BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

In their article “The Rise of Citizen Science in Health and Biomedical Research,” Wiggins and Wilbanks (2019) present a new typology for understanding the complex landscape of health and biomedical...

We argue that the universal recommendations against “off-label” pediatric use of approved COVID-19 issued by the FDA, CDC, and AAP are overbroad. Especially for higher-risk children, vaccination can be ethically justified even before FDA authorization or approval – and similar reasoning is relevant for even younger patients. Legal risks can also be managed, although the FDA, CDC, and Department of Health and Human Services (HHS) should move quickly to provide clarity.

The speed and scale of the COVID‐19 pandemic has highlighted the limits of current health systems and the potential promise of non‐establishment research such as “DIY” research. We consider one example of how DIY research is responding to the pandemic, discuss the challenges faced by DIY research more generally, and suggest that a “trust architecture” should be developed now to contribute to successful future DIY efforts.

Context Opioid treatment agreements (OTAs) are documents that clinicians present to patients when prescribing opioids that describe the risks of opioids and specify requirements that patients must meet to receive their medication. Notwithstanding a lack of evidence that OTAs effectively mitigate opioids’ risks, professional organizations recommend that they be implemented, and jurisdictions increasingly require them. We sought to identify the jurisdictions that require OTAs, how OTAs might affect the outcomes of lawsuits that arise when things go wrong, and instances in (...) which the law permits flexibility for clinicians and health care institutions to adopt best practices. -/- Methods We surveyed the laws and regulations of all 50 states and the District of Columbia to identify which jurisdictions require the use of OTAs, the circumstances in which OTA use is mandatory, and the terms OTAs must include (if any). We also surveyed criminal and civil judicial decisions in which OTAs were discussed as evidence on which a court relied to make its decision to determine how OTA use influences litigation outcomes. -/- Findings Results show that a slight majority (27) of jurisdictions now require OTAs. With one exception, the jurisdictions’ requirements for OTA use are triggered at least in part by long-term prescribing. There is otherwise substantial variation and flexibility within OTA requirements. Results also show that even in jurisdictions where OTA use is not required by statute or regulation, OTA use can inform courts’ reasoning in lawsuits involving patients or clinicians. Sometimes, but not always, OTA use legally protects clinicians from liability. -/- Conclusions -/- Our results show that OTA use is entwined with legal obligations in various ways. Clinicians and health care institutions should identify ways for OTAs to enhance clinician–patient relationships and patient care within the bounds of relevant legal requirements and risks. (shrink)

Martin Heidegger's commitment to the idea that _Dasein_ is ultimately gender neutral, as well as several other major aspects of his thought, raises significant questions for feminist philosophers. The fourteen essays included in this volume clearly illustrate the ways in which feminist readings can deepen our understanding of his philosophy. They illuminate both the richness and the limitations of the resources his work can provide for feminist thought. This volume engages the full scope of Heidegger's writings from_ Being and Time (...) _through his latest work, from his readings of the ancient Greek poets to his critique of modern technology. At the same time, it reflects a wide range of contemporary feminist concerns: the significance of gender difference; the role of the body in philosophical thought; the relationship between philosophy and the natural world, and between philosophy and the domestic realm; and the aspiration to move forward into a new, more just, political world. Included in this volume are important new essays by Ellen Armour, Carol Bigwood, Jack Caputo, Tina Chanter, Trish Glazebrook, Jennifer Gosetti, Luce Irigaray, Dorothy Leland, Mechthild Nagel, Gail Stenstad, and the editors—as well as a valuable historical and theoretical Introduction by Patricia Huntington, the first of Jacques Derrida's "Geschlecht" articles, and an important 1997 essay by Iris Marion Young. (shrink)

This paper examines the impact of a week-long philosophy summer camp on middle and high school-age youth with specific attention paid to the development of intellectual humility in the campers. In June 2016 a university in Texas hosted its first philosophy summer camp for youth who had just completed sixth through twelfth grades. Basing our camp on the pedagogical model of the Philosophy for Children program, our aim was specifically to develop a community of inquiry among the campers, providing them (...) with a safe intellectual space to be introduced to philosophy and philosophical discussion. In 2017 we launched a formal longitudinal study to determine what impact a week-long philosophy summer camp would have on teens and tweens. Examining quantitative and qualitative data collected from 2016–2020, we found that the camp has had a significant impact on the teenagers who have attended. In particular, we found that intellectual humility increased over the duration of their camp experience and that this increase correlates with an increased affinity for philosophy and philosophical discussion. (shrink)

This article discusses feminist self-defense as a victim-prevention strategy, describes the nature and scope of the self-defense movement, examines a case history of a women's self-defense organization, and analyzes the mobilization and organizational dilemmas that confronted that organization. We compare self-defense services with victim services to help explain the development of the women's self-defense movement, and in particular, its feminist component.

In our response we consider several broad sets of issues raised in the commentaries on our target article. We provide an elaboration of the general theory of pragmatic reasoning schemas and of the mechanisms posited to explain pespective effects and other contextual influences on reasoning. We consider the strengths and limitations of a number of alternative proposals offered by the commentators. Finally, we discuss possible links between pragmatic schemas and more elementary “building blocks” for human reasoning.

Theorists in various scientific disciplines offer radically different accounts of the origin of violent behavior in humans, but it is not clear how the study of violence is to be scientifically grounded. This problem is made more complicated because both what sorts of acts constitute violence and what needs to be appealed to in explaining violence differs according to social scientists, biologists, anthropologists and neurophysiologists, and this generates serious problems with respect to even attempting to ascertain the differential bona fides (...) of these various explanatory programs. As a consequence, there is little theoretical reason to suspect that efforts to prevent violence will have any appreciable effect. In this paper we investigate the general issue of whether any of the general theoretical approaches to violent behavior can reasonably be taken to be the best approach to the explanation of seriously violent behavior. Our more specific aim is to examine the controversial explanation of violent behavior offered by Lonnie Athens in order to ascertain whether it can be seriously considered to be the best explanation of violent behavior. (shrink)

Over the last decade, empirical research on compassion has burgeoned in the biomedical, clinical, translational, and foundational sciences. Increasingly sophisticated understandings and measures of compassion continue to emerge from the abundance of multi- and cross-disciplinary studies. Naturally, the diversity of research methods and theoretical frameworks employed presents a significant challenge to consensus and synthesis of this knowledge. To bring the empirical findings of separate and sometimes siloed disciplines into conversation with one another requires an examination of their disparate assumptions about (...) what compassion is and how it can be known. Here, we present an integrated theoretical review of methodologies used in the empirical study of compassion. Our goal is to highlight the distinguishing features of each of these ways of knowing compassion, as well as the strengths and limitations of applying them to specific research questions. We hope this will provide useful tools for selecting methods that are tailored to explicit objectives (methods matching), taking advantage of methodological complementarity across disciplines (methods-mixing), and incorporating the empirical study of compassion into fields in which it may be missing. (shrink)

This article is the lead piece in a special report that presents the results of a bioethical investigation into chimeric research, which involves the insertion of human cells into nonhuman animals and nonhuman animal embryos, including into their brains. Rapid scientific developments in this field may advance knowledge and could lead to new therapies for humans. They also reveal the conceptual, ethical, and procedural limitations of existing ethics guidance for human‐nonhuman chimeric research. Led by bioethics researchers working closely with an (...) interdisciplinary work group, the investigation focused on generating conceptual clarity and identifying improvements to governance approaches, with the goal of helping scholars, funders, scientists, institutional leaders, and oversight bodies (embryonic stem cell research oversight [ESCRO] committees and institutional animal care and use committees [IACUCs]) deliver principled and trustworthy oversight of this area of science. The article, which focuses on human‐nonhuman animal chimeric research that is stem cell based, identifies key ethical issues in and offers ten recommendations regarding the ethics and oversight of this research. Turning from bioethics’ previous focus on human‐centered questions about the ethics of “humanization” and this research's potential impact on concepts like human dignity, this article emphasizes the importance of nonhuman animal welfare concerns in chimeric research and argues for less‐siloed governance and oversight and more‐comprehensive public communication. (shrink)

Over the last decade, numerous interventions and techniques that aim to engender, strengthen, and expand compassion have been created, proliferating an evidence base for the benefits of compassion meditation training. However, to date, little research has been conducted to examine individual variation in the learning, beliefs, practices, and subjective experiences of compassion meditation. This mixed-method study examines changes in novice meditators’ knowledge and contemplative experiences before, during, and after taking an intensive course in CBCT®, a contemplative intervention that is increasingly (...) used for both inter- and intrapersonal flourishing. The participants in this study were Christian healthcare chaplains completing a 1-year residency in Clinical Pastoral Education who learned CBCT as part of their professional chaplaincy training curriculum. Prior to and upon completion of training, we surveyed participants to assess their beliefs about the malleability of compassion, types of engagement in compassion meditation, and perceptions of the impact of taking CBCT. We also conducted in-depth interviews with a subset of participants to gain a qualitative understanding of their subjective experiences of learning and practicing compassion meditation, a key component of CBCT. We found that participants reported increases in the extent to which they believed compassion to be malleable after studying CBCT. We also found high levels of variability of individual ways of practicing and considered the implications of this for the study of contemplative learning processes. This multi-methodological approach yielded novel insights into how compassion practice and compassion-related outcomes interrelate, insights that can inform the basic scientific understanding of the experience of learning and enacting compassion meditation as a means of strengthening compassion itself. (shrink)

This article analyzes positions on pornography using Q-methodology. Eighty-five respondents sorted a sample of 86 opinion statements on definitions of pornography, personal reactions to it, its causes and effects, and social policy recommendations. Factor analysis was used to identify clusters of individuals in the United States who share common subjectively defined points of view on pornography. The three patterns of responses that emerged from the analysis were labeled Religious-Conservative, Liberal, and Antipornography Feminist. Using the empirical data, we examine the logical (...) and ethical structures of these points of view and their political and legal implications. We conclude that the viewpoints are too incompatible to sustain stable and effective political alignments among the adherents. (shrink)

When developing the Ontology of Biomedical Investigations (OBI), the process of adding classes with similar patterns of logical definition is time consuming, error prone, and requires an editor to...

We propose that people typically reason about realistic situations using neither content-free syntactic inference rules nor representations of specific experiences. Rather, people reason using knowledge structures that we term pragmatic reasoning schemas, which are generalized sets of rules defined in relation to classes of goals. Three experiments examined the impact of a “permission schema” on deductive reasoning. Experiment 1 demonstrated that by evoking the permission schema it is possible to facilitate performance in Wason's selection paradigm for subjects who have had (...) no experience with the specific content of the problems. Experiment 2 showed that a selection problem worded in terms of an abstract permission elicited better performance than one worded in terms of a concrete but arbitrary situation, providing evidence for an abstract permission schema that is free of domain-specific content. Experiment 3 provided evidence that evocation of a permission schema affects not only tasks requiring procedural knowledge, but also a linguistic rephrasing task requiring declarative knowledge. In particular, statements in the form if p then q were rephrased into the form p only if q with greater frequency for permission than for arbitrary statements, and rephrasings of permission statements produced a pattern of introduction of modals totally unlike that observed for arbitrary conditional statements. Other pragmatic schemas, such as “causal” and “evidence” schemas can account for both linguistic and reasoning phenomena that alternative hypotheses fail to explain. (shrink)

Anydomainofscientificresearchhasitssustainingorthodoxy. Thatis, research on a problem, whether in astronomy, physics, or biology, is con- ducted against a backdrop of broadly shared assumptions. It is these as- sumptionsthatguideinquiryandprovidethecanonofwhatisreasonable-- of what "makes sense." And it is these shared assumptions that constitute a framework for the interpretation of research results. Research on the problem of how we see is likewise sustained by broadly shared assump- tions, where the current orthodoxy embraces the very general idea that the business of the visual system is to (...) create a detailed replica of the visual world, and that it accomplishes its business via hierarchical organization and by operatingessentiallyindependently of other sensorymodalitiesas well as independently of previous learning, goals, motor planning, and motor execution. (shrink)

_Employment and Employee Rights_ addresses the issue of rights in the workplace. Although much of the literature in this field focuses on employee rights, this volume considers the issue from the perspective of both employees and employers. Considers the rights of both employees and employers. Discusses the moral and legal landscape and traditional assumptions about right in employment. Investigates arguments for guaranteeing rights, particularly for employees, which are derived from relational, developmental, and economic bases. Explores new dimensions of employment including (...) a model that incorporates growing workplace diversity, builds upon our understanding of the legal landscape, and expands upon our justifications for recognizing and protecting rights. (shrink)

Interweaves elements of Kristevan and Heideggerian thought in order to reconstruct a linguistically embedded, existentially and affectively rich, dialectical model of willed self-regulation.

_Basic principles and practical strategies to promote learning in any setting!_ From K-12 to corporate training settings––the Third Edition of Patricia Smith and Tillman Ragan’s thorough, research-based text equips you with the solid foundation you need to design instruction and environments that really facilitate learning. Now updated to reflect the latest thinking in the field, this new edition offers not only extensive procedural assistance but also emphasizes the basic principles upon which most of the models and procedures in the (...) instructional design field are built. The text presents a comprehensive treatment of the instructional design process, including analysis, strategy design, assessment, and evaluation. (shrink)

Children's comprehension of the universal quantifiers all and each was explored in a series of experiments using a picture selection task. The first experiment examined children's ability to restrict a quantifier to the noun phrase it modifies. The second and third experiments examined children's ability to associate collective, distributive, and exhaustive representations with sentences containing universal quantifiers. The collective representation corresponds to the "group" meaning (for All the flowers are in a vase all of the flowers are in the same (...) vase). The distributive representation implies a pairing (e.g., each flower paired with a vase for Each flower is in a vase). The exhaustive representation exhausts both sets (e.g., for The flowers are in the vases all the flowers are in vases and all the vases have flowers in them). Four- to 10-year-olds children had little difficulty restricting the quantifier all to the noun it modified in a task which required them to attend to the group feature of all. In contrast, only 9- and 10-year-olds were able to solve the task when the quantifier was each and the pictures showed entities in partial one-to-one correspondence. Children showed a preference for associating collective pictures with sentences containing all and distributive pictures with sentences containing each. The results suggest that between the ages of 5 and 10 years, children's semantic representations undergo less radical changes than others have proposed. Instead, developmental change may occur gradually as children acquire linguistic cues which map onto existing semantic representations. (shrink)

We examined the attitudes of 600 students in large introductory algebra and psychology classes toward an actual or hypothetical cheating incident and the subsequent retake procedure. Overall, 57% of students in one class and 49Y0 in the other reported that they either cheated or would have cheated if given the opportunity. More men (59%) than women (53%) reported cheating or potential cheating. Students who had actually experienced a retake procedure to handle cheating were more satisfied with such a procedure than (...) others were about a hypothetical situation. Despite having a retake, cheaters were significantly more likely than noncheaters to predict that they would cheat again. Results suggest that instructors who require a retake following extensive cheating should devote class time to a discussion of the issue and all possible alternatives. (shrink)