Recent evidence, from both epidemiological and animal experimental studies, suggest that the very first environment, the intrauterine, is extremely important in determining the future health of the individual. Genetic and ‘lifestyle’ factors impinge on, and can exacerbate, a ‘programming’ effect of an adverse fetal environment. In this review, we present compelling evidence to suggest that one of the major organs affected by an unfavourable prenatal environment is the kidney. Many of the factors that can affect fetal renal (...) development (i.e. exposure to excess glucocorticoids, insufficient vitamin A, protein/calorie malnutrition (in rats) and alterations in the intrarenal renin angiotensinogen system), also produce hypertension in the adult animal. When nephron number is compromised during kidney development, maladaptive functional changes occur and can lead, eventually, to hypertension and/or renal disease. Surprisingly, it is during the very earliest stages of kidney development that the vulnerability to these effects occurs. BioEssays 25:212–220, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

Fetal alcohol spectrum disorders is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD. Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of (...) discussions with experts in the field, published literature, and medical ethicists. Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the social services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition. The value for the concerned individuals of obtaining a FASD-related description of their condition – for instance, in terms of wellbeing – is not established. Nor is it established that allocating resources based on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs. (shrink)

The developing mammalian heart responds to a variety of conditions, including changes in nutrient availability, blood oxygenation, hemodynamics, or tissue homeostasis, with impressive growth plasticity. This ensures the formation of a functional and normal sized organ by birth. During embryonic and fetal development the heart is exposed to various physiological and potentially pathological changes in the intrauterine environment which dramatically impact on normal cardiac function, tissue composition, and morphology. This paper summarizes the mechanisms employed by the embryonic and (...) class='Hi'>fetal heart to adapt to various intrauterine challenges to prevent or minimize postnatal consequences of impaired cardiac development. Future investigations of this growth plasticity might lead to new therapeutic strategies for the prevention of cardiac disease in postnatal life. (shrink)

Adversities in pregnancy, including poor diet and stress, are associated with increased risk of developing both metabolic and mental health disorders later in life, a phenomenon described as fetal programming or developmental origins of disease. Predominant hypotheses proposed to explain this relationship suggest that the adversity imposes direct changes to the developing fetus which are maintained after birth resulting in an increased susceptibility to ill health. However, during pregnancy the mother, the developing fetus, and the placenta are all (...) exposed to the adversity. The same adversities linked to altered offspring outcome can also result in suboptimal maternal care, which is considered an independent adverse exposure for the offspring. Recent key experiments in mice reveal the potential of prenatal adversity to drive alterations in maternal care through abnormal maternal–pup interactions and via alterations in placental signaling. Together, these data highlight the critical importance of viewing fetal programming holistically paying attention to the intimate, bidirectional, and reiterative relationship between mothers and their offspring. (shrink)

As the new Cell-free DNA (Cf-DNA) prenatal screening test for Down syndrome was being introduced into the UK’s fetal anomaly screening program, Down syndrome charities had an opportunity to participate. An experience of co-production where we were the minority voice then followed. This paper explores that process and our experience as a charity. Institutional and societal structures meant that it was difficult to be heard and a significant amount of bias was noted within the program. Consequently, our viewpoints were (...) often considered and then dismissed. However, at times we were listened to, and feel that there were some valuable changes made resulting from our involvement. The end product was far from reflective of all that we stand for, and there are still lessons to be learned in England about the need to place a higher value on minority voices of lived experience in a co-production exercise. (shrink)

Stigma can influence the prevention and identification of fetal alcohol spectrum disorder, a leading cause of developmental delay in North America. Understanding the effects of public health practices and policies on stigma is imperative. We reviewed social science and biomedical literatures to understand the nature of stigma in FASD and its relevance from an ethics standpoint in matters of health practices and policies. We propose a descriptive model of stigma in FASD and note current knowledge gaps; discuss the ethical (...) implications of stigma based on two distinct criteria ; and describe two cases and the concerns associated with inadvertent stigmatization by public health initiatives for FASD. We recommend further empirical and ethical analyses to examine whether public health policies and practices inadvertently stigmatize and impact the success of public health initiatives and programs for FASD. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:PHARAOH'S.MAGICIANS: THE ETHICS AND EFFICA:CY OF HUMAN FETAiL TISSUE TRANSPLANTS ROBERT BARRY, O.P. Program for the Study of Religion University of Illinois, Champaign-Urbana DARREL KESLER Department of Animal Sciences University of Illinois, Champaign-Urbana. IN RECENT YEARS increasing attention ha;s been given to v:rurious types of scientific riese,arch involving the human fetus. In the 1970s, :a tremendous amount of concern was expres1 sed IJ.'egiaroing the fetus,a;.s a rSU!bject of e~erimenrtation. (...) In this debate, the announced " research impeiiat:i:ve " was pos,ed against other moral imperativ;es.1 Following much soctiet :JaJl drebarte, protootlive meiaisumeis 1 WeIDe il!dopited 1by oompireihensive regiutatiions in 1975 estaiblishiing protections foT a number of research sUibjects. These regulrutions protect the fetus from non-beneficiail experimentation. that iworuild pose more than minima;l risk rto the fetus. Current debates in science and ethics now swirl arlOiund a new topic regarding human '.fetal life: the fetus as a sourrce of tissue for triansplaintation into other persons ais run e~erimental thempy. It is an issue that is rapidly moving torward the same Jevel of" research imperative" as did the earlier debate on the 1 See Paul Ramsey, The Ethics of Fetal Research (New Haven: Yale University Press, 1975): "Today one often hears statements like' Fetal Research must be done,' or 'It would be immoral not to do this research'" (P. xv). The validity of such opinions and utterances entirely depends on a netbenefits ethics, and the validity of that moral universe has been called increasingly into question in recent years. 575 576 ROBERT BARRY, O.P. AND DARREL KESLER ~etus as subject. Recently,,a new level of intensity was added to this deharte rby the imposition of an indefinite moratorium on federal support for research on transplantrution experiments inv;olving human.fetirul tissue and other!humans. 1Thls " :indefinite moratorium " w1as a result of a process that 1 began with research p110posaJs considered rby the National In- 'stituites of Health (NIH) in October 1987. In Marich 1988 a momtorium wa;g plaioed on the r:eseareh, and an 1advisory panel was summoned to consider the ethical issues involved. This panel presented 1a cveoommendation for the procedures. However, the Secretary of the Department of Health and Ruman Se1wfoes (HHS), Dr. Louis Sullivan, decided against the research proposal on etmcal grounds. His decision w:as with the 'concU'l'Tenoe of the Assistant Secretary :£m.· Health of HHS, Dr. James Mason, who has Tespons~bility for the NIH. Secretary SulliV1an's decision was oommumcarted to the Acting Director of the NIH, Dr. William Raub, in Nov,ember 1989. A :firestorm of criticism erupted from,rudv;ocates of this research, including the Council of Judicial and Ethical Affairs of tihe American Medical Association, which 5.n June 1989 called for an end to the:ban.2 In this article, we wish to question both the science and the ethics of the rproposed fotal tissue transplantation therapy. We!Will 1support the £edeml funding moratorium and surggest new pmtections for the fetuses (whether po,ssibly living or de2 " Medical Applications of Fetal Tissue Transplantation", JAMA, Vol. 263, No. 4, January 26, 1990, 'PP· 565-570. There has been a.great deal of public debate, not only in the U.S. but also in Europe over whether human embryo research should be supported with public funds. Many Catholic countries in Europe have prohibited such research, while a number of other nations have allowed it. Dickson, D., "Europe Split on Embyro Research", Science, Vol. 242, November 21, 1988, pp. 1117-1118. The most interesting controversy is in West Germany where there is a strong movement to prohibit it because many there believe such an experimentation requires judgments that there are certain forms of human life that do not deserve to survive. Ibid., p. 1117. Many Germans regard these sorts of judgments as too close to those made by Nazis, and there is strong sentiment to prohibit such research altogether. Ibid. HUMAN FETAL TISSUE TRANSPLANTS 577 oea:sed) of elective a.bortfons. We will also describe new reseaooh directions in t~apy.for the diseases in which it is claimed that fetal... (shrink)

Alcohol consumption during pregnancy can lead to fetal alcohol spectrum disorders. FASD is a spectrum of structural, functional, and neurodevelopmental problems with often lifelong implications, affecting communities worldwide. It is a leading preventable form of intellectual disabilities and therefore warrants effective prevention approaches. However, well-intended FASD prevention can increase stigmatization of individuals with FASD, women who consume or have consumed alcohol during pregnancy, and non-biological parents and guardians of individuals with FASD. This narrative review surveyed the literature on stigmatization (...) related to FASD. Public stigma appears to be the most common form of stigma studied. Less is known about FASD-related self-stigma, stigma by association, and structural stigma. Accordingly, the current literature on FASD-related stigma does not appear to provide sufficient guidance for effectively reducing FASD-related stigma. However, lessons can be learned from other related health topics and the use of a systematic approach for the development of health promotion programs, namely Intervention Mapping. (shrink)

This book discusses how to deal ethically with people with Fetal Alcohol Spectrum Disorder in the police, courts and correctional services. Ethical and legal issues associated with the deficits of individuals with a brain disorders such as FASD are surfacing more and more frequently in criminal proceedings. People with FASD often have not been diagnosed and rarely exhibit any visible evidence of the disorder. It has been argued that this invisible disability puts them in a disadvantaged position in the (...) justice system, since the awareness of this condition is limited. The need to identify and to address FASD more effectively and the many ethical issues this raises within the context of the law is increasingly acknowledged within judicial and legislative branches, as well as in government departments, agencies and community programs that provide services to those with FASD and their caretakers and families. This is the first book to give to elaborate on ethical and legal issues of FASD. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021) by Sarah RichardsonQuill KuklaQuill Kukla, review of Sarah Richardson's The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021)I had been eagerly anticipating the release of Sarah Richardson's meticulously researched The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021) for several years, and I was not disappointed. A leading feminist scholar of the history (...) and philosophy of science, Richardson traces the scientific history of the idea that pregnant people's bodies control the future health, character, and well-being of their offspring. She also explores how this science is translated into social messaging and shaped by social ideology. Richardson delves into the details of the methodology, motivations, results, and communication of the science of maternal influences. She reveals a history of shaky results, contested methods, and socially loaded messaging, unified by a sustained interest in framing maternal bodies as sites of risk and responsibility for birth outcomes.A central narrative of the book is that the perceived location and mechanism through which pregnant bodies control fetal development keeps shifting around; over time, scientists have located this maternal influence in the uterine environment, the cytoplasm, the methylation of DNA, maternal nutrition, and even in the emotions, thoughts, and imagination of the mother, among other locations.1 Each time a version of the maternal influence hypothesis re-emerges, targeting a different bodily location and mechanism, it comes along with similar social messaging: pregnant people are distinctively responsible for the 'quality' of their children; their bodies are distinctive sites of risk, in need of social management; and their influence can be understood and controlled independent of the context in which they live. Given how many times this scientific hypothesis and its accompanying social messaging has died and been reborn, it is hard not to conclude, with Richardson, that background ideology compels us to keep searching for new stories that take this same form. The idea that pregnant people's bodies are understood as decontextualized and heightened sites of risk and responsibility for birth outcomes, in need of systematic discipline (both self-discipline and social discipline) in order to ensure their production of proper offspring, is one that has been explored [End Page e-1] in quite a bit of depth within feminist theory and reproductive ethics over the last thirty years. To name just a few, Barbara Duden's Disembodying Women: Perspectives on Pregnancy and the Unborn (1993), Deborah Lupton's "Risk and the Ontology of Pregnant Embodiment" (1999), Lisa Mitchell's Baby's First Picture: Ultrasound and the Politics of Fetal Subjects (2001), and my own Mass Hysteria: Medicine, Culture, and Mothers' Bodies (2005) are all works firmly within this tradition. What is new about Richardson's book is not the development and exploration of this cultural narrative and imaginary, but rather her rigorous and skillful analysis of the science that has grown out of and undergirded it. Richardson is a masterful writer, who makes scientific details comprehensible and fascinating. Her historical and epistemological analyses of exactly what shaped the science at each stage, what each scientific iteration did and didn't manage to show, and how these different scientific movements were translated into public messaging, is sharp and compelling. Richardson shows us the inner workings of how scientific programs build momentum; how scientists make methodological decisions; and how results feed into ongoing research programs. From this book, we also develop a rich sense of just how much uncertainty is baked into the science of human development, and how both scientific and public excitement about a given research program are mostly independent of the success and security of the science that comes out of it. The book traces 150 years of the history of the science of maternal influences, culminating in the current focus on epigenetics—which, like various past maternal influence theories, has ignited our broader social imagination. Epigenetics, roughly, is the study of molecular changes outside our DNA that control how genes express themselves. Environmental stimuli (such as stress) can cause changes in methylation, and thereby influence the expression of the genome: "Epigenetic markers that help determine whether a... (shrink)

Normal fetal development is dependent upon an intricate exchange between mother and embryo. Several maternal and embryonic elements can influence this intimate interaction, including genetic, environmental or epigenetic factors, and have a significant impact on embryo development. The interaction of the genetic program of both mother and embryo, within the uterine environment, can shape the development of an individual. Accumulating data from animal models indicate that prenatal events may well initiate long‐term changes in the expression of the embryo genetic (...) program, which persist, or may only become apparent, much later in the individual's life. Also, environmental conditions during prenatal development may prompt the adoption of different developmental pathways, leading to alternative life histories. This review focuses on environmental factors, specifically maternally derived molecules, to illustrate how they can influence in utero embryonic development and, by extension, adult life. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bibliography of Resources by and about André E. Hellegers*Compiled by Doris Mueller Goldstein (bio)This bibliography is derived from the holdings of the National Reference Center for Bioethics Literature and the BIOETHICSLINE© database (both of which are at the Kennedy Institute of Ethics and supported by the National Library of Medicine); the archives of Lauinger Library, Georgetown University; the Medline databases of the National Library of Medicine; the WorldCat database (...) of OCLC, Dublin, Ohio, and selected Internet sites.Primarily comprised of writings by Dr. Hellegers, the list also includes interviews and media programs in which he participated, as well as writings about him that were written following his death. The arrangement within each section is by date. The 231 authored pieces reflect the transition from Dr. Hellegers’s early career as a researcher in fetal physiology at Johns Hopkins Medical School, where he published his first research report at the age of 29, to the early years of the Kennedy Institute, where he produced so many provocative columns on bioethical issues that influenced the growth of the field.Due to the diversity of sources and the 40-year time span covered, there are some variations in bibliographic style. Time and availability constraints precluded verifying all of the citations with the original documents. Any additions or corrections should be submitted to the compiler.Works Authored by André E. HellegersNo Date Ethical Issues in Sterilization of the Retarded. Unpublished paper.1956Vitamin B12 Serum Level and Pregnancy. American Journal of Clinical Nutrition 4: 440+, 1956. [With Bacon F. Chow and Kunio Okuda] [End Page 89]1957Vitamin B12 Absorption in Pregnancy and in the Newborn. American Journal of Clinical Nutrition 5: 327+, 1957. [With Bacon F. Chow, Robert E. L. Nesbitt, Kunio Okuda, and David W. Smith]1958The Effects of Acute Hypoxia on the Osmotic Pressure of the Plasma. Quarterly Journal of Experimental Physiology 43: 197+, 1958. [With Donald H. Barron, Frederick C. Battaglia, and Giacomo Meschia]Studies on the Absorption of Vitamin B12 in Human Pregnancy with Especial Reference to the Effect of D-Sorbitol. American Journal of Obstetrics and Gynecology 76: 91+, 1958. [With Bacon F. Chow, Harry Prystowsky, and Vernon Wong]1959The Alveolar PCO2 and PO2 in Pregnant and Nonpregnant Women at Altitude. Proceedings of the Society for Clinical Investigation 38: 1010+, 1959. [With Donald Barron, William Huckabee, Giacomo Meschia, James Metcalfe, and Harry Prystowsky]A Comparison of the Oxygen Dissociation Curves of the Bloods of Maternal and Fetal Goats at Various pHs. Quarterly Journal of Experimental Physiology 44: 215–21, July 1959. [With Donald Barron, Giacomo Meschia, Harry Prystowsky, and A. Stark Wolkoff]Fetal Blood Studies. XII. On the Relationship Between the Position of the Oxygen Dissociation Curve of Human Fetal Blood and Adult Fetal Hemoglobin. American Journal of Obstetrics and Gynecology 77: 585+, 1959. [With Paul D. Bruns, Julian Cotter, and Harry Prystowsky]Fetal Blood Studies. XIV. A Comparative Study of the Oxygen Dissociation Curve of Nonpregnant, Pregnant and Fetal Human Blood. American Journal of Obstetrics and Gynecology 78: 489–93, September 1959. [With Paul D. Bruns and Harry Prystowsky]Fetal Blood Studies. XVI. On the Changes in Total Osmotic Pressure and Sodium and Potassium Concentration of Amniotic Fluid During the Course of Human Gestation. Surgery, Gynecology and Obstetrics 109: 509–12, October 1959. [With Frederick Battaglia, Paul D. Bruns, Harry Prystowsky, and Clayton Smisson]Further Observations on the Metabolism of Vitamin B12 in Human Pregnancy. American Journal of Obstetrics and Gynecology 77: 1+, 1959. [With Bacon F. Chow, Harry Prystowsky, Bruno Ranke, and Elma Ranke]The Oxygen Dissociation Curves of the Bloods of Adult and Fetal Llamas. Federation Proceedings 18, 1959. [With Donald Barron, William Huckabee, Giacomo Meschia, James Metcalfe, and Harry Prystowsky] [End Page 90]Transfer of Oxygen Across the Sheep Placenta at High Altitude. Federation Proceedings 18, 1959. [With Donald Barron, William Huckabee, Giacomo Meschia, and Harry Prystowsky]Uterine Blood Flow and Metabolism in Pregnant Sheep at High Altitude. Federation Proceedings 18, 1959. [With Donald Barron, William Huckabee, Giacomo Meschia, James Metcalfe, and Harry Prystowsky]Uterine Blood Flow and Metabolism in Unanesthetized Pregnant Sheep. Federation Proceedings 18, 1959. [With Donald Barron, William Huckabee, Giacomo... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Genetic Testing and Genetic ScreeningPat Milmoe McCarrick (bio)In recent years there has been an enormous expansion in the knowledge that may be gleaned from the testing of an individual's genetic material to predict present or future disability or disease either for oneself or one's offspring. The Human Genome Project, which is currently mapping the entire human gene system, is identifying progressively more genetic sequencing information (see Scope Note 17, (...) The Human Genome Project). Information obtained from genetic testing raises ethical and legal questions about its uses by society. The ethical dilemmas were foreseen two decades ago by bioethicists who asked whether questionable applications could stop "legitimate pursuits" (IV, Gaylin 1972) and whether genetic disease might come to be viewed as "transmissible" in the sense of being contagious (IV, Veatch 1974).Not only has knowledge expanded, but the practice of genetic testing and screening has greatly increased as well. For example, in the case of testing for cystic fibrosis (CF), the U.S. Congress' Office of Technology Assessment (OTA) estimates that instances of screening jumped from 9310 tests in 1991 to 63,000 tests in 1992 (I, OTA [Cystic Fibrosis] 1992). In addition, the OTA estimates that within the next few years, the six million women who become pregnant each year routinely will be informed of available CF carrier tests (I, OTA [Cystic Fibrosis] 1992).Following the recent identification of a gene linked to breast cancer, Dr. Francis Sellers Collins, director of the National Center for Human Genome Research, said that "it is not inconceivable that every woman in America may want to be screened for this gene. The economic, ethical, and counseling issues will be very daunting." Dr. Collins opines that in the near future physical examinations for 18-year-olds will include DNA testing for diseases with genetic components and that physicians, in the interests of preventive medicine, will make risk-based recommendations for a healthy life-style (IV, Breo 1993). The U.S. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research predicted as early as 1983 that before the end of the century genetic screening and counseling would become major components of both public health and individual medical care (I, U.S. President's Commission 1983). [End Page 333]The OTA defines genetic testing as "the use of specific assays to determine the genetic status of individuals already suspected to be at high risk for a particular inherited condition. The terms genetic test, genetic assay, and genetic analysis are used interchangeably to mean the actual laboratory examination of samples." In contrast, genetic screening usually uses the same assays employed for genetic testing but is distinguished from genetic testing by its target population (I, OTA [Genetic Monitoring] 1990). The National Academy of Sciences (NAS) defines screening as the systematic search of populations for persons with latent, early, or asymptomatic disease (III, NAS 1975). Some of the literature annotated for this Scope Note appears to use the terms "testing" and "screening" interchangeably.Philip Boyle of the Hastings Center points out that the language used to describe genetic variation is important and asks what words should be used: "Defects, flaws, deleterious genes, disorders, or the more neutral conditions? Using words such as normal—and its corollary, abnormal—is likely to foster stigmatization and discrimination" (III, Genetic Grammar, Boyle 1992).Areas of focus in genetic testing include: prenatal diagnosis, newborn screening, carrier screening, forensic screening, and susceptibility screening.Prenatal diagnosis discerns whether a fetus is at risk for various identifiable genetic diseases or traits. Prenatal diagnosis is made using amniotic fluid, fetal cells, and fetal or maternal blood cells obtained during amniocentesis testing; alpha fetoprotein assays or chorionic villus sampling; or ultrasound tomography, which creates fetal images on a screen. Another method, known as fetoscopy, uses a camera on a needle inserted in the uterus to view the fetus. Since prenatal screening began in 1966 (I, U.S. President's Commission 1983), the number of metabolic defects and genetic disorders that can be diagnosed prenatally has expanded greatly. There is also discussion of requiring testing for parents who are participating in an in vitro fertilization program and are at genetic... (shrink)

This essay explores the relationship between the modern era’s impulse toward control and the practices of family planning and disability-selective abortion. Drawing from experiences as a pediatric palliative care physician working within a busy fetal care program, as well as the social theory of sociologist Hartmut Rosa, the author argues that there is an unresolved cultural and professional conflict within perinatal medicine between maximizing control of the future and maximizing a culture of anti-ableism.

The oocyte is not only the rarest and the largest cell in the body, but it also has one of the most remarkable life histories. Formed in the fetal ovary and suspended at diplotene of meiosis, it may wait for years before beginning to grow, and not until this process is complete can it resume meiosis and undergo fertilisation. Major changes in the number, morphology and distribution of cytoplasmic organelles occur during growth, and a molecular program for embryogenesis is (...) formed. Specific yolk proteins are absent and much of the RNA and some of the protein are degraded by the cleavage stage. The zona pellucida has been intensively studied, but knowledge of oocyte‐specific genes is otherwise surprisingly patchy given the significance of this cell type and the expansion of reproductive technology. Finally, it is now clear that oocytes are not mere passengers which depend on granulosa cells for nutrition and regulation but actively promote the growth and differentiation of their follicles. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Are We There Yet?A Narrative of Firsthand Interpreter Experiences in the Medical Field and Insights to Aid Language Access ComplianceHilda Sanchez-HerreraMy Spanish interpreting journey began in 2008. In those days, very little training was available, and online studies were very new and rare. Early trainings involved out-of-town interpreter and translation conferences, reading the recently released Culturally and Linguistically Appropriate Services (CLAS) standards documents, and participating in the diversity events (...) at the hospital and in the community. Eventually, I did three different medical interpreter training programs, each teaching me something new and improving my skills. The first few years opened my eyes to what it meant for one to be trained, qualified, and certified. It has been a marvelous learning experience.Now, with sixteen years of experience and the vastness and richness of being an interpreter in various settings, I continue to learn to be flexible, patient, and courageous. I've also learned to be a teacher because clinical staff have one perspective of what interpreting is, and we have another. I've learned to be courageous because the field of Language Access is very demanding and involves encountering a lot of biases and judgmental perspectives. Language Access champions advocate throughout the nation so that those who are working in this field will have better working conditions. Collaborations started in the community, extending into social services, legal, and beyond.Interpreting sessions that had the most impact are many, but a few stand out, including a patient I assisted who had presumed Locked-In Syndrome and a domestic abuse female at a maternal-fetal appointment. I have had to explain to a family what it means to be brain dead and have interpreted for numerous palliative care sessions.The presumed Locked-In syndrome patient was quite the experience. I had recently started working on the floor at the hospital and was making my rounds to Spanish-speaking inpatients. One morning, I arrived just as the physician team was making their rounds. I listened to the briefing: a 42-year-old female had suffered a stroke. She could not speak and could not use her extremities. The team had done what they could and reached the conclusion that she was "locked-in" because she was aware but their neurological exams were inconclusive. I asked if they had used the video or phone interpreting services and they said yes but it was not fruitful. I offered to rule out a language barrier. They agreed.It was then that the patient began making great progress in her recovery. The team was amazed at the patient's reaction. She cried when she heard her language spoken. We established communication via a board and eye signals. Speech therapy came and they were able to assess her ability to speak and swallow. While she remained approximately 6 months in the hospital, it was not until the last two [End Page 154] months that she made great strides, and it was all due to language access. Eventually, she was transferred to another healthcare facility closer to home. I was overjoyed and wondered why they had not had this success earlier. It was later determined that the connections were not good, and the interpreter could not "see" what the patient was doing.The domestic violence female was an emotional one for me. I was scheduled to assist at two of her appointments that morning: one at maternal fetal and the other at ENT. Upon arrival, I greeted her and noticed her eyes were watery and her face seemed a little swollen, but I did not want to make her feel embarrassed, so I remained quiet. I accompanied her to the ENT appointment first. The doctor asked her questions, and she seemed nervous. Still no intervention. We finished and went to the maternal-fetal appointment. On the way to the office, I asked if she was ok. She began to cry and said in a soft tone, looking around, that her partner had hit her on the way to the clinic.I was shocked! I knew that permission was needed to share this information with the providers and that her safety was critical. She thought... (shrink)

If scientists can successfully clone sheep, will humans be next? Today's headlines read like a science fiction novel! Due Consideration takes a poignant look at the rapidly changing field of biomedicine and the consequences it will have on our lives. Arthur Caplan, one of this nation's leading bioethicists, explores these issues and analyzes moral questions including: * Will we retain our essential humanity if we modify our biological blueprint? * Would it be irresponsible to procreate without a thorough genetic examination? (...) * Who will decide if physical traits like short stature and baldness are considered diseases? * Can biomedicine make our lives better? You'll also learn about the most current and controversial topics such as: * Cloning, abortion and assisted suicide. * Genetically engineering a human to be immune from infectious diseases. * The ability to "design" our children from head to toe. * Diagnosing and treating illnesses during fetal development. * Programs to prevent the transmission of HIV. No other book on the market today combines this analytic clarity with the latest from medical journals and media headlines. Now, you can decide for yourself what the future ought to hold in store. (shrink)

Death is something we mourn or fear as the worst thing that could happen―whether the deaths of close ones, the deaths of strangers in reported accidents or tragedies, or our own. And yet, being dead is something that no one can experience and live to describe. This simple truth raises a host of difficult philosophical questions about the negativity surrounding our sense of death, and how and for whom exactly it is harmful. The question of whether death is bad has (...) occupied philosophers for centuries, and the debate emerging in philosophical literature is referred to as the "badness of death." Are deaths primarily negative for the survivors, or does death also affect the deceased? What are the differences between death in fetal life, just after birth, or in adolescence? In order to properly evaluate deaths in global health, we must find answers to these questions. -/- In this volume, leading philosophers, medical doctors, and economists discuss different views on how to evaluate death and its relevance for health policy. This includes theories about the harm of death and its connections to population-level bioethics. For example, one of the standard views in global health is that newborn deaths are among the worst types of death, yet stillbirths are neglected. This raises difficult questions about why birth is so significant, and several of the book's authors challenge this standard view. -/- This is the first volume to connect philosophical discussions on the harm of death with discussions on population health, adjusting the ways in which death is evaluated. Changing these evaluations has consequences for how we prioritize different health programs that affect individuals at different ages, as well as how we understand inequality in health. (shrink)

Noninvasive prenatal screening using cell-free DNA, which analyzes placental DNA circulating in maternal blood to provide information about fetal chromosomal disorders early in pregnancy and without risk to the fetus, has been hailed as a potential “paradigm shift” in prenatal genetic screening. Commercial provision of cell-free DNA screening has contributed to a rapid expansion of the tests included in the screening panels. The tests can include screening for sex chromosome anomalies, rare subchromosomal microdeletions and aneuploidies, and most recently, the (...) entire fetal genome. The benefits of this screening tool are generally framed, by both providers and commercial laboratories, as enhancing reproductive autonomy and choice by providing an earlier, simpler, and more accurate screening while potentially reducing the need for invasive follow-up testing. The majority of the literature has explored these issues empirically or conceptually from a European or North American vantage point, one that assumes normative priorities such as individual reproductive autonomy and the clinical availability of maternal health care or prenatal screening programs within which cell-free DNA screening is offered. While its implementation has raised both challenges and opportunities, very little is known about real-world experiences and the implications of the rapid introduction of cell-free DNA screening outside of North America and Europe, especially in low- and middle-income countries. To begin addressing this gap in knowledge, we organized a four-day international workshop to explore the ethical, legal, social, economic, clinical, and practical implications of the global expansion of cell-free DNA screening. We describe eight key insights that arose from the workshop. (shrink)

CEOs’ social and environmental activism attracts significant public and research interest. Positioned as an expression of personal morality, such activism is potentially highly influential because of CEOs’ public visibility and associated positional and resource-based power. This paper questions the assumption that CEO activism can only be explained in relation to individual moral action, and illuminates its wider social implications. We critically evaluate the recent upsurge in CEO activism by juxtaposing it against broader social activism, identifying its distinctive characteristics, and empirically (...) examining two recent ‘moral episodes’: the Deferred Action for Childhood Arrivals program and the Fetal Heartbeat Acts. Our analysis demonstrates that CEO activism is more heterogeneous than research to date has shown. Building on this analysis, a refined understanding of the character and morality of CEO activism is developed by establishing a typology of its forms. We conclude that while CEO activism is an important and potent new phenomenon, it may not be universally appropriate to regard CEOs as moral leaders. Instead, it is paramount to question the motives and effects of what CEOs do in the name of morality. (shrink)

In many countries, prenatal testing for certain fetal abnormalities is offered via publicly funded screening programs. The concept of reproductive autonomy is regarded as providing a justificatory basis for many such programs. The purpose of this study is to re‐examine the normative basis of public prenatal screening for fetal abnormalities by changing our perspective from that of autonomy to obligation. After clarifying the understanding of autonomy adopted in the justification for public prenatal screening programs, we identify two problems (...) concerning this justification: first, the extent to which the government is obliged to meet this demand is not evident; and, second, it is not clear whether the provision of public screening is the most appropriate way to promote autonomy. Next, to tackle these problems, we focus on Onora O’Neill’s argument of rights and obligations. Drawing on this argument, we show that, in addressing the problems above, it is important to change our normative perspective from rights or autonomy to obligation. Our argument will show that since the government does not have an incontrovertibly fundamental obligation to promote autonomy, this obligation needs to be constrained in terms of compatibility with other fundamental obligations. In addition, even if a government is obliged to promote autonomy to some degree, there could be more appropriate means to achieve it than providing public prenatal screening; therefore, it is not necessary for government obligations to extend to the provision of public prenatal screening. (shrink)

People are worried that advances in genetics will lead to a revival of eugenics. Such worries are often associated with eugenic practices carried out early in the 20th century---the forcible sterilization of feebleminded persons in the United States and the Nazi program of Racial Hygiene. A "new eugenics" involving prenatal genetic testing and the selective abortion of fetuses diagnosed with severe genetic disorders might, nonetheless, be acceptable. In chapter one I examine the history of eugenics and discuss what might make (...) a new eugenics more tolerable. ;Chapters two and three discuss reproductive decision making by individuals . Chapter 2 investigates the morality of abortion. I conclude that the moral status of the fetus is ultimately uncertain. In exceptional circumstances, such as the case where a fetus would develop into a severely disabled infant, there are good reasons for thinking that abortion is morally permissible. It is plausible, for example, that the value of a fetal life is a function of its future quality of life. ;In chapter three I discuss what quality of life consists in. I develop a pluralistic perspective according to which quality of life is a function of multiple independent components. When deciding to bring a child into existence parents should consider the quality of life expected for the child and also take into account the likely impact on their own lives, the lives of other family members, and society as a whole. ;Chapter four asks whether or not governmental restrictions should be placed on the kinds of genetic interventions which will be permitted. A worry is that interventions aimed at enhancement would only be available to the financially fortunate and thus promote unjust social inequalities. Another worry is that the development and use of such interventions would drain medical resources away from more fruitful purposes and thus have a negative impact on aggregate utility. The social aim to promote liberty, on the other hand, speaks against the imposition of restrictions. Faced with conflicting social values, we need to think more about how to make trade-offs between liberty, equality, and aggregate utility. (shrink)

The United States Food and Drug Administration , in collaboration with pharmaceutical manufacturers, have recently implemented a heavily revised risk-management program for patients on isotretinoin , a drug with known and pronounced teratogenic effects. This revised risk management plan places significant burdens on both providers and patients in the hopes of achieving its goal of reducing fetal exposure to isotretinoin. The main focus of this paper is to discuss the burdens of various aspects of the program in relationship to (...) potential corresponding benefits. In particular, we evaluate the pregnancy rates of women on isotretinoin therapy compared with that of the general population and the rate changes based on the risk management programs. Additionally, we investigate whether the benefits of the program for women have increased as the benefits have risen. We devote special attention to the ethical implications of the intent of the program and to an analysis of the ethical justification of the restrictions placed on women of childbearing potential as it compares to the risk-benefit relationship of using isotretinoin. (shrink)

The Joint International Conference on Logic Programming, sponsored by the Association for Logic Programming, is a major forum for presentations of research, applications, and implementations in this important area of computer science. Logic programming is one of the most promising steps toward declarative programming and forms the theoretical basis of the programming language Prolog and its various extensions. Logic programming is also fundamental to work in artificial intelligence, where it has been used for nonmonotonic (...) and commonsense reasoning, expert systems implementation, deductive databases, and applications such as computer-aided manufacturing. Krzysztof R. Apt is project leader at the Centre for Mathematics and Computer Science in Amsterdam and part-time Professor in Computer Science at the University of Amsterdam. Topics covered: Theory Foundations. Programming Languages. Implementation. Programming Methodologies and Tools. Applications. Deductive Databases. Artificial Intelligence. Parallelism. (shrink)

The First International Workshop brings together researchers from the theoretical ends of the logic programming and artificial intelligence communities to discuss their mutual interests. Logic programming deals with the use of models of mathematical logic as a way of programming computers, where theoretical AI deals with abstract issues in modeling and representing human knowledge and beliefs. One common ground is nonmonotonic reasoning, a family of logics that includes room for the kinds of variations that can be found (...) in human reasoning. Topics covered: Stable Semantics. Default Logic. AutoEpistemic Logic. Truth Maintenance Systems. Implementation Issues. Diagnosis. Applications. Inheritance Reasoning. Logics of Belief. Inconsistency and Non-Monotonicity. (shrink)

Doctoral programs at U.S. universities play a critical role in the development of human resources both in the United States and abroad. This volume reports the results of an extensive study of U.S. research-doctorate programs in five broad fields: physical sciences and mathematics, engineering, social and behavioral sciences, biological sciences, and the humanities. Research-Doctorate Programs in the United States documents changes that have taken place in the size, structure, and quality of doctoral education since the widely used 1982 editions. This (...) update provides selected information on nearly 4,000 doctoral programs in 41 subdisciplines at 274 doctorate-granting institutions. This volume also reports the results of the National Survey of Graduate Faculty, which polled a sample of faculty for their views on the scholarly quality of program faculty and the effectiveness of doctoral programs in preparing research scholars/scientists. This much-anticipated update of such an essential reference will be useful to education administrators, university faculty, and students seeking authoritative information on doctoral programs. (shrink)

We present an infinite-game characterization of the well-founded semantics for function-free logic programs with negation. Our game is a simple generalization of the standard game for negation-less logic programs introduced by van Emden [M.H. van Emden, Quantitative deduction and its fixpoint theory, Journal of Logic Programming 3 37–53] in which two players, the Believer and the Doubter, compete by trying to prove a query. The standard game is equivalent to the minimum Herbrand model semantics of logic programming in (...) the sense that a query succeeds in the minimum model semantics iff the Believer has a winning strategy for the game which begins with the Doubter doubting this query. The game for programs with negation that we propose follows the same rules as the standard one, except that the players swap roles every time the play “passes through” negation. We start our investigation by establishing the determinacy of the new game by using some classical tools from the theory of infinite-games. Our determinacy result immediately provides a novel and purely game-theoretic characterization of the semantics of negation in logic programming. We proceed to establish the connections of the game semantics to the existing semantic approaches for logic programming with negation. For this purpose, we first define a refined version of the game that uses degrees of winning and losing for the two players. We then demonstrate that this refined game corresponds exactly to the infinite-valued minimum model semantics of negation [P. Rondogiannis,W.W. Wadge, Minimum model semantics for logic programs with negation-as-failure, ACM Transactions on Computational Logic 6 441–467]. This immediately implies that the unrefined game is equivalent to the well-founded semantics. (shrink)

This study extends the examination of moral content in the media by exploring moral messages in television programming and viewer characteristics predictive of the ability to perceive such messages. Generalisability analyses confirmed the reliability of the Media’s Moral Messages (MMM) rating form for analysing programme content and the existence of 10 moral themes prevalent in television media. Standard regression analyses yielded evidence indicating viewers’ moral expertise, as measured by the Defining Issues Test (DIT), familiarity with the programme and level (...) of education predicted their ability to perceive moral messages in a television drama popular in the USA at the time of data collection. Identification of patterns in moral content represented in television programming, as well as knowledge of how viewer characteristics relate to their ability to perceive such content, can provide parents and educators with a means for better comprehending messages regarding human interaction to which they or their children are exposed. (shrink)

Information about the structure, function and regulation of the maize Suppressormutator (Spm) transposable element has emerged from the genetic and molecular characterization of both deletion mutations and an unconventional type of reversible genetic change (epimutation). The element is subject to an epigenetic mechanism that can either stably inactivate it or specify one of a variety of heritable programs of differential element expression in development. The essay explores the relationship between the Spm element's epigenetic developmental programming mechanism and the determinative (...) events central to plant development and differentiation. (shrink)

In this paper, Taylor series is used to solve neutrosophic multi-objective programming problem (NMOPP). In the proposed approach, the truth membership, Indeterminacy membership, falsity membership functions associated with each objective of multi-objective programming problems are transformed into a single objective linear programming problem by using a first order Taylor polynomial series. Finally, to illustrate the efficiency of the proposed method, a numerical experiment for supplier selection is given as an application of Taylor series method for solving neutrosophic (...) multi-objective programming problem at end of this paper. (shrink)

Modern education attaches great importance to interdisciplinary skills, among which computational thinking is a core element, and heralds a new era. IT application has shaped education in the 21st century. Computational thinking has provided further impetus for building an all-encompassing social network and fostering a DIY culture enabled by digital technologies. One empirical study used four apps to test children's development in computational thinking and fluency. The article will help students overcome their fears of coding. Peer reviews provide students with (...) an opportunity to learn from each other and become more motivated. These reviews also serve as feedback for teachers to evaluate students' performance. Experimental design is used in this study, and a peer review system is implemented. Freshmen attending a programming class in a university are used as samples. At the class, students write computer programs with f-Chart, which provides a graphical user interface for students to learn programming logic and design. Zuvio, a cloud-based interactive response system, is used to conduct the peer reviews. The data of this study are analyzed through R. The results show not only an improvement in students' learning performance but also a gap between students' peer review scores and teachers' evaluation scores. Learning feedback and evaluation is crucial to transform education between students and teachers into a sustainable cycle system. (shrink)

In this paper, I set out some basic elements of a deontic logic with an implementation appropriate for handling conflicting legal obligations for purposes of programming autonomous machine agents. Kantian justice demands that the prescriptive system of enforceable public laws be consistent, yet statutes or case holdings may often describe legal obligations that contradict; moreover, even fundamental constitutional rights may come into conflict. I argue that a deontic logic of the law should not try to work around such conflicts (...) but, instead, identify and expose them so that the rights and duties that generate inconsistencies in public law can be explicitly qualified and the conflicts resolved. I then argue that a credulous, non-monotonic deontic logic can describe inconsistent legal obligations while meeting Kant’s demand for consistency in the prescriptive system of public law. Finally, I propose an implementation of this logic via a modified form of “answer set programming,” which I demonstrate with some simple examples. (shrink)

Denotational semantics of logic programming and its extensions have been studied thoroughly for many years. In 1998, a game semantics was given to definite logic programs by Di Cosmo, Loddo, and Nicolet, and a few years later it was extended to deal with negation by Rondogiannis and Wadge. Both approaches were proven equivalent to the traditional semantics. In this paper we define a game semantics for disjunctive logic programs and prove soundness and completeness with respect to the minimal model (...) semantics of Minker. The overall development has been influenced by the games studied for PCF and functional programming in general, in the styles of Abramsky–Jagadeesan–Malacaria and Hyland–Ong–Nickau. (shrink)

It is a wonderful, often beautiful book."--Brian Hyer, University of Wisconsin-Madison "This is an important book that many in music will profit from confronting. It is a performative work, embodying and recreating what it wishes to argue.

There has been considerable discussion in the past about the assumptions and basis of different ethical rules. For instance, it is commonplace to say that ethical rules are defaults rules, which means that they tolerate exceptions. Some authors argue that morality can only be grounded in particular cases while others defend the existence of general principles related to ethical rules. Our purpose here is not to justify either position, but to try to model general ethical rules with artificial intelligence formalisms (...) and to compute logical consequences of different ethical theories. More precisely, this is an attempt to show that progress in non-monotonic logics, which simulates default reasoning, could provide a way to formalize different ethical conceptions. From a technical point of view, the model developed in this paper makes use of the Answer Set Programming (ASP) formalism. It is applied comparatively to different ethical systems with respect to their attitude towards lying. The advantages of such formalization are two-fold: firstly, to clarify ideas and assumptions, and, secondly, to use solvers to derive consequences of different ethical conceptions automatically, which can help in a rigorous comparison of ethical theories. (shrink)

Gatekeeping, or determining membership of your group, is crucial to science: the moniker ‘scientific’ is a stamp of epistemic quality or even authority. But gatekeeping in science is fraught with dangers. Gatekeepers must exclude bad science, science fraud and pseudoscience, while including the disagreeing viewpoints on which science thrives. This is a difficult tightrope, not least because gatekeeping is a human matter and can be influenced by biases such as groupthink. After spelling out these general tensions around gatekeeping in science, (...) we shed light on them with a case study from psychology. This concerns whether academic psychologists rightly or wrongly classify the applied-psychology framework of NLP (‘neuro-linguistic programming’) as unscientific and even pseudoscientific. This example of gatekeeping is particularly instructive because both the NLP community and the psychology community, we argue, make legitimate but also illegitimate moves. This case gives rise to several general insights about gatekeeping in science more generally. (shrink)