Transgender and gender expansive (TGE) youth often seek a variety of gender-affirming healthcare services, including pubertal suppression and hormone therapy requiring that TGE youth and their parents participate in informed consent and decision making. While youth must demonstrate the ability to understand and appreciate treatment options, risks, benefits, and alternatives as well as make and express a treatment choice, standardized approaches to assess the capacity of TGE youth to consent or assent in clinical practice are not routinely used. This scoping (...) review identified the currently available data regarding adolescent capacity to consent to gender-affirming medical treatments. Articles relevant to assessing adolescent capacity for clinical decision-making were identified using OVID Medline, Web of Science, and PubMed. Articles were reviewed and thematically analyzed. Eight relevant articles were identified using three tools for measuring adolescent clinical decision-making capacity: Measure of Understanding, Measure of Competence, and MacArthur Competence Assessment Tool (MacCAT). These studies explored hypothetical treatment decisions, mental health treatment decisions, HIV treatment decisions, genetic testing decisions, and gender-affirming medical decisions. Only one study specifically examines the capacity of TGE youth to consent to medical treatments. Age was correlated with capacity in most, but not all studies. Other studies found cognitive measures (IQ, literacy, numeracy) may impact important aspects of capacity (understanding and reasoning). For clinicians caring for TGE youth, tools such as the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) may prove useful, in conjunction with consideration of youth developmental abilities and utilization of shared decision-making practices. A standardized, collaborative approach to assessing TGE youth capacity would benefit TGE youth and their parents, and allow clinicians to more easily resolve ethical concerns. (shrink)

El estallido de una epidemia o una pandemia es siempre un momento de amenaza, emergencia e incertidumbre. Cuando la salud y la vida de las personas se pone en peligro se requieren respuestas urgentes y coordinadas por parte de los agentes estatales a nivel nacional, regional y global que tengan el potencial de contener la pandemia y evitar su propagación. De esta situación de emergencia y de continuos cambios en las normas que imponen nuevas restricciones, obligaciones y responsabilidades a los (...) ciudadanos, se deriva dilema sobre el equilibrio entre la protección del derecho a la salud y otros derechos económicos, sociales y culturales. (shrink)

What do the terms “profession, professional, professionalism” mean in 2002? One dictionary defines profession as “a calling requiring specialized knowledge and often long and intensive academic preparation,” and it defines professionalism as “the conduct, aims, or qualities that characterize or make a profession or professional person.” These definitions are appealingly simple. Complexity arises when we add the term “medical” as in the medical profession, a medical professional, or medical professionalism; and, here a specific understanding of “the conduct, aims, and qualities (...) that characterize” the field of medicine is required. To complicate matters, professionalism applies to both the profession as a whole as well as the individual professional persons, such as the physicians. (shrink)

The results of some high-stakes aptitude tests in Austria have revealed sex differences. We suggest that such discrepancies are mediated not principally by differences in aptitudes, skills, and knowledge but gender differences in test takers’ perceptions of the test situation. Furthermore, previous research has indicated that candidates’ evaluations of the fairness of the testing tool are of great importance from an institutional point of view because such perceptions are known to influence an organization’s attractiveness. In this study, we aimed to (...) investigate how women and men perceive and evaluate certain aspects of a high-stakes test situation by using the results and evaluations of an actual medical school aptitude test (753 applicants; 59% women). Test takers voluntarily evaluated the test situation and rated specific aspects of it (e.g., the fairness of the selection tool) and provided information regarding their test anxiety immediately after they completed the 4-hour test. Data analyses indicated small, albeit significant sex differences in participants’ perceptions of the test. Men described the test situation as slightly giving more opportunity to socialize and possessing more opportunity to deceive than women did. Furthermore, the perception of the test situation did not directly predict the test results, but it served as a moderator for the indirect effect of test anxiety on test results. By contrast, there were significant direct effects but no indirect effects of situation perception on evaluations of the fairness of the selection tool: The more the test situation was perceived as a high-pressure situation, the lower the fairness ratings of the testing tool. Results were discussed with reference to gender roles and test fairness. (shrink)

Early adversity and trauma can have profound effects on children’s affective development and mental health outcomes. Interventions that improve mental health and socioemotional development are essential to mitigate these effects. We conducted a pilot study examining whether a reading-based program improves emotion recognition and mental health through socialization in Syrian refugee and Jordanian non-refugee children aged 7–12 years old living in Jordan. To measure emotion recognition, children classified the expression in faces morphed between two emotions, while mental health was assessed (...) using survey measures of optimism, depression, anxiety, distress, and insecurity. Prior to the intervention, both groups of children were significantly biased to interpret ambiguous facial expressions as sad, while there was no clear bias on the fear–anger spectrum. Following the intervention, we found changes in Syrian refugee children’s bias in emotion recognition away from sad facial expressions, although this returned to pre-intervention levels 2 months after the end of the program. This shift in the bias away from sad facial expressions was not associated with changes in self-reported mental health symptoms. These results suggest a potential positive role of the reading intervention on affective development, but further research is required to determine the longer-term impacts of the program. (shrink)

Book reviewed in this article: Encounters Between Patients and Doctors: An Anthology. By John D. Stoeckle.

De Marco and colleagues claim that the standard account of invasiveness as commonly encountered ‘…does not capture all uses of the term in relation to medical interventions1 ’. This is open to challenge. Their first example is ‘non-invasive prenatal testing’. Because it involves puncturing the skin to obtain blood, De Marco et al take this as an example of how an incision or insertion is not sufficient to make an intervention invasive; here is a procedure that involves an incision, but (...) it is regarded as non-invasive. However, this ignores the context, and the term should really be understood in reference to the fetus. It is hard to believe healthcare professionals regard taking blood to measure, for example, ferritin levels as invasive but taking blood to look for fragments of fetal DNA as not. If anyone uses the term thinking it is not invasive to the mother, the solution would be to call it invasive, not redefine what is invasive. De Marco and colleagues’ second example is describing electroconvulsive therapy (ECT) as invasive. However, this is not borne out by their referenced papers. The first cited source is about non-invasive brain stimulation2 and only contains a single sentence about ECT. This sentence may suggest that their view is that ECT …. (shrink)

Background Families whose child has unexplained intellectual or developmental differences often hope that a genetic diagnosis will lower barriers to community-based therapeutic and support services. However, there is little known about efforts to mobilize genetic information outside the clinic or how socioeconomic disadvantage shapes and constrains outcomes.Methods We conducted an ethnographic study with predominantly socioeconomically disadvantaged families enrolled in a multi-year genomics research study, including clinic observations and in-depth interviews in English and Spanish at multiple time points. Coding and thematic (...) development were used to collaboratively interpret fieldnotes and transcripts.Results Thirty-two families participated. Themes included familial expectations that a genetic diagnosis could be translated into information, understanding, and assistance to improve the quality of a child’s day-to-day life. After sequencing, however, genetic information was not readily converted into improved access to services beyond the clinic, with families often struggling to use a genetic diagnosis to advocate for their child.Conclusion Families’ ability to use a genetic diagnosis as an effective advocacy tool beyond the clinic was limited by the knowledge and resources available to them, and by the eligibility criteria used by therapeutic service providers’ – which focused on clinical diagnosis and functional criteria more than etiologic information. All families undertaking genomic testing, particularly those who are disadvantaged, need additional support to understand the limits and potential benefits of genetic information beyond the clinic. (shrink)

The two target articles in this issue bring into focus the struggle for governance over biomedical interventions that may offer some families more agency—the capacity to act—in the context of many...

Dispositional forgiveness is positively associated with many facets of wellbeing and has protective implications against depression and anxiety in adolescents. However, little work has been done to examine neurobiological aspects of forgiveness as they relate to clinical symptoms. In order to better understand the neural mechanisms supporting the protective role of forgiveness in adolescents, the current study examined the middle frontal gyrus, which comprises the majority of the dorsolateral prefrontal cortex and is associated with cognitive regulation, and its relationship to (...) forgiveness and clinical symptoms in a sample of healthy adolescents. In this cross-sectional study, larger MFG volume was significantly associated with higher self-reported dispositional forgiveness scores and lower levels of depressive and anxiety symptoms. Forgiveness mediated the relationship between MFG volume and both depressive and anxiety symptom levels. The mediating role of forgiveness in the relationship between MFG volume and clinical symptoms suggests that one way that cognitive regulation strategies supported by this brain region may improve adolescent mental health is via increasing a capacity for forgiveness. The present study highlights the relevance of forgiveness to neurobiology and their relevance to emotional health in adolescents. Future longitudinal studies should focus on the predictive quality of the relationship between forgiveness, brain volume and clinical symptoms and the effects of forgiveness interventions on these relationships. (shrink)

We surveyed selected physician members of the Society for Health and Human Values (SHHV) to study the benefits and problems of combining a medical career with a strong scholarly interest in the humanities. The 19 usable narrative responses characterized major benefits as experiential base and teaching opportunities. Barriers were numerous and fell under the general headings of: lack of time; lack of institutional rewards; lack of money for research and scholarship; lack of support from humanities peers; lack of suport from (...) medical colleagues; personal financial sacrifice; and lack of training. Some respondents offered creative solutions to these problems, including assertive negotiation of a job description, identification of helpful mentors, and various networking and administrative strategies. The survey results, while preliminary, suggest ways in which SHHV can assist clinicians who wish to develop a serious commitment to humanities study and teaching. (shrink)

Introducción, traducción y notas de C. Eggers Lan y V. E. Juliá. Revisada por A. del Pozo Ortiz.

We examined whether midazolam impairs short-term/working memory processes. We hypothesize that prior dissociations in midazolam’s effects on short-term/working memory tasks and episodic memory tasks arise because midazolam has a larger effect on episodic memory processes than on short-term/working memory processes. To examine these issues, .03 mg/kg of participant’s bodyweight of midazolam was administered in a double-blind placebo-controlled within-participant design. Performance on the digit span and category generation/recall tasks was examined. The results of Experiment 1 demonstrated that: midazolam impaired performance on (...) the digit span task; midazolam did not impair performance on the category generation task; midazolam impaired performance on the category recall task; and midazolam’s effect on category recall was four times as large as its effect on digit span. The results of Experiment 2 demonstrated that midazolam did not impair digit span performance when the digit span task was administered at a later time. These results suggest that midazolam can impair short-term/working memory processes, but these effects are substantially smaller than midazolam’s effect on episodic memory processes. Moreover, they demonstrate that conscious awareness of materials during study is not sufficient to produce episodic memory. (shrink)

Abstract:Open neural tube defects or myelomeningoceles are a common congenital condition caused by failure of closure of the neural tube early in gestation, leading to a number of neurologic sequelae including paralysis, hindbrain herniation, hydrocephalus and neurogenic bowel and bladder dysfunction. Traditionally, the condition was treated by closure of the defect postnatally but a recently completed randomized controlled trial of prenatal versus postnatal closure demonstrated improved neurologic outcomes in the prenatal closure group. Fetal surgery, or more precisely maternal-fetal surgery, raises (...) a number of ethical issues that we address including who the patient is, informed consent, surgical innovation and equipoise as well maternal assumption of risk. As the procedure becomes more widely adopted into practice, we suggest close monitoring of new fetal surgery centers, in order to ensure that the positive results of the trial are maintained without increased risk to both the mother and fetus. (shrink)

This paper interrogates and reclaims clown practices in children’s rehabilitation as ‘foolish.’ Attempts to legitimize and ‘take seriously’ clown practices in the health sciences frame the work of clowns as secondary to the ‘real’ work of medical professionals and diminish the ways clowns support emotional vulnerability and bravery with a willingness to fail and be ridiculous as fundamental to their work. Narrow conceptualizations of clown practices in hospitals as only happy and funny overlook the ways clowns also routinely engage with (...) sadness, despair, discomfort and many other ways of being and doing. Our exploration of clown practices as foolish exposes the ways children’s rehabilitation upholds particular neoliberal models of success and invites a re-centring of rehabilitation and health care research and practice towards relationship building, supporting meaningful projects and a continued nurturing of aesthetic and pleasurable ways of being-in-the-world in the present moment as valuable unto themselves. (shrink)

For many children with complex medical conditions, decisions regarding their goals of care lie in the zone of parental discretion. That is, clinicians appropriately recognize that in many cases whether to prioritize quantity of life or quality of life is a deeply personal, values-laden decision best made by those who are most deeply invested in the outcome. Once a family has committed to a goal, however, there may be new or ongoing conflict between parents and clinicians regarding the specific interventions (...) provided or not provided in support of that goal. To what extent is it ethically permissible for a seriously ill child’s surrogate decision makers to reject individual interventions that support their desired goal of care? This question might be best described thus: is pediatric healthcare “prix fixe,” in which clinicians help parents decide the best of one or more set combinations (“menus”) of interventions, or is it “à la carte,” in which parents are free to accept or reject each individual intervention? We argue that the concept of a “prix fixe” approach should be discussed with families early in the development of the clinical relationship, as an essential facet of shared decision making. (shrink)

Michigan is a critical agricultural state, and small family farms are a crucial component of the state’s food sector. This paper examines how the race/ethnicity of the family farm owners/operators is related to farm characteristics, financing, and impacts of the pandemic. It compares 75 farms owned/operated solely by Whites and 15 with People of Color owners/operators. The essay examines how farmers finance their farm operations and the challenges they face doing so. The article also explores how the Coronavirus-19 pandemic affected (...) farming operations, the financial viability of farms, and how farmers responded to the challenges posed by the pandemic. The study found that People of Color farm owners/operators were younger than White farm owners/operators. The People of Color farm owners/operators tended to manage smaller farms for shorter periods than White farm owners/operators. Though two-thirds of the Farmers of Color owned their farms, they were more financially vulnerable than White farm owners/operators. The farmers studied had difficulty obtaining loans to finance their farms. Farmers reported increasing requests from people for food assistance during the pandemic. Farmers responded to the pandemic by participating in government programs such as the Farm to Families Food Box Program that purchased their produce. It allowed farmers to supply emergency food assistance programs with products from their farms. The products went to families receiving food assistance from soup kitchens, food banks, and other community-based nonprofits. (shrink)

This book features new essays by philosophers, psychologists, and a theologian on the important topic of virtue development. The essays engage with work from multiple disciplines and thereby seek to bridge disciplinary divides. The volume is a significant contribution to the emerging interdisciplinary field of virtue development studies.

The narratives that emerging adults wrote about a time when they learned an important moral, value or lesson were explored in order to determine the characteristics of events that lead to internalized values as well as to compare the way different kinds of moral values are socialized. Lessons resulting from misbehavior were reported most frequently. Those involving direct teaching of values were most highly internalized, with internalization assessed by importance and current impact. Self-reflection and self-generation of values was identified as (...) a key means to value learning and was reported more frequently than any other source of values (e.g., parents, peers). Finally, it appears that a framework for understanding socialization that involves different domains can reflect how individuals categorize their value-learning experiences. (shrink)

In the past ten years, there has been growing interest in and concern about protecting the privacy of personal medical information. Insofar as medical records increasingly are stored electronically, and electronic information can be shared easily and widely, there have been legislative efforts as well as scholarly analyses calling for greater privacy protections to ensure that patients can feel safe disclosing personal information to their health-care providers. At the same time, the volume of biomedical research conducted in this country continues (...) to grow. The budget of the National Institutes of Health, for example, was $20,298 million in 2001, having more than doubled from a budget of $9,218 million 10 years before. This growing body of research includes increased efforts to use stored medical records as a source of data for health services, epidemiologic, and clinical studies. (shrink)

Physicians’ fear of criminal prosecution for prescribing opioid analgesics is a major reason why many chronic pain patients are having an increasingly difficult time obtaining medically appropriate pain relief. In Ruan v. United States, 142 S. Ct. 2370 (2022), the Supreme Court unanimously vacated two federal convictions under the Controlled Substances Act. The Court held that the government must prove that the defendant knowingly or intentionally acted in an unauthorized manner.

Around the world, newly qualified teachers are leaving the profession after only a short time working at school. This not only has a negative effect on the capacities of the respective education systems, but also for the teachers themselves, as it often due to factors such as stress and burnout that leads to this decision. The COVID-19 pandemic has exacerbated this situation by adding to the teachers’ workload, uncertainty, and stress. Previous research has investigated strategies that may help teachers improve (...) their well-being and, among other factors, found social support to be an important condition. In this mixed methods design-based research study, we developed a design to enhance social support among newly qualified teachers in their first months working at school. Our quantitative and qualitative results show that the design has positive effects on many aspects of teachers’ well-being in the intervention group both longitudinally and when compared to a comparison group. The findings are being discussed considering the recent changes in the working conditions of teachers as imposed by the COVID-19 pandemic. (shrink)

An example is given of a complete theory with minimal models of arbitrarily large minimality rank.

1. Il problema della povertà evangelica e francescana nel sec. XIII e XIV. Origine del pensiero politico di G. d'Ockham.--2. Il potere come servizio. Dal Principatus dominativus al Principatus ministrativus.

This volume is a collection of essays by various contributors in honor of the late Laurence Berns, Richard Hammond Elliot Tutor Emeritus at St. John's College, Annapolis. The essays address the literary, political, theological, and philosophical themes of his life's work as a scholar, teacher, and constant companion of the "great books.".