The application of machine learning in health care holds great promise for improving care. Indeed, our own team is collaborating with experts in machine learning and statistical modeling to bu...

The literature on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises concerns that these technologies may affect personality, mood, and behavior. We conducted semi-structured interviews with researchers (n = 23) involved in developing next-generation DBS systems, exploring their perspectives on ethics and policy topics including whether DBS/aDBS can cause such changes. The majority of researchers reported being aware of personality, mood, or behavioral (PMB) changes in recipients of DBS/aDBS. Researchers offered varying estimates of the frequency of PMB changes. A (...) smaller majority reported changes in personality specifically. Some expressed reservations about the scientific status of the term ‘personality,’ while others used it freely. Most researchers discussed negative PMB changes, but a majority said that DBS/aDBS can also result in positive changes. Several researchers viewed positive PMB changes as part of the therapeutic goal in psychiatric applications of DBS/aDBS. Finally, several discussed potential causes of PMB changes other than the device itself. (shrink)

Academic integrity has become a significant point of concern in the post-secondary landscape, and many institutions are now exploring ways on how to implement academic integrity training for students. This paper delineates the development of an Academic Integrity E-Learning (AIE-L) tutorial at MacEwan University, Canada. In its first incarnation, the AIE-L tutorial was intended as an education tool for students who had been found to violate the University’s Academic Integrity Policy. However, in a discourse of the academic integrity process, the (...) University reimagined it from only emphasising the increased understanding and strengthened commitment of students found to have committed academic misconduct to a proactive focus with education for all students. The purpose of the present paper is three-fold: first, describe the development of the AIE-L tutorial as an experiential case study; second, improve the content of the AIE-L tutorial through students’ quantitative and qualitative feedback; third, calibrate the pre and post-test questions for content validity for a forthcoming large-scale measurement of the AIE-L tutorial effectiveness. (shrink)

K. Lüscher, M. Sánchez, A. Klimczuk, Generations, intergenerational relationships, generational policy: A multilingual compendium, 12 languages, Universität Konstanz, Konstanz 2016, 300pp.

K. Lüscher, A. Klimczuk, Generations, intergenerational relationships, generational policy: A multilingual compendium, 17 languages, Universität Konstanz, Konstanz 2017, 428pp. TS - BibTeX M4 - Citavi.

K. Lüscher, A. Klimczuk, Generations, intergenerational relationships, generational policy: A multilingual compendium, 17 languages, Universität Konstanz, Konstanz 2017, 428pp. TS - BibTeX M4 - Citavi.

K. Lüscher, M. Sánchez, A. Klimczuk, Generations, intergenerational relationships, generational policy: A multilingual compendium, 12 languages, Universität Konstanz, Konstanz 2016, 300pp.

K. Lüscher, M. Sánchez, A. Klimczuk, Generations, intergenerational relationships, generational policy: A multilingual compendium, 12 languages, Universität Konstanz, Konstanz 2016, 300pp.

K. Lüscher, A. Klimczuk, Generations, intergenerational relationships, generational policy: A multilingual compendium, 17 languages, Universität Konstanz, Konstanz 2017, 428pp. TS - BibTeX M4 - Citavi.

K. Lüscher, M. Sánchez, A. Klimczuk, Generations, intergenerational relationships, generational policy: A multilingual compendium, 12 languages, Universität Konstanz, Konstanz 2016, 300pp.

The ethical principle of ‘respect for persons’ in clinical research has traditionally focused on protecting individuals’ autonomy rights, but respect for participants also includes broader, although less well understood, ethical obligations to regard individuals’ rights, needs, interests and feelings. However, there is little empirical evidence about how to effectively convey respect to potential and current participants. To fill this gap, we conducted exploratory, qualitative interviews with participants in a clinical genomics implementation study. We interviewed 40 participants in English or Spanish (...) about their experiences with respect in the study and perceptions of how researchers in a hypothetical observational study could convey respect or a lack thereof. Most interviewees were female, identified as Hispanic/Latino or non-Hispanic white, reported annual household income under US$60 000 and did not have a Bachelor’s degree ; 30% had limited health literacy. We identified four key domains for demonstrating respect: personal study team interactions, with an emphasis on empathy, appreciation and non-judgment; study communication processes, including following up and sharing results with participants; inclusion, particularly ensuring materials are understandable and procedures are accessible; and consent and authorisation, including providing a neutral informed consent and keeping promises regarding privacy protections. While the experience of respect is inherently subjective, these findings highlight four key domains that may meaningfully demonstrate respect to potential and current research participants. Further empirical and normative work is needed to substantiate these domains and evaluate how best to incorporate them into the practice of research. (shrink)

Lee emphasizes the need to better understand the moral relationship between researchers and participants connoted by precision medicine, with the framework of “the gift” offering bioethics a...

The proliferation of multistakeholder initiatives (MSIs) over the past years has sparked an intense debate on the political role of corporations in the governance of global business conduct. To gain a better understanding of corporate political behavior in multistakeholder governance, this article investigates how firms construct a political identity when participating in MSIs. Based on an in-depth case study of the Accord on Fire and Building Safety in Bangladesh—an MSI established after the collapse of the Rana Plaza garment factory complex (...) in 2013 to improve working conditions in the Bangladeshi garment industry—we introduce the construct of a political CSR (corporate social responsibility) identity (PCSRI) and explore how firms construct their PCSRIs in MSIs. Employing a qualitative, inductive theory-building method, we analyze interviews and archival data to develop a framework that elucidates how companies construct their PCSRIs within a continuum ranging from conservative to progressive. We show that constructing a PCSRI involves enacting specific, yet interrelated, political strategies that are themselves shaped by several forces over time. This article contributes to the literature by providing a political perspective on organizational identity construction that extends the emerging integrative perspective in political corporate social responsibility (PCSR) research. We suggest that MSIs should be conceptualized as inherently political governance mechanisms that are driven by multidirectional and dynamic political processes of identity construction. Our study shows that corporate political engagement in MSIs is a more nuanced and complex phenomenon than presently theorized. (shrink)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care (...) left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

Trust relations in the health services have changed from asymmetrical paternalism to symmetrical autonomy-based participation, according to a common account. The promises of personalized medicine emphasizing empowerment of the individual through active participation in managing her health, disease and well-being, is characteristic of symmetrical trust. In the influential Kantian account of autonomy, active participation in management of own health is not only an opportunity, but an obligation. Personalized medicine is made possible by the digitalization of medicine with an ensuing increased (...) tailoring of diagnostics, treatment and prevention to the individual. The ideal is to increase wellness by minimizing the layer of interpretation and translation between relevant health information and the patient or user. Arguably, this opens for a new level of autonomy through increased participation in treatment and prevention, and by that, increased empowerment of the individual. However, the empirical realities reveal a more complicated landscape disturbed by information ‘noise’ and involving a number of complementary areas of expertise and technologies, hiding the source and logic of data interpretation. This has lead to calls for a return to a mild form of paternalism, allowing expertise coaching of patients and even withholding information, with patients escaping responsibility through blind or lazy trust. This is morally unacceptable, according to Kant’s ideal of enlightenment, as we have a duty to take responsibility by trusting others reflexively, even as patients. Realizing the promises of personalized medicine requires a system of institutional controls of information and diagnostics, accessible for non-specialists, supported by medical expertise that can function as the accountable gate-keeper taking moral responsibility required for an active, reflexive trust. (shrink)

Questions on what it means to live and die well are raised and discussed in the hospice movement. A phenomenological lifeworld perspective may help professionals to be aware of meaningful and important dimensions in the lives of persons close to death. Lifeworld is not an abstract philosophical term, but rather the opposite. Lifeworld is about everyday, common life in all its aspects. In the writings of Cicely Saunders, known as the founder of the modern hospice movement, facets of lifeworld are (...) presented as important elements in caring for dying patients. Palliative care and palliative medicine today are, in many ways, replacing hospices. This represents not only a change in name, but also in the main focus. Hospice care was originally very much about providing support and comfort for, and interactions with the patients. Improved medical knowledge today means improved symptomatic palliation, but also time and resources spent in other ways than before. Observations from a Nordic hospice ward indicate that seriously ill and dying persons spend much time on their own. Different aspects of lifeworld and intersubjectivity in the dying persons’ room is presented and discussed. (shrink)

In their article “Implementing Expanded Prenatal Genetic Testing: Should Parents Have Access to Any and All Fetal Genetic Information?” Bayefsky and Berkman briefly mention that: “[s]ome are...

The expansion of research on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises important neuroethics and policy questions related to data sharing. However, there has been little empirical research on the perspectives of experts developing these technologies. We conducted semi-structured, open-ended interviews with aDBS researchers regarding their data sharing practices and their perspectives on ethical and policy issues related to sharing. Researchers expressed support for and a commitment to sharing, with most saying that they were either sharing their data (...) or would share in the future and that doing so was important for advancing the field. However, those who are sharing reported a variety of sharing partners, suggesting heterogeneity in sharing practices and lack of the broad sharing that would reflect principles of open science. Researchers described several concerns and barriers related to sharing, including privacy and confidentiality, the usability of shared data by others, ownership and control of data (including potential commercialization), and limited resources for sharing. They also suggested potential solutions to these challenges, including additional safeguards to address privacy issues, standardization and transparency in analysis to address issues of data usability, professional norms and heightened cooperation to address issues of ownership and control, and streamlining of data transmission to address resource limitations. Researchers also offered a range of views on the sensitivity of neural activity data (NAD) and data related to mental health in the context of sharing. These findings are an important input to deliberations by researchers, policymakers, neuroethicists, and other stakeholders as they navigate ethics and policy questions related to aDBS research. (shrink)

Background Deep brain stimulation is approved for treating refractory obsessive-compulsive disorder in adults under the US Food and Drug Administration Humanitarian Device Exemption, and studies have shown its efficacy in reducing symptom severity and improving quality of life. While similar deep brain stimulation treatment is available for pediatric patients with dystonia, it is not yet available for pediatric patients with obsessive-compulsive disorder, although soon could be. The prospect of growing indications for pediatric deep brain stimulation raises several ethical concerns relating (...) to bodily integrity, the ability to offer informed assent, and the role pediatric patients play in the decision-making process. Objective The aim of this study is to solicit and assess the views of stakeholders (children, parents, clinicians) on pediatric assent, autonomy, and bodily integrity in the context of potential pediatric deep brain stimulation for obsessive-compulsive disorder. Methods Semi-structured interviews were conducted with pediatric obsessive-compulsive disorder patients ( n = 21), caregivers of pediatric obsessive-compulsive disorder patients aged 14–18 ( n = 19), and clinicians with experience treating refractory obsessive-compulsive disorder ( n = 25). Interviews were transcribed and coded in MAXQDA 2018 and 2020 software and processed for thematic content analysis to isolate and compare specific themes. Results A majority of respondents (74%, 48/65) across all three stakeholder groups voiced that the decision-making process should be collaborative and involve everyone (clinicians: 84% or 21/25, caregivers 71% or 15/21, and patients 63% or 12/19). We identified a split between respondents’ views on who should have the final say in the event of disagreement (38% or 25/65 favored the patient versus 35% or 23/65 favoring caregivers). A split between respondents also emerged concerning the maturity relevant for deep brain stimulation decision-making, with 45% (29/65) favoring developmental maturity (age/physiological development) and 45% (29/65) favoring decisional maturity (capacity to understand and weigh information). A majority of clinicians indicated that they would not move forward with deep brain stimulation without securing patient assent (80% or 20/25), with some stating the only exception is if patient quality of life was very poor and/or they lacked insight. Both caregivers and patients expressed a significant respect for the patient's right to bodily integrity, with 67% of caregivers (14/21) and 68% of patients (13/19) justifying patient involvement in decision-making specifically with reference to infringements of bodily integrity. Conclusion Our findings demonstrate that despite broad agreement across stakeholders that the decision-making process for pediatric deep brain stimulation for obsessive-compulsive disorder should be collaborative and somehow involve pediatric patients, there is disagreement about what this process entails and what factors determine patient involvement in the process. However, there is agreement that children have a right to bodily and brain integrity, which should only be infringed upon in rare circumstances. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

This collection of essays provides a reassessment of the question of sexual difference, taking into account important shifts in feminist thought, post-humanist theories, and queer studies. The contributors offer new and refreshing insights into the complex question of sexual difference from a post-feminist perspective, and how it is reformulated in various related areas of study, such as ontology, epistemology, metaphysics, biology, technology, and mass-media.

The field of second language acquisition (SLA) is by nature of its subject a highly interdisciplinary area of research. Learning a (foreign) language, for example, involves encoding new words, consolidating and committing them to long-term memory, and later retrieving them. All of these processes have direct parallels in the domain of human memory and have been thoroughly studied by researchers in that field. Yet, despite these clear links, the two fields have largely developed in parallel and in isolation from one (...) another. The present article aims to promote more cross-talk between SLA and memory science. We focus on foreign language (FL) attrition as an example of a research topic in SLA where the parallels with memory science are especially apparent. We discuss evidence that suggests that competition between languages is one of the mechanisms of FL attrition, paralleling the interference process thought to underlie forgetting in other domains of human memory. Backed up by concrete suggestions, we advocate the use of paradigms from the memory literature to study these interference effects in the language domain. In doing so, we hope to facilitate future cross-talk between the two fields and to further our understanding of FL attrition as a memory phenomenon. (shrink)

The aim of the study was to compare the acute effects of traditional resistance training and superset training on training duration, training volume and different perceptive measures. Twenty-nine resistance-trained participants performed a whole-body workout traditionally and as supersets of exercises targeting different muscle groups, in a randomized-crossover design. Each session was separated by 4–7 days, and consisted of eight exercises and three sets to failure. Training duration and number of repetitions lifted were recorded during the sessions. Rate of perceived exertion (...) for effort, rate of perceived exertion for discomfort, session displeasure/pleasure, and exercise enjoyment were measured 15 min after each session. Forty-eight hours after the final session participants reported which session they preferred. The superset session led to significantly higher values for RPE and RPD and tended to be higher for sPDF, i.e., more pleasurable, compared to the traditional session. There was no difference in EES. The traditional session led to significantly increased training volume and lasted 23 min longer than the superset session. Eighteen of the participants preferred the superset session, while 11 preferred the traditional session. In conclusion, performing a whole-body workout as a superset session was more time-efficient, but reduced the training volume and was perceived with greater exertion for effort and discomfort than a traditional workout. (shrink)

Agricultural diversification in the Midwestern Corn Belt has the potential to improve socioeconomic and environmental outcomes by buffering farmers from environmental and economic shocks and improving soil, water, and air quality. However, complex barriers related to agricultural markets, individual behavior, social norms, and government policy constrain diversification in this region. This study examines farmer perspectives regarding the challenges and opportunities for both corn and soybean production and agricultural diversification strategies. We analyze data from 20 focus groups with 100 participants conducted (...) in Indiana, Illinois, and Iowa through a combined inductive and deductive approach, drawing upon interpretive grounded theory. Our results suggest that when identifying challenges and opportunities, participants center economics and market considerations, particularly income, productivity, and market access. These themes are emphasized both as benefits of the current corn-soybean system, as well as challenges for diversification. Additionally, logistical, resource and behavioral hurdles– including the comparative difficulty and time required to diversify, and constraints in accessing land, labor, and technical support– are emphasized by participants as key barriers to diversification. Agricultural policies shape these challenges, enhancing the comparative advantage and decreasing the risk of producing corn and soybeans as compared to diversified products. Meanwhile, alternative marketing arrangements, farmer networks, family relationships, and improved soil health are highlighted as important opportunities for diversification. We contextualize our findings within the theories of reasoned action and diffusion of innovation, and explore their implications for farmer engagement, markets, and agricultural policy, and the development of additional resources for business and technical support. (shrink)

Through case studies that highlight the type of information that is seldom reported in the news, Faces of Environmental Racism exposes the type and magnitude of environmental racism, both domestic and international. The essays explore the justice of current environmental practices, asking such questions as whether cost-benefit analysis is an appropriate analytic technique and whether there are alternate routes to sustainable development in the South.

We expand Chater & Loewenstein's discussion of barriers to s-frames by highlighting moral psychological mechanisms. Systemic aspects of moralized social issues can be neglected because of (a) the individualistic frame through which we perceive moral transgressions; (b) the desire to punish elicited by moral emotions; and (c) the motivation to attribute agency and moral responsibility to transgressors.

Comparative psychology, the multidisciplinary study of animal behavior and psychology, confronts the challenge of how to study animals we find cute and easy to anthropomorphize, and animals we find odd and easy to objectify, without letting these biases negatively impact the science. In this Element, Kristin Andrews identifies and critically examines the principles of comparative psychology and shows how they can introduce other biases by objectifying animal subjects and encouraging scientists to remain detached. Andrews outlines the scientific benefits of (...) treating animals as sentient research participants who come from their own social contexts and with whom we will be in relationship. With discussions of science's quest for objectivity, worries about romantic and killjoy theories, and debates about chimpanzee cognition between primatologists who work in the field and those in the lab, Andrews shows how scientists can address the different biases through greater integration of the subdisciplines of comparative psychology. (shrink)

Does the unequal participation of non-traditional students in higher education indicate social injustice, even if it can be traced back to individuals' choices? Drawing on luck egalitarian approaches,this article suggests that an answer to this question must take into account the effects of unequal brute luck on educational choices.I use a framework based on expected utility theory to analyse qualitative studies on educational choice.This reveals a variety of mechanisms through which differences in background conditions make non-traditional students less likely to (...) apply to university and/or particular institutions; the unequal participation of nontraditional students in higher education remains a problem of social justice. (shrink)

In this contribution to the Common Knowledge symposium “Fuzzy Studies,” the authors, all of whom work in the field of science, technology, and society, begin from the assumption that, as Bruno Latour has put it, “we have never been modern.” They accept the STS thesis that, while modern practices purport to be entirely rational and coherent, on closer inspection they turn out to be as much noncoherent as coherent. This article poses the question of what forms “noncoherences” take and how (...) they are managed. The basic argument is that there is a range of styles of noncoherence or “modes of syncretism.” In small case studies, the authors identify six such modes or styles, which they term denial, domestication, separation, care, conflict, and collapse. Given that consistency and coherence seem less important now than they were once taken to be — and given that the conditions of possibility for purity are, in any case, in decline — this list and its supporting case studies, while not meant to be definitive, are offered as a way of understanding how practices that do not cohere may still function and fit together admirably. (shrink)

Working memory is the system responsible for maintaining and manipulating information, in the face of ongoing distraction. In turn, WM span is perceived to be an individual-differences construct reflecting the limited capacity of this system. Recently, however, there has been some evidence to suggest that WM capacity can increase through training, raising the possibility that training can functionally alter the neural structures supporting WM. To address the hypothesis that the neural substrates underlying WM are targeted by training, we conducted a (...) meta-analysis of functional magnetic resonance imaging studies of WM training using Activation Likelihood Estimation. Our results demonstrate that WM training is associated exclusively with decreases in blood oxygenation level-dependent responses in clusters within the fronto-parietal system that underlie WM, including the bilateral inferior parietal lobule, middle and superior frontal gyri, and medial frontal gyrus bordering on the cingulate gyrus. We discuss the various psychological and physiological mechanisms that could be responsible for the observed reductions in the BOLD signal in relation to WM training, and consider their implications for the construct of WM span as a limited resource. (shrink)

Much experimental evidence shows that minimally counterintuitive concepts, which violate one intuitive ontological expectation of domain-specific natural kinds, are remembered as well as or better than intuitive concepts with no violations of ontological expectations, and much better than maximally counterintuitive concepts with more than one violation of ontological violations. It is also well established that concepts rated as high in imagery, are recalled better than concepts that are low in imagery. We conducted three studies to test whether imagery levels affected (...) recall rates of intuitive, minimally counterintuitive, and maximally counterintuitive concepts. In study 1, we obtained imagery level ratings for 48 three-word items. In study 2, we used the ratings obtained in study 1 in a 2 × 3 recall task in which imagery was manipulated along with counterintutiveness. High imagery items were recalled significantly better than low imagery items for intuitive and maximally counterintuitive items but not for minimally counterintuitive items. Study 3, replicated the findings from study 2 in a 2 × 2 study using a larger number of intuitive and minimally counterintuitive items. In both studies, High imagery items were recalled significantly better than low imagery items for intuitive but not for minimally counterintuitive items. Thus, minimally counterintuitive concepts appear insulated from imagery effects on recall. (shrink)

Health equity can be defined as the absence of disadvantage to individuals and communities in health outcomes, access to health care, and quality of health care regardless of one’s race, gender, nationality, age, ethnicity, religion, and socioeconomic status. Health equity concerns those disparities in public health that can be traced to unequal, systemic economic, and social conditions. Despite significant improvements in the health of the overall population, health inequities in America persist. Racial and ethnic minorities continue to experience higher rates (...) of morbidity and mortality than non-minorities across a range of health issues. For example, African-American children with asthma have a seven times greater mortality rate than Non-Hispanic white children with the illness. While cancer is the second leading cause of death among all populations in the U.S., ethnic minorities are especially burdened with the disease. (shrink)

The chapter begins with a discussion of the determinism relatum (§2) and the free-will relatum (§3). The next section (§4) identifies four relations which are commonly used to characterize (in)compatibilism: metaphysical incompossibility, logical inconsistency, metaphysical incompatibility, and logical incompatibility. In closing (§5), I suggest a way to disambiguate the terms “compatibilism” and “incompatibilism”. -/- For the most recent draft, please gmail me: kristin.mickelson.42.

Alternative food networks, such as farmers’ markets and community-supported agricultural and fishery programs, often struggle to reach beyond a consumer base that is predominantly white and affluent. This case study explores seven inclusion strategies deployed by a community-supported fishery program (Fishadelphia, in Philadelphia, PA, USA) including discounting prices, accepting payment in multiple forms and schedules, offering a range of product types, communicating and recruiting through a variety of media (especially in person), and choosing local institutions and people of color (POC) (...) as pickup location hosts. Our analysis indicated that all of these strategies were associated with increased participation of customers of color and/or customers without a college degree. For Asian customers, accepting cash, offering whole fish, recruiting in-person, and POC-hosted pickup locations were key factors. For Black customers, discounted price, accepting cash, offering fillets, and communicating through means other than email were most important. Discounted price and communicating through means other than email were most important for customers without a college degree. Payment method, payment schedule and communication method were highly correlated with other strategies; we suggest that these strategies work in synergy to make the program attractive and feasible to these customers. We consider how Fishadelphia’s inclusion efforts have benefitted from both tactical approaches (i.e., programmatic features) and a structural approaches (i.e., the people and places represented within the project), and suggest that elements of both tactical and structural inclusion can be applied in other contexts. This work is crucial for increasing food access, and underscores the importance of relationships in recruiting diverse customers. (shrink)

The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients’ views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts (...) to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and “normalcy” in the context of OCD. (shrink)