This article reports on the Boundaries in Practice (BIP) Scale developed to measure knowledge, comfort, ethical decision making, and experience. Few instruments used in studies conducted on professional/?client boundaries have been validated. The BIP demonstrated sound face, content and construct validity, and adequate internal consistency reliability. The BIP Scale provides the first reliable and valid means of investigating multiple boundary domains across health disciplines and teams. The sensitivity and complexity of boundary issues and the serious consequences of breaches highlight the (...) importance of a valid and reliable measure in building empirical knowledge in this field. (shrink)

The philosophy of family‐centered care (FCC) promotes partnerships between families and staff to plan, deliver, and evaluate services for children and has been officially adopted by a majority of pediatric hospitals throughout North America. However, studies indicated that many parents have continued to be dissatisfied with their decision‐making roles in their child's care. This is particularly salient for parents of children with chronic ongoing complex health problems. These children are dependent upon medical technology and require frequent hospitalizations during which parents (...) must contribute to difficult decisions regarding their child's care. Given this clinical issue, an alternative theoretical perspective was explored to redress this problem. Pierre Bourdieu's theoretical concepts of field, capital, and habitus were used to analyze the hierarchical relationships in pediatric acute care hospitals and to design a briefing intervention aimed at improving parents' satisfaction with decision making in that health care setting. (shrink)

Introduction Future HIV vaccine efficacy trials with adolescents will need to ensure that participants comprehend study concepts in order to confer true informed assent. A Hepatitis B vaccine trial with adolescents offers valuable opportunity to test youth understanding of vaccine trial requirements in general. Methods Youth reviewed a simplified assent form with study investigators and then completed a comprehension questionnaire. Once enrolled, all youth were tested for HIV and confirmed to be HIV-negative. Results 123 youth completed the questionnaire (mean age=15 (...) years; 63% male; 70% Hispanic). Overall, only 69 (56%) youth answered all six questions correctly. Conclusions Youth enrolled in a Hepatitis B vaccine trial demonstrated variable comprehension of the study design and various methodological concepts, such as treatment group masking. (shrink)

BackgroundStructured, systematic methods to formulate consensus recommendations, such as the Delphi process or nominal group technique, among others, provide the opportunity to harness the knowledge of experts to support clinical decision making in areas of uncertainty. They are widely used in biomedical research, in particular where disease characteristics or resource limitations mean that high-quality evidence generation is difficult. However, poor reporting of methods used to reach a consensus – for example, not clearly explaining the definition of consensus, or not stating (...) how consensus group panellists were selected – can potentially undermine confidence in this type of research and hinder reproducibility. Our objective is therefore to systematically develop a reporting guideline to help the biomedical research and clinical practice community describe the methods or techniques used to reach consensus in a complete, transparent, and consistent manner.MethodsThe ACCORD project will take place in five stages and follow the EQUATOR Network guidance for the development of reporting guidelines. In Stage 1, a multidisciplinary Steering Committee has been established to lead and coordinate the guideline development process. In Stage 2, a systematic literature review will identify evidence on the quality of the reporting of consensus methodology, to obtain potential items for a reporting checklist. In Stage 3, Delphi methodology will be used to reach consensus regarding the checklist items, first among the Steering Committee, and then among a broader Delphi panel comprising participants with a range of expertise, including patient representatives. In Stage 4, the reporting guideline will be finalised in a consensus meeting, along with the production of an Explanation and Elaboration document. In Stage 5, we plan to publish the reporting guideline and E&E document in open-access journals, supported by presentations at appropriate events. Dissemination of the reporting guideline, including a website linked to social media channels, is crucial for the document to be implemented in practice.DiscussionThe ACCORD reporting guideline will provide a set of minimum items that should be reported about methods used to achieve consensus, including approaches ranging from simple unstructured opinion gatherings to highly structured processes. (shrink)

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

In this paper, I submit that it is the controlled part of skilled action, that is, that part of an action that accounts for the exact, nuanced ways in which a skilled performer modifies, adjusts and guides her performance for which an adequate, philosophical theory of skill must account. I will argue that neither Jason Stanley nor Hubert Dreyfus have an adequate account of control. Further, and perhaps surprisingly, I will argue that both Stanley and Dreyfus relinquish an account of (...) control for precisely the same reason: each reduce control to a passive, mechanistic, automatic process, which then prevents them from producing a substantive account of how controlled processes can be characterized by seemingly intelligent features and integrated with personal-level states. I will end by introducing three different kinds of control, which are constitutive of skilled action: strategic control, selective, top–down, automatic attention, and motor control. It will become clear that Dreyfus cannot account for any of these three kinds of control while Stanley has difficulty tackling the two latter kinds. (shrink)

Darwin’s classic ‘Origin of Species’ (Darwin 1859) described forces of selection acting upon individuals, but there remains a great deal of controversy about what exactly the status and definition of a biological individual is. Recently some authors have argued that the individual is dispensable – that an inability to pin it down is not problematic because little rests on it anyway. The aim of this paper is to show that there is a real problem of biological individuality, and an urgent (...) need to arbitrate over the current plethora of solutions to it. (shrink)

This chapter develops the idea that the germ-soma split and the suppression of individual fitness differences within the corporate entity are not always essential steps in the evolution of corporate individuals. It illustrates some consequences for multilevel selection theory. It presents evidence that genetic heterogeneity may not always be a barrier to successful functioning as a higher-level individual. This chapter shows that levels-of-selection theorists are wrong to assume that the central problem in transitions is always that of minimizing within-group competition. (...) Evidence of intralevel conflict does not qualify as evidence against the existence of a higher level of selection. (shrink)

Microbes are generally thought of as unicellular organisms, but we know that many microbes live as parts of biofilms—complex, surface-attached microbial communities numbering millions of cells. Some authors have recently argued in favour of reconceiving biofilms as biological entities in their own right. In particular, some have claimed that multispecies biofilms are evolutionary individuals : 10126–10132 2015). Against this view, I defend the conservative consensus that selection acts primarily upon microbial cells.

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

American Academy of Pediatrics (AAP) and American College of Medical Genetics (ACMG) recently provided two recommendations about predictive genetic testing of children. The Clinical Sequencing Exploratory Research Consortium's Pediatrics Working Group compared these recommendations, focusing on operational and ethical issues specific to decision making for children. Content analysis of the statements addresses two issues: (1) how these recommendations characterize and analyze locus of decision making, as well as the risks and benefits of testing, and (2) whether the guidelines conflict or (...) come to different but compatible conclusions because they consider different testing scenarios. These statements differ in ethically significant ways. AAP/ACMG analyzes risks and benefits using best interests of the child and recommends that, absent ameliorative interventions available during childhood, clinicians should generally decline to order testing. Parents authorize focused tests. ACMG analyzes risks and benefits using the interests of the child and other family members and recommends that sequencing results be examined for additional variants that can lead to ameliorative interventions, regardless of age, which laboratories should report to clinicians who should contextualize the results. Parents must accept additional analysis. The ethical arguments in these statements appear to be in tension with each other. (shrink)

What changes when an evolutionary transition in individuality takes place? Many different answers have been given, in respect of different cases of actual transition, but some have suggested a general answer: that a major transition is a change in the extent to which selection acts at one hierarchical level rather than another. The current paper evaluates some different ways to develop this general answer as a way to characterise the property ‘evolutionary individuality’; and offers a justification of the option taken (...) in Clarke :413–435, 2013)—to define evolutionary individuality in terms of an object’s capacity to undergo selection at its own level. In addition, I suggest a method by which the property can be measured and argue that a problem which is often considered to be fatal to that method—the problem of ‘cross-level by-products’—can be avoided. (shrink)

The remember/know procedure is the most widely used method to investigate recollection and familiarity. It uses trial-by-trial reports to determine how much recollection and familiarity contribute to different kinds of recognition. Few other methods provide information about individual memory judgements and no alternative allows such direct indications of recollection and familiarity influences. Here we review how the RK procedure has been and should be used to help resolve theoretical disagreements about the processing and neural bases of components of recognition memory. (...) Emphasis is placed on procedural weaknesses and a possible confound of recollection and familiarity with recognition memory strength. Recommendations are made about how to minimise these problems including using modified versions of the procedure. The proposals here are important for improving behavioural and lesion research, and vital for brain imaging work. (shrink)

The connection between understanding and explanation has recently been of interest to philosophers. Inglis and Mejía-Ramos (Synthese, 2019) propose that within mathematics, we should accept a functional account of explanation that characterizes explanations as those things that produce understanding. In this paper, I start with the assumption that this view of mathematical explanation is correct and consider what we can consequently learn about mathematical explanation. I argue that this view of explanation suggests that we should shift the question of explanation (...) away from why-questions and towards a “what’s going on here” question. Additionally, I argue that when we recognize the connection between understanding and explanation we naturally see how more than just proof can be explanatory. I expand this point by detailing how definitions and diagrams can be explanatory. In all, we see that when we take seriously the connection between understanding and explanation, we get a better sense of how explanation arises within mathematics. (shrink)

In the spirit of full disclosure, I have been a member of the Delphi panels discussed in this article (Beskow and Weinfurt 2019) since their inception and was one of the people who was recently int...

Culture, defined as shared behavior or information within a community acquired through some form of social learning from conspecifics, is now suggested to act as a second inheritance system. Cultural processes are important in a wide variety of vertebrate species. Birdsong provides a classic example of cultural processes: cultural transmission, where changes in a shared song are learned from surrounding conspecifics, and cultural evolution, where the patterns of songs change through time. This form of cultural transmission of information has features (...) that are different in speed and form from genetic transmission. More recently, culture, vocal traditions and an extreme form of song evolution has been documented in cetaceans. Humpback whale song ‘revolutions’, where the single population-wide shared song type is rapidly replaced by a new, novel song type introduced from a neighbouring population, represents an extraordinary example of ocean basin-wide cultural transmission rivalled in its geographic extent only by humans. In this review, we examine the cultural evolutions and revolutions present in some birdsong and whale song, respectively. By taking a comparative approach to these cultural processes, we review the existing evidence to understand the similarities and differences for their patterns of expression and the underlying drivers, including anthropogenic influences, which may shape them. Finally, we encourage future studies to explore the role of innovation vs. production errors in song evolution, the fitness information present in song, and how human-induced changes in population sizes, trajectories and migratory connections facilitating cultural transmission may be driving song revolutions. (shrink)

Intersex—the fact of bodies neither typically male nor female, together with the grim history of its medical management—was a topic for feminist theory before there was such a thing as intersex activism. Indeed, critical academic scholarship about intersex supported the consciousness raising that made an intersex activist movement possible. Activist engagement, in turn, has expanded the understanding of the theorists whose work is responsive to that activism. Central to the thinking about intersex are the questions of identity and its limits (...) that are an important focus of the work of Gloria Anzaldúa, whose narrative suggests she had a condition associated with intersex. While her work largely predates intersex activism, it powerfully encapsulates the tensions displayed in contests over identity that have become central over the last 15 years, and furthermore offers insight into the challenges that lie ahead. (shrink)

This article discusses outcomes of a dialogue conference on ‘The road ahead for ELSA in Norway: Issues of quality, influence and network cooperation’ held in Oslo in December 2012. Norwegian researchers in the field of ethical, legal and social aspects of technologies were invited to discuss conceptual and strategic issues, as well as the setup of a researcher network. In the article I take an institutionalist approach and discuss challenges in institutionalising an ELSA network at a time when a designated (...) ELSA funding programme is coming to an end. The research question is how the Norwegian ELSA network can succeed as a persistent network in times of greater uncertainties. The article claims that the network needs to gain legitimacy, outlines different dimensions of legitimacy and interprets the conference discussions in light of these dimensions. Central challenges and success factors facing the ELSA network are discussed and the article concludes with reflections on the potential future of ELSA in Norway. Although the article has a Norwegian context, the discussions in the article are likely to be relevant for researchers all across Europe, as similar developments are taking place also elsewhere in the European research funding context. (shrink)

Walt Disney’s movie, The Pagemaster (1994) begins on a dark and stormy night, with a young boy stumbling into an immense, gothic-styled library for refuge from the rain. Once inside, he is soon carried away by a tumultuous river of coloured paints, transformed into an animated characterization of himself, and thrust into an animated world of literature, where he battles Captain Hook, flees Moby Dick, and participates in other classic tales of adventure, horror, and fantasy. -/- Adults might understand the (...) film as a fanciful description of how they feel when reading a lively book. Although they would probably not imagine themselves tagging along with the animated characters like a 4th musketeer, they might very well claim that they enter a fiction through the viewpoint of one or more of the characters, experiencing, imaginatively, mental images of the sights, sounds, smells, and movements that the character would experience. Under this description, the reader would be forming multi- modal images that would correspond directly to what the literary characters are doing, thinking, and experiencing. When a fictional hero whips out his sword and slashes a rope in half, the reader might form a visual image of the hero’s determined face, an auditory image of the sound of the whizzing sword, and a motor image of an extended arm movement. I call such an imitative participation, by use of mental images in any modality, a simulation. -/- I suggest that this imitative experiencing of a fiction through the production of multi-modal imagery - a simulation - is not the only way in which readers might engage a literary text. In this paper I explore the hypothesis that readers might use their own bodily processes - those of the somato-viscero-motor system (SVM) for a non-imitative activity that I call a reinterpretation and that the reinterpretation might make a distinctive contribution to the reading process. As an example of a simulation and a reinterpretation, take the SVM experience of the reader’s breathing. A simulation would occur if the text describes a character who is taking deep breaths of air and the reader creates a mental image representing the experience of breathing. In this case, the reader’s mental image of breathing would stand for a property of the literary work - the fictional experience of breathing. -/- By contrast to the simulation, a reinterpretation would occur if the text describes a character who is gazing at long, wispy clouds that extend outward from a horizon and the reader uses his own experience of breathing to stand for the visual sense of looking at a long, continuous expanse of filmy white: the reader’s actual breathing would stand for a property of the literary work - the fictional experience of seeing. Breathing is not the same as seeing. This should help clarify the following definition. -/- I hypothesize that a reinterpretation occurs when the reader becomes aware of some component of the SVM system and reinterprets it as a property of the literary work that is not the same as that particular SVM process. The SVM experience is projected into the literary work. (shrink)

This commentary responds to the suggestion that we can humanize online university education through the design decisions we make about it. It offers several reasons why the suggestion may be unrealistic, given that choice in online course design is increasingly narrowed by the prevalence of relatively powerless part-time instructors, student preference for convenient online offerings, and the use of learning management systems. However, if our design decisions are constrained, it becomes all the more important that we engage in critical conversations (...) about what we gain and lose when technology is used to automate or mediate university education. (shrink)

The first-ever compilation of articles that highlights the intersection of Derridean and feminist theories--a work that represents the extensive and diverse response feminist theorists have had to Derrida, particularly to the issues of gender, identity, and the construction of the subject.

Parents, providers, policy makers, and the public need to talk about the implications of advances in genomic technologies for state run newborn metabolic screening programs. Technologies, such as highly multiplex testing and whole genome sequencing, are raising old issues with new urgency and are posing new challenges that threaten to overwhelm newborn screening programs.Newborn screening programs in their current form were born in the late 1960s. Robert Guthrie developed a screening test for phenylketonuria that could be performed on blood spots (...) collected on filter cards that Guthrie also developed. States rapidly established newborn screening programs, which were almost always mandatory, in response to advocacy by geneticists and parents. Although the programs initially varied in form and experienced significant pushback from the medical community, by the early 1970s, all states had established programs with centralized laboratories, and the medical community had come on board. (shrink)

Adolescents may often have opinions about whether they want genetic and genomic testing in both the clinic and research and about who should have access to the results. This legal analysis demonstrates that the law provides very little protection to minors' wishes.

The concept of adaptation is pivotal to modern evolutionary thinking, but it has long been the subject of controversy, especially in respect of the relative roles of selection versus constraints in explaining the traits of organisms. This paper tackles a different problem for the concept of adaptation: its interpretation in light of multilevel selection theory. In particular, I arbitrate a dispute that has broken out between the proponents of rival perspectives on multilevel adaptations. Many experts now say that multilevel and (...) kin selection views are mathematically equivalent to one another—that the mathematical accounting of evolution can be carried out at any hierarchical level one chooses. But what does this formal equivalence imply - are they equivalent in other ways too? I show here that significant conceptual non-equivalence has survived: the two sides commit to different views regarding how much selection has to act at a level before we can call traits at that level adaptations; about whether policing mechanisms are adaptations, and about whether non-organisms can bear adaptations. (shrink)

- How can anthropology improve our understanding of the interrelationship between nature and culture? - What can anthropology contribute to practical debates which depend on particular definitions of nature, such as that concerning sustainable development? Humankind has evolved over several million years by living in and utilizing 'nature' and by assimilating it into 'culture'. Indeed, the technological and cultural advancement of the species has been widely acknowledged to rest upon human domination and control of nature. Yet, by the 1960s, the (...) idea of culture in confrontation with nature was being challenged by science, philosophy and the environmental movement. Anthropology is increasingly concerned with such issues as they become more urgent for humankind as a whole. This important book reviews the current state of the concepts of 'nature' we use, both as scientific devices and ideological constructs, and is organised around three themes: - nature as a cultural construction; - the cultural management of the environment; and - relations between plants, animals and humans. (shrink)

Courts and legal commentators have been notoriously unsuccessful in articulating a rule to differentiate between uncompensated police power regulations of land by govemment and situations in which the govemment can only interfere with property rights if it provides compensation to those owners who suffer losses. Noticeably absent from most discussions of this “takings” issue is any foundational underpinning in a theory of justice with respect to property holdings. Can two of the most influential contemporary theories ofjustice-that of John Rawls and (...) Robert Nozick -provide such needed support for the analysis of the “takings” issue? By employing the vehicle of three hypothetical exampIes I investigate this question and reach some conclusions conceming the applicability of such abstract theories of justice to the real world. (shrink)