Background: Ethical relationships are important among many participants in healthcare, including the ethical relationship between nurse and employer. One aspect of organizational behavior that can impact ethical culture and moral well-being is institutional betrayal. Research aim: The purpose of this concept analysis is to develop a conceptual understanding of institutional betrayal in nursing by defining the concept and differentiating it from other forms of betrayal. Design: This analysis uses the method developed by Walker and Avant. Research context: Studies were reviewed (...) using health literature databases with no date restrictions. Ethical considerations: Analysis was conducted using established guidelines for ethical research. Findings: Although institutional betrayal is a concept applied in the literature, there was a paucity of studies exploring the concept within nursing. Examples of the concept in the literature include violation of trust between organization (i.e. employer) and nurse, such as provision of inadequate workplace protections, ineffective or hostile management, and gaslighting of those who experience negative events. Examples of institutional betrayal have become more visible during the COVID-19 pandemic. Discussion: A conceptual definition of institutional betrayal is a deep violation of trust or confidence or violation of moral standards committed by an institution toward a nurse. This definition incorporates experiences and issues suggested by the literature. Outcomes are likely negative, including impacts on nurse psychological and workplace well-being. This concept likely fits within a framework of ethical workplaces and has conceptual relationships with moral distress and moral resilience. Further studies can help qualitatively explore and empirically measure this concept. Conclusion: In the pursuit of improving the ethical culture of healthcare workplaces, this concept can provide meaningful insight into organizational behavior and its consequences. Naming and describing the concept can promote conceptual clarity and equip researchers, nurses, and leaders to identify and mitigate the issue. (shrink)

Between 1820 and 1870, middle-class Americans became convinced of the role nonhuman animals could play in socializing children. Companion animals in and around the household were the medium for training children into self-consciousness about, and abhorrence of, causing pain to other creatures including, ultimately, other people. In an age where the formation of character was perceived as an act of conscious choice and self-control, middle-class Americans understood cruelty to animals as a problem both of individual or familial deficiency and of (...) good and evil. Training children to be self-conscious about kindness became an important task of parenting. Domestic advisors also argued that learning kindness was critical for boys who were developmentally prone to cruelty and whose youthful cruelty had implications both for the future of family life and for the body politic. The practice of pet keeping, where children became stewards of companion animals who were then able to teach young humans such virtues as gratitude and fidelity, became a socially meaningful act. (shrink)

Background Healthcare worker retention and burnout are confounding issues. Trust among workers and their employer, that is, organization, is an important yet underexplored concept in research. Research aim The aim of this qualitative study is to explore organizational actions and systems that promote or denigrate trust among registered nurses and patient care aides (aides). Research design The study uses the Model of Psychological Contract as a theoretical framework. Focus groups were conducted to explore the concept of organizational trust and the (...) consequences of broken trust. Participants Registered nurses (RNs) (n=6) and aides (n=6) participated in the study. Six focus groups (three RN and three aide) were conducted, with two participants per group. Focus groups were conducted online. Ethical considerations The study's methods were reviewed by the University of Pittsburgh Institutional Review Board. Findings Among RNs and aides, a sense of trust and feeling valued were important to their sense of relationship with their employers. Trust was breached when resources were scarce, employees did not feel validated and listened to, and problems were not addressed. RNs and aides described feeling devalued when compensation practices were unjust or inequitable, they had limited autonomy, and the employer created an organizational climate where business needs superceded human caring. Consequences of trust breach included burnout, dejection, and feelings of non-belonging. Discussion Tangible organizational resources (compensation and staffing) and intangible resources (value, respect, autonomy) are important to RNs and aides alike. Inability to provide these resources diminishes trust and even causes a sense of betrayal. Conclusion Future research can explore the concepts of organizational justice and interventions to restore lost trust and improve healthcare worker well-being. This is one of only a few identified studies to explore organizational factors and well-being among aides and more research among this healthcare worker population is warranted. (shrink)

This article proposes a reconsidered chaîne opératoire framework drawing on theories of embodied, extended, and enacted cognition. I investigate three hypotheses: (1) the chaîne opératoire framework (as it is used) takes a cognitivist approach to the mind, (2) technical tendencies and milieus can encompass and support modern theories of embodied, extended, enactive cognition, and (3) that by reconsidering these elements of the chaîne opératoire framework alongside contemporary theories of cognition we may re-envision a novel chaîne opératoire framework which takes a (...) non-cognitivist approach. First, the development of chaîne opératoire and its uses are reviewed and analyzed for evidence of a cognitivist approach. Second, I argue that elements of the chaîne opératoire framework (technical tendencies and milieus) can and do support contemporary theories of cognition. Similar methods for connecting methodological frameworks with the phenomenological nature of human being such as Cognigrams and the Four-Field Co-Evolutionary approach are analyzed to provide context for this work. Following this, I outline a unique approach to the chaîne opératoire framework which accounts for theories of embodied, enacted, and extended cognition. (shrink)

Unraveling molecular and functional heterogeneity of niche cells within the developing endoderm could resolve mechanisms of tissue formation and maturation. Here, we discuss current unknowns in molecular mechanisms underlying key developmental events in pancreatic islet and intestinal epithelial formation. Recent breakthroughs in single‐cell and spatial transcriptomics, paralleled with functional studies in vitro, reveal that specialized mesenchymal subtypes drive the formation and maturation of pancreatic endocrine cells and islets via local interactions with epithelium, neurons, and microvessels. Analogous to this, distinct intestinal (...) niche cells regulate both epithelial development and homeostasis throughout life. We propose how this knowledge can be used to progress research in the human context using pluripotent stem cell‐derived multilineage organoids. Overall, understanding the interactions between the multitude of microenvironmental cells and how they drive tissue development and function could help us make more therapeutically relevant in vitro models. (shrink)

Research that examines unethical interpersonal treatment has received a great deal of attention from scholars and practitioners in recent years due to the remarkable impact of mistreatment in the workplace. However, the literature is incomplete because we have an inadequate understanding of insubordination, which we define as “subordinates’ disobedient behaviors that intentionally exhibit a defiant refusal of their supervisors’ authority.” In our study, we integrate social exchange theory and the advantageous comparison component of moral disengagement within the integrative model of (...) experiencing and responding to mistreatment at work. Then, we explain why subordinates disengage from moral control as they balance experiencing abusive supervision with perpetrating insubordination within negative supervisor–subordinate social exchange relationships. In Studies 1–4, we validate a five-item measure of insubordination and demonstrate its content, convergent, discriminant, criterion-related, and predictive validity. In Study 5, we demonstrate that there is a positive indirect effect of abusive supervision on insubordination through negative social exchange relationship quality that strengthens for subordinates who perceive higher levels of supervisors’ task performance than others. Overall, our study advances the conversation in the business ethics literature by creating a solid conceptual, empirical, and theoretical foundation for a cohesive program of insubordination research that meaningfully builds on prior findings in unethical interpersonal treatment research. (shrink)

Social responsibility is at the heart of the Engineer’s Creed embodied in the pledge that we will “dedicate [our] professional knowledge and skill to the advancement and betterment of human welfare...[placing] public welfare above all other considerations.” However, half century after the original creed was written, we find ourselves in a world with great technological advances and great global-scale technologically-enabled peril. These issues can be naturally integrated into the engineering curriculum in a way that enhances the development of the technological (...) skill set. We have found that these global challenges create a natural opportunity to foster social responsibility within the engineering students whom we educate. In freshman through senior-level materials engineering courses, we used five guiding principles to shape several different classroom activities and assignments. Upon testing an initial cohort of 28 students had classroom experiences based on these five principles, we saw a shift in attitude: before the experience, 18% of the cohort viewed engineers as playing an active role in solving global problems; after the experiences, 79% recognized the engineer’s role in solving global-scale problems. In this paper, we present how global issues can be used to stimulate thinking for socially-responsible engineering solutions. We set forth five guiding principles that can foster the mindset for socially responsible actions along with examples of how these principles translate into classroom activities. (shrink)

One day in the year 1274, Giuntino Jacobi appeared at the church of Santo Stefano in Quarrata. According to the notarial contract in the register of Ildebrandino d'Accatto, Giuntino was already seething with rage when he arrived at the sanctuary. When he then tried to force his way into the church, the presbyter Donato refused him access by slamming the door in his face. There is little doubt that Donato felt threatened, as he very quickly set about raising the hue (...) and cry by sounding the church bell and calling out for help. Meanwhile Giuntino, in a gesture portending Khrushchev's more famous one, took off his shoe and began pounding on the church door until a group of local men arrived and carted him away. Donato lost no time in denouncing the shoe-thumping Giuntino to the court of the podestà. When Giuntino absented himself from court, he was fined 200 fiorini piccoli, declared contumacious, and by order of the General Council banished from the commune of Florence and its territories. Thanks to the institution of the peace agreement, this story has an unexpected ending. Six months later, Donato and Giuntino stood before a notary and three witnesses in the church of Sant'Angelo di Quarrata and reconciled their differences. Their dispute was settled with the kiss of peace. The written witness—the peace agreement—was duly registered in the notarial protocol of Ildebrandino d'Accatto. (shrink)

The DRM paradigm produces robust false memories of non-presented critical words. After studying a thematic word list participants falsely remember the critical item “sleep.” We report two false memory experiments. Study One introduces a novel use of the lexical decision task to prime critical words. Participants see two letter-strings and make timed responses indicating whether they are both words. The word pairs Night-Bed and Dream-Thweeb both prime “sleep” but only one pair contains two words. Our primary purpose is to introduce (...) this new methodology via two pilot experiments. The results, considered preliminary, are promising as they indicate that participants were as likely to recognize critical words and presented words just as when studying thematic lists. Study Two actually employs the standard DRM lists so that semantic priming is in play there as well. The second study, however, uses functional near-infrared spectroscopy to measure activity in the prefrontal cortex during a DRM task which includes a deception phase where participants intentionally lie about critical lures. False and true memories occurred at high levels and activated many of the same brain regions but, compared to true memories, cortical activity was higher for false memories and lies. Accuracy findings are accompanied by confidence and reaction time results. Both investigations suggest that it is difficult to distinguish accurate from inaccurate memories. We explain results in terms of activation-monitoring theory and Fuzzy Trace Theory. We provide real world implications and suggest extending the present research to varying age groups and special populations. A nagging question has not been satisfactorily answered: Could neural pathways exist that signal the presence of false memories and lies? Answering this question will require imaging experiments that focus on regions of distinction such as the anterior prefrontal cortex. (shrink)

We propose an approach to designing smart wearables that act as partners to help people cope with stress in daily life. Our approach contributes to the developing field of smart wearables by addressing how technological capabilities can be designed to establish partnerships that consider the person, the situation, and the appropriate type of support. As such, this study also contributes to healthcare by opening up novel technology-supported routes to stress treatment and care. We present the results of a phenomenological study (...) conducted with three war veterans who suffer from chronic posttraumatic stress disorder. We describe how their experiences of dealing with their stress informed our design approach, and discuss the implications of these results on smart wearables and stress management in general. We conclude by reflecting on the limitations of this study and directions for future work. (shrink)

Borrett, Kelly and Kwan [ Phenomenology, dynamical neural networks and brain function, Philosophical Psychology, 13, 000-000] claim that unbiased, self-evident, direct description is possible, and may supply the data that brain theories account for. Merleau-Ponty's [ Phenomenology of perception, London: Routledge] description of Schneider's apraxia is offered as a case in point. According to the authors, Schneider's apraxia justifies brain components of predicative and pre-predicative experience. The description derives from a bias, however, that parallels modularity's morphological reduction. The presence of (...) biasing presuppositions contradicts the goal of direct description. Moreover, the authors' brain account is not necessary to explain Schneider's apraxia, and morphological reduction is not sufficient to explain emergent phenomena of motor control. (shrink)

Robust technology infrastructure is needed to enable learning health care systems to improve quality, access, and cost. Such infrastructure relies on the trust and confidence of individuals to share their health data for healthcare and research. Few studies have addressed consumers’ views on electronic data sharing and fewer still have explored the dual purposes of healthcare and research together. The objective of the study is to explore factors that affect consumers’ willingness to share electronic health information for healthcare and research. (...) This study involved a random-digit dial telephone survey of 800 adult Californians conducted in English and Spanish. Logistic regression was performed using backward selection to test for significant associations of each explanatory variable with the outcome variable. The odds of consent for electronic data sharing for healthcare decreased as Likert scale ratings for EHR impact on privacy worsened, odds ratio = 0.74, 95% CI [0.60, 0.90]; security, OR = 0.80, 95% CI [0.66, 0.98]; and quality, OR = 0.59, 95% CI [0.46–0.75]. The odds of consent for sharing for research was greater for those who think EHR will improve research quality, OR = 11.26, 95% CI [4.13, 30.73]; those who value research benefit over privacy OR = 2.72, 95% CI [1.55, 4.78]; and those who value control over research benefit OR = 0.49, 95% CI [0.26, 0.94]. Consumers’ choices about electronically sharing health information are affected by their attitudes toward EHRs as well as beliefs about research benefit and individual control. Design of person-centered interventions utilizing electronically collected health information, and policies regarding data sharing should address these values of importance to people. Understanding of these perspectives is critical for leveraging health data to support learning health care systems. (shrink)

We argue that environmental aesthetics, and specifically the concept of aesthetic integrity, should play a central role in a public environmental philosophy designed to communicate about environmental problems in an effective manner. After developing the concept of the “aesthetic integrity” of the environment, we appeal to empirical research to show that it contributes significantly to people’s sense of place, which is, in turn, central to their well-being and motivational state. As a result, appealing to aesthetic integrity in policy contexts is (...) both strategically and morally advisable. To provide a concrete illustration of the ways in which such appeals can play a role in policy making, we examine a specific case study in which attention to aesthetic integrity contributed to blocking a proposed development. The case yields at least four lessons: (1) aesthetic integrity can be a practically effective framing device; (2) local deliberative settings are particularly conducive for addressing it; (3) it can serve as an umbrella under which multiple other issues can be brought to the fore; and (4) judgments about aesthetic integrity need not be entirely objective in order for them to play a productive role in the policy sphere. (shrink)

Volume 20, Issue 4, May 2020, Page 83-85.

Can human beings be free and responsible if there is an all-powerful God? Anselm of Canterbury offers viable answers to questions which have plagued religious people for at least two thousand years. Katherin Rogers examines Anselm's reconciliation of human free will and divine omnipotence in the context of current philosophical debates.

This article blends cultural history and theoretical psychology in a discussion of new treatment methods for psychiatric casualties that emerged early in World War II. It draws on philosophical hermeneutics and Hacking's historical ontology to clarify how our interpretation of this history inevitably reflects current struggles making sense of PTSD while efforts to understand this history can enrich present-day reflections about war neurosis and the social good. 2012 APA, all rights reserved).

Potential conflicts between the roles of physicians and researchers have been described at the theoretical level in the bioethics literature (Czoli, et al., 2011). Physicians and researchers are generally in mutually distinct roles, responsible for patients and participants respectively. With increasing emphasis on integration of research into clinical settings, however, the role divide is sometimes unclear. Consequently, physician–researchers must consider and negotiate salient ethical differences between clinical– and research–based obligations (Miller et al, 1998). This paper explores the subjective experiences and (...) perspectives of 30 physician–researchers working in three Canadian paediatric settings. Drawing on qualitative interviews, it identifies ethical challenges and strategies used by physician–researchers in managing dual roles. It considers whether competing obligations could have both positive and adverse consequences for both physician–researchers and patients. Finally, we discuss how empirical work, which explores the perspectives of those engaged in research and clinical practice, can lead the way to understanding and promoting best practice. (shrink)

ABSTRACTThis research investigated whether precues engage proactive control to reduce emotional interference during speech production. A picture-word interference task required participants to name target pictures accompanied by taboo, negative, or neutral distractors. Proactive control was manipulated by presenting precues that signalled the type of distractor that would appear on the next trial. Experiment 1 included one block of trials with precues and one without, whereas Experiment 2 mixed precued and uncued trials. Consistent with previous research, picture naming was slowed in (...) both experiments when distractors were taboo or negative compared to neutral, with the greatest slowing effect when distractors were taboo. Evidence that precues engaged proactive control to reduce interference from taboo distractors was found in Experiment 1. In contrast, mixing precued trials in Experiment 2 resulted in no taboo cueing benefit. These results suggest that item-level proactive control can b... (shrink)

ABSTRACTAlthough previous studies have examined killing as an outcome-oriented measure, few have explored non-killing as a socially organized process. Using letters written by soldiers, police offi...

Carbon monoxide intoxication leads to acute and chronic neurological deficits, but little is known about the specific noxious mechanisms. 1 H magnetic resonance spectroscopy may allow insight into the pathophysiology of CO poisoning by monitoring neurochemical disturbances, yet only limited information is available to date on the use of this protocol in determining the neurological effects of CO poisoning. To further examine the short-term and long-term effects of CO on the central nervous system, we have studied seven patients with CO (...) poisoning assessed by gray and white matter MRS, magnetic resonance imaging and neuropsychological testing. Five patients suffered from acute high-dose CO intoxication and were in coma for 1–6 days. In these patients, MRI revealed hyperintensities of the white matter and globus pallidus and also showed increased choline and decreased N -acetyl aspartate ratios to creatine, predominantly in the white matter. Lactate peaks were detected in two patients during the early phase of high-dose CO poisoning. Two patients with chronic low-dose CO exposure and without loss of consciousness had normal MRI and MRS scans. On follow-up. five of our seven patients had long-lasting intellectual impairment, including one individual with low-dose CO exposure. The MRS results showed persisting biochemical alterations despite the MRI scan showing normalization of morphological changes. In conclusion, the MRS was normal in patients suffering from chronic low-dose CO exposure; in contrast, patients with high-dose exposure showed abnormal gray and white matter levels of NAA/Cr, Cho/Cr and lactate, as detected by 1 H MRS, suggesting disturbances of neuronal function, membrane metabolism and anaerobic energy metabolism, respectively. Early increases in Cho/Cr and decreases of NAA/Cr may be related to a poor long-term outcome, but confirmation by future studies is needed. (shrink)

The 2015 Paris Agreement set a global warming limit of 2°C above preindustrial levels. Corporations play an important role in achieving this objective, and methods have recently been developed to map global climate targets to specific industries, and individual corporations within those industries. In this article, we assess whether Sustainability ratings capture corporate performance in meeting the 2°C target. We analyze nine rating schemes used by investors and three commonly used in academic studies. Most rating schemes do consider corporate greenhouse (...) gas emissions in their analysis, whereas only a minority scale emissions by factors that have the potential to allow benchmarking against science-based targets. None take the final step of mapping climate indicators against the 2°C target. Furthermore, we find a lack of consistency in the climate change ratings of the databases used in academic studies. These results are concerning in the context of being able to meet global climate change goals. (shrink)

Although it is an increasingly popular assumption that leader mindfulness may positively affect leader behaviors and, in turn, employee outcomes, to date, little empirical evidence supports this view. Against this backdrop, the present research seeks to develop and test a serial mediation model of leader mindfulness. Specifically, we propose that leader mindfulness enhances employee performance and that this relationship is explained by increased leader procedural justice enactment and, subsequently, reduced employees’ emotional exhaustion. We conducted three studies to test this model. (...) Study 1 involved employees from a wide range of organizations in the USA. Study 2 used a sample of leaders and employees from China and measured our model variables at three different points in time. Both studies provide consistent support for our hypotheses. Finally, Study 3 involved a laboratory experiment in which 62 senior executives were assigned to either a mindfulness induction or to a control condition. Again, results revealed a significant and positive link between leader mindfulness and leader procedural justice enactment. In sum, these findings expand our understanding of mindfulness to the domain of leadership, a key area of organizational research. Moreover, they complement prior studies by showing that mindfulness dynamics go beyond intrapersonal effects but also influence the attitudes and behaviors of others. We discuss our findings in light of their contributions to the mindfulness, ethics, and leadership literatures and point out implications for practice. (shrink)

The purpose of this article is to investigate how cultural meanings associated with the left ventricular assist device inform acceptance and experience of this innovative technology when it is used as a destination therapy. We conducted open-ended, semistructured interviews with family caregivers and patients who had undergone LVAD-DT procedures at six U.S. hospitals. A grounded theory approach was used for the analysis. Thirty-nine patients and 42 caregivers participated. Participants described a sense of obligation to undergo the procedure because of its (...) promise for salvation. However, once the device was implanted, patients described being placed into a liminal state of being neither sick nor healthy, with no culturally scripted role. Consideration of end-of-life decisions was complicated by the uncertainties about how patients with LVADs die. Pre-implantation communications among patient, family, and clinicians should take into account the impact of the technology on meaning, identity, and patient experience. (shrink)

Where there is trust, there is also vulnerability, and vulnerability can be exploited. Epistemic trust is no exception. This chapter maps the phenomenon of the exploitation of epistemic trust. I start with a discussion of how trust in general can be exploited; a key observation is that trust incurs vulnerabilities not just for the party doing the trusting, but also for the trustee (after all, trust can be burdensome), so either party can exploit the other. I apply these considerations to (...) epistemic trust, specifically in testimonial relationships. There, we standardly think of a hearer trusting a speaker. But we miss an important aspect of this relationship unless we consider too that the speaker standardly trusts the hearer. Given this mutual trust, and given that both trustees and trusters can exploit each other, we have four possibilities for exploitation in epistemic-trust relationships: a speaker exploiting a hearer (a) by accepting his trust or (b) by imposing her trust on him, and a hearer exploiting a speaker (c) by accepting her trust or (d) by imposing his trust on her. One result is that you do not need to betray someone to exploit him – you can exploit him just as easily by doing what he trusts you for. (shrink)

We examined how the cultural dimension of universalism–particularism influences managers’ attitudes toward relational favoritism. Paradoxically, we found in a survey study that Brazilian and Chinese managers perceived more negative consequences of relational favoritism than did American managers—even though the Brazilians and the Chinese perceived stronger particularistic cultural norms in their countries than Americans did in the United States. We attribute this pattern of results to “cultural reflexivity”—the ability of people from transforming economies to be culturally self-critical during a period of (...) dramatic societal change. This pattern of results also emerged in a scenario study in which we asked these same Brazilian, Chinese, and American participants to assess managerial succession decisions made by a General Manager. We varied the scenarios so that the promoted manager was either a colleague with no pre-existing relation with the GM or a colleague who was a relative, a close friend, from the same town, or from the same school. Consistent with the results of the survey study, we found that perceived cultural norms of particularism were negatively related to perceptions of fairness. In other words, Brazilians and Chinese, even while living in more particularistic cultures, were more harsh in judging relational favoritism. We conclude with a discussion on the implications of these paradoxical relationships. (shrink)

Shortages of life-saving medical resources caused by COVID-19 have prompted hospitals, healthcare systems, and governmentsto develop crisis standards of care, including 'triage protocols' to potentially ration medical supplies during the public health emergency. At the same time, the pandemic has highlighted and exacerbated racial, ethnic, and socioeconomic health disparities that together constitute a form of structural racism. These disparities pose a critical ethical challenge in developing fair triage systems that will maximize lives saved without perpetuating systemic inequities. Here we review (...) alternatives to 'utilitarian' triage, including first-come first-served, egalitarian, and prioritarian systems of allocating scarce medical resources. We assess the comparative advantages and disadvantages of these allocation schemes. Ultimately, we argue that while triage protocols should not exacerbate disparities, they are not an adequate mechanism for redressing systemic health inequities. Entrenched health disparities must be addressed through broader social change. (shrink)

Robert H. Blank and Janna C. Merrick, End-of-life decision making: A cross-national study, Cambridge, MA: MIT Press, 2005, reviewed by Katherine Wayne.

On August 29, 2006, the United States Court of Appeals for the District of Columbia Circuit held that an injured ERISA plan beneficiary need not be “made whole” by any injury-related recovery from a third party in order for her ERISA plan to assert subrogation or reimbursement rights if the plan's terms either 1) “unambiguously establish a plan priority” to any funds a beneficiary recovers from a third party, or 2) are reasonably interpreted to establish such a priority by an (...) ERISA plan fiduciary clearly authorized to do so.In 1991, appellants William and Judith Moore purchased an ERISA health insurance policy from Blue Cross Blue Shield of the National Capital Area and its wholly-owned subsidiary CapitalCare. On September 10, 1992, the Moores’ daughter Alistaire, a plan beneficiary, was seriously injured in an automobile accident. (shrink)

This essay shows how South African Pentecostal teachings about sexuality, particularly HIV prevention and divorce, constrain women’s real and imagined choices. Institutional Review Board–approved fieldwork revealed the prevalence of wives remaining faithful to unfaithful husbands despite high risks of physical abuse and HIV infection. Maintaining the “ideal” of abstinence and faithfulness, male pastors actively oppose condom use and emphasize that “God hates divorce”. In this essay I engage and resist such hermeneutics. Using scripture as source and norm, I construct an (...) A-B-C-D prevention strategy to enhance women’s freedom: Abstain, Be faithful, use Condoms, or Divorce. (shrink)