Some transgender and nonbinary people undergo phalloplasty and/or metoidioplasty as part of their medical transition process. Across surgical disciplines, a variety of resources are used to assist patients who are preparing for surgeries, including educational materials, workshops, peer support, and lifestyle changes. For gender-affirming surgeries, patients undergoing assessments to discern whether they are ready to undergo the surgery, and to assist them in achieving preparedness when needed. Little research investigates what resources are useful in helping patients to feel prepared to (...) undergo phalloplasty or metoidioplasty, and how assessments and resources can promote patient autonomy in the process. Respect for patient autonomy is one of the central tenets of ethical healthcare, yet historically, scholarship related to pre-surgical assessments for gender-affirming surgery has focused determining the ideal surgical candidate rather than respecting patient autonomy and ascertaining individual patient needs. This study sought to fill this gap by utilizing data from PROGRESS (Patient-Reported Outcomes of Genital Reconstruction and Experiences of Surgical Satisfaction), a cross-sectional, community-based survey of trans and nonbinary adults from the United States of America and Canada who had undergone one or more of these surgeries. Results revealed most participants (86%, n = 186) felt prepared to undergo surgery, though the majority of our sample (53%, n = 105) did not find referral letter assessments to be helpful. Peer support such as online resources/blogs were rated as highly useful, along with surgical consults. In a multivariable logistic regression, higher perceived preparedness was associated with identifying as queer (inclusive of gay, bi and pansexual compared to being straight), and feeling that one’s assessment process was useful (as opposed to not useful). Type of assessment was not significantly associated with preparedness; therefore, what is most useful when preparing for surgery may vary across individuals. Healthcare professionals who interact with preparing patients should develop new or utilize existing resources to assist patients in identifying their preparation needs and achieving preparedness. Our data supports assessments that center surgical care planning rather than assessing level of gender dysphoria. Future longitudinal research could further refine which assessment processes are most effective in helping patients who are preparing for these surgeries. Assessments should ensure that patients are appropriately prepared to undergo and recover from surgery through a robust process of informed consent. (shrink)

In the paper ‘COVID-19 vaccine boosters for young adults: a risk–benefit assessment and ethical analysis of mandate policies at universities,’ Bardoshet alargued that college mandates of the COVID-19 booster vaccine are unethical. The authors came to this conclusion by performing three different sets of comparisons of benefits versus risks using referenced data and argued that the harm outweighs the risk in all three cases. In this response article, we argue that the authors frame their arguments by comparing values that are (...) not scientifically or reasonably comparable and that the authors used values that represent grossly different risk profiles and grouped them into a set of figures to create an illusion of fair comparisons. We argue that absent the falsely skewed portrayals of a higher level of risk over benefit in their misrepresented figures, the five ethical arguments they presented completely fall apart. (shrink)

This insightful selection, features four discourses from The Idea of a University: Knowledge Its Own End; Knowledge Viewed in Relation to Learning; Knowledge Viewed in Relation to Professional Skill; and Knowledge Viewed in Relation to Religion. Also included are excerpts from the "Preface" and the following appendices: Discipline of Mind; Literature and Science; and Style. Edited by Leo L. Ward, this volume also contains an introduction, a list of principal dates in Newman's life, and a bibliography.

Volume 28, Issue 3, May 2020, Page 431-441.

This study builds on prior research investigating the antecedents of firm supererogation. Examining vehicle recalls in the U.S. automobile industry from 1966 to 2010 reveals that surveillance-based government enforcement programs can have widespread industry effects on a specific type of supererogatory action, firm volunteerism. Specifically, increases in government surveillance are associated with firms going beyond what is legally required of them by initiating voluntary product recalls for defects not covered in existing government regulation. Such effects are shown to be unique (...) among surveillance efforts as other government enforcement activities, such as standards-based regulation, are revealed to have a negative association with firm supererogation. (shrink)

This concise and accessible introduction to Strauss's thought provides, for wider audience, a bridge to his more complex theoretical work. Editor Pangle has gathered five of Strauss's previously unpublished lectures and five hard-to-find published writings and has arranged them so as to demonstrate the systematic progression of the major themes that underlay Strauss's mature work. "[These essays] display the incomparable insight and remarkable range of knowledge that set Strauss's works apart from any other twentieth-century philosopher's."—Charles R. Kesler, National Review.

In lieu of an abstract, here is a brief excerpt of the content:Full Collection of Personal NarrativesGianna O'Leary, Paul Hostovsky, Yilu Ma, Leo Almazan, Hilda Sanchez-Herrera, Marisa Rueda Will, Elaine Hsieh, Manuel Patiño, Felicity Ratway, Liliana Crane, Laisson DeSouza, Nilsa Ricci, Linda Pollack-Jackson, Kelley Cooper, Mateo Rutherford-Rojas, Rosa C. Moreno, Maja Milkowska-Shibata, Patricia Coronado, and Catalina Meyer• A Day in the Life of a Spanish Interpreter• Deaf Interpreter• "Call me Dr. XXX!"• Translating Care for the Voiceless Patient• Are We (...) There Yet? A Narrative of Firsthand Interpreter Experiences in the Medical Field and Insights to Aid Language Access Compliance• One Interpreter's Journey of Interpreting for Pregnancy Loss• More Than Words: Communicating for the Quality of Care• From Linguistic Bridge Builder to Aspiring Physician• Towards Language Justice: A Call to Identify and Overcome Structural Barriers• Voices in the Shadows: The Hidden Complexities of Being a Medical Interpreter• The Voice of Patients: The Exclusive Work of a Human Who Can Advocate• Don't Mute the Messenger• The Ramp and the Stop Sign• How Policies and Practices in Medical Settings Impact Communication Access with Deaf Patients and Caregivers• And When May I Cry? Juggling Emotions in Healthcare Interpreting• To Engage or Not to Engage: An Interpreter and a Mother's Need for Connection in the Cardiothoracic Unit• Witnessing Trauma: Emotional Challenges in Medical Interpretation• Being an Interpreter—Beyond Linguistics• 1-800-Quit-NowCopyright © 2024 Johns Hopkins University Press... (shrink)

DNA sequence variation is abundant in wild populations. While molecular biologists use genetically homogeneous strains of model organisms to avoid this variation, evolutionary biologists embrace genetic variation as the material of evolution since heritable differences in fitness drive evolutionary change. Yet, the relationship between the phenotypic variation affecting fitness and the genotypic variation producing it is complex. Genetic buffering mechanisms modify this relationship by concealing the effects of genetic and environmental variation on phenotype. Genetic buffering allows the build-up and storage (...) of genetic variation in phenotypically normal populations. When buffering breaks down, thresholds governing the expression of previously silent variation are crossed. At these thresholds, phenotypic differences suddenly appear and are available for selection. Thus, buffering mechanisms modulate evolution and regulate a balance between evolutionary stasis and change. Recent work provides a glimpse of the molecular details governing some types of genetic buffering. BioEssays 22:1095–1105, 2000. © 2000 John Wiley & Sons, Inc. (shrink)

There is a national movement supporting the retention and use of bio-specimens from deceased individuals for the purpose of genetic testing. This manuscript discusses the significance of postmortem genetic testing in the context of death determination by medical examiners. We highlight distinctive concerns that are raised in the areas of consent, confidentiality, and return of results when genetic testing is performed as part of a public molecular autopsy. We believe our manuscript will contribute to the development of a robust ethical (...) and legal framework for genetic testing in this context. (shrink)

This new edition brings Farquharson's authoritative 1944 translation up to date and includes a helpful introduction and notes for the student and general reader. Rutherford includes a selection of letters from Marcus to his tutor Fronto--most of which date from his earlier years--that offer personal detail and help to fill out the somber portrait of the emperor that is found in the Meditations.

The “tragedy of the commons” argument developed by Garrett Hardin is applied to problems associated with the increasing use of the national parks in the United States. The relevance of his argument to such problems is illustrated by a discussion of the proposals included in the recent Draft General Management Plan for Yosemite National Park. Implications for the future management of Yosemite andother public recreation resources conclude the article.

The authors explore the simulating, philosophical question, "What is the importance of parks and recreation to the quality of life?". Asked by students, educators and practitioners alike, the answer to the question is the core of one's philosophy in the field of recreation. The text has been written so that it is easy to comprehend. The authors present the material in a first person plural and without gender biased language. Each section contains probing questions and a list of references.

User satisfaction as the ultimate goal of recreation planning and management is contested by a discussion of human adaptability which makes it possible for people to adjust to a progressively lower quality of recreation opportunities without loss of satisfaction. Recreation planning and management based on such satisfaction levels are then shown to perpetuate a deterioration in the quality of recreationenvironments themselves. To arrest this trend, a new goal for recreation planning and management is proposed based on the equation of quality (...) of opportunity with diversity of environmental settings. The article concludes with a discussion of this goal in light of the Recreation Opportunity Spectrum (ROS) concept developed recently by members of the United States Forest Service. (shrink)

Since Darwin, there has been a long and arduous struggle to understand the source and maintenance of natural genetic variation and its relationship to phenotype. The reason that this task is so difficult is that it requires integration of detailed, and as yet incomplete, knowledge from several biological disciplines, including evolutionary, population, and developmental genetics. In this ‘post‐genomic’ era, it is relatively easy to identify differences in the DNA sequence between individuals. However, the task remains to delineate how this abundant (...) genetic diversity actually contributes to phenotypic diversity. This necessitates tackling the problem of hidden genetic variation. Genetic polymorphisms can be conditionally cryptic, but have the potential to contribute to phenotypic variation in particular genetic backgrounds or under specific environmental conditions. A recent paper by Lauter and Doebley highlights the contribution of hidden genetic variation to traits characterizing the morphological evolution of modern maize from its wild grass‐like progenitor teosinte.1 This work is the first to demonstrate hidden variance for selected (agronomically ‘adaptive’) traits in a well‐characterized model for morphological evolution. BioEssays 24:685–689, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

A computational model of inference during story comprehension is presented, in which story situations are represented distributively as points in a high‐dimensional “situation‐state space.” This state space organizes itself on the basis of a constructed microworld description. From the same description, causal/temporal world knowledge is extracted. The distributed representation of story situations is more flexible than Golden and Rumelhart's [Discourse Proc 16 (1993) 203] localist representation.A story taking place in the microworld corresponds to a trajectory through situation‐state space. During the (...) inference process, world knowledge is applied to the story trajectory. This results in an adjusted trajectory, reflecting the inference of propositions that are likely to be the case. Although inferences do not result from a search for coherence, they do cause story coherence to increase. The results of simulations correspond to empirical data concerning inference, reading time, and depth of processing.An extension of the model for simulating story retention shows how coherence is preserved during retention without controlling the retention process. Simulation results correspond to empirical data concerning story recall and intrusion. (shrink)

Selon une accusation lancée par Mendelssohn en 1785, Kant est souvent considéré comme le brise-tout (Alleszermalmer) de la métaphysique. Les textes permettent de montrer qu'une telle attitude était étrangère à Kant, et qu'il projetait en réalité une réforme et une renaissance de la métaphysique. A cet effet, il s'est servi d'une argumentation qui, outre ses aspects originaux, plonge aussi ses racines dans une stratégie que Baumgarten, puis son disciple Georg Friedrich Meier, avaient déjà déployée contre l'attitude antimétaphysique. Gemäss Mendelssohns Anklage (...) von 1785 wird Kant oft als ein Alleszermalmer, als der Zermalmer der Metaphysik, betrachtet. Die Texte belegen jedoch, dass Kant keine derartige Absicht hegte, und dass er in Wirklichkeit die Metaphysik einer Reform unterziehen wollte. Dazu bediente er sich einer Argumentation, die ausser ihren originellen Aspekten auch in einer Strategie wurzelt, die schon von Baumgarten und seinem Schüler Georg Friedrich Meier gegen die antimetaphysische Haltung durchgeführt wurde. (shrink)

Cancer and its treatment pose challenges that affect not only patients but also their significant others, including intimate partners. Accumulating evidence suggests that couples’ ability to communicate effectively plays a major role in the psychological adjustment of both individuals and the quality of their relationship. Two key conceptual models have been proposed to account for how couple communication impacts psychological and relationship adjustment: the social-cognitive processing (SCP) model and the relationship intimacy (RI) model. These models posit different mechanisms and outcomes, (...) and thus have different implications for intervention. The purpose of this project is to test and compare the utility of these models using comprehensive and methodologically rigorous methods. Aims are: (1) to examine the overall fit of the SCP and RI models in explaining patient and partner psychological and relationship adjustment as they occur on a day-to-day basis and over the course of 1 year; (2) to examine the fit of the models for different subgroups (males vs. females, and patients vs. partners); and (3) to examine the utility of various methods of assessing communication by examining the degree to which baseline indices from different measurement strategies predict self-reported adjustment at 1-year follow up. The study employs a longitudinal, multi-method approach to examining communication processes including: standard self-report questionnaires assessing process and outcome variables collected quarterly over the course of 1 year; smartphone-based ecological momentary assessments to sample participant reports in real time; and laboratory-based couple conversations from which we derive observational measures of communicative behavior and affective expression, as well as vocal indices of emotional arousal. Participants are patients with stage II-IV breast, colon, rectal, or lung cancer and their spouses/partners, recruited from two NCI-designated comprehensive cancer centers. Results will be published in scientific journals, presented at scientific conferences, and conveyed to a larger audience through infographics and social media outlets. Findings will inform theory, measurement, and the design and implementation of efficacious interventions aimed at optimizing both patient and partner well-being. (shrink)

Medicine regulation demands the application of sound medical, scientific, and technical knowledge and skills, and operates within a legal framework. Regulatory functions involve interactions with various stakeholders (e.g., manufacturers, traders, consumers, health professionals, researchers, and governments) whose economic, social, and political motives may differ, making implementation of regulation both politically and technically challenging. This book discusses regulatory landscape globally and the current global regulatory scenario of medicinal products and food products comprehensively.

We apply two contrasting principles of human workmanship, the principles of design and eolithism, to the issue of responsible environmental stewardship. Both principles are described and analyzed in an environmental context with an emphasis on the weaknesses of the more popular design principle and the strengths of the lesser known eolithic principle. We conclude with a discussion of the principles’complementary potential for environmental planning and management.

Bien que Descartes n’emploie que rarement les mots officium ou « devoir », sa morale confère une place centrale à la notion d’action appropriée, dans un sens qui rappelle le kathekon des stoïciens. Cette notion enveloppe les devoirs de l’être humain envers Dieu et envers les autres êtres humains, ainsi que les actions qui trouvent leur justification dans le fait qu’elles favorisent la conservation et la santé du corps. Tout en relevant ces parallèles, je montre également que Descartes, dans son (...) analyse de la vertu et des passions, s’écarte des doctrines stoïciennes ; divergence que j’explique en partie par l’acceptation de la tripartition des biens (bien moral, biens du corps, biens extérieurs) que rejettent les stoïciens. (shrink)

For much of the first fifty years of its existence, analytic philosophy shunned discussions of normativity and ethics. Ethical statements were considered as pseudo-propositions, or as expressions of pro- or con-attitudes of minor theoretical significance. Nowadays, in contrast, prominent analytic philosophers pay close attention to normative problems. Here we focus our attention on the work of Searle, at the same time drawing out an important connection between Searle’s work and that of two other seminal figures in this development: H.L.A. Hart (...) and John Rawls. We show that all three thinkers tend to assume that there is but one type of normativity within the realm of social institutions – roughly, the sort of normativity that is involved in following the results of chess – and that they thereby neglect features that are of crucial significance for an adequate understanding of social reality. (shrink)