the shock wore off, I reengaged in several failed attempts to get help from him. He seemed to have convinced himself that the reason the surgery had gone awry was because of my excess weight, and not because, as I later learned, I had been misdiagnosed and the procedure, as it was performed, was far too aggressive. My health condition was deteriorating and it appeared as if weight was being scapegoated for the complications.If a solution was to be found, I was going to have to find it. After many months of research, I discovered that I have lipedema, an unrecognized [End Page E6] and generally misdiagnosed hereditary, genetically-based fat disorder. I had always had lipedema, which in my case seems to have been triggered at least since puberty. There are an estimated 17 million women in the USA alone who have lipedema, unrecognized or misdiagnosed.I, like most other women in America, knew that weight was a personal choice, and fat is a result of eating too much. Or was it? This ingrained and culturally accepted structure of knowledge began to disintegrate. I then asked the question, if this disease of lipedema is a fat disorder—and I had been to many, many doctors in my 63 years—why was it never identified? Why was I left to struggle in a constant battle trying to accomplish the impossible? I then learned about and named “anti-fat bias” and began to unravel the answers.About LipedemaAccording to Karen L. Herbst, Ph.D., M.D., endocrinologist and expert on fat disorders, lipedema (lipoedema in Europe) is an inherited genetic disease, affecting at least 11% of women of all sizes, from the extremely thin to the morbidly obese, resulting in localized fat that is bilateral, symmetrical and usually from the waist to just above the ankles. It can also affect the upper arms. Unlike the “normal” fat of obesity, lipedemic fat cannot be lost through diet and exercise. It is not uncommon for the comorbidity of overweight or obesity to accompany lipedema. Allen and Hines, physicians at the Mayo Clinic, first named Lipedema in 1940.Believed... (shrink)

Commentators on Machiavelli's Discourses have disagreed about whether he seeks to establish a new, more democratic form of republic, revive an imperial republic like Rome, or educate a new political elite, because they have not seen the logic that connects the three books. Machiavelli first argues that the internal liberty of Rome depended on arming her people. He then shows how a modern republic can avoid the destructive effects of Roman imperialism. Finally, he teaches his readers how to preserve a (...) republic better than the Romans. (shrink)