A series of structural constitutional arguments lodged in multiple cases against Centers for Medicare and Medicaid Services’ (CMS) authorities to negotiate prescription drug prices via the 2022 Inflation Reduction Act threaten the legitimacy of CMS program and federal agency powers.

In a dynamic term of the United States Supreme Court in 2021-2022 a series of critical cases raise manifold changes and impacts on individual and communal health through 10 key areas ranging from abortions to vaccinations.

In another tumultuous term of the United States Supreme Court in 2022-2023 a series of critical cases implicate instant and forthcoming changes in multiple fronts that collectively shift the national public health law and policy environment.

Among the morass of critical issues impacting the results of the midterm elections in 2022 were core public health issues related to health care access, justice, and reforms. Collectively, voters’ communal health and safety concerns dominated outcomes in key races which may shape national, state, and local legal approaches to protecting the public’s health in the modern era.

As the United States emerges from the worst public health threat it has ever experienced, the Supreme Court is poised to reconsider constitutional principles from bygone eras. Judicial proposals to roll back rights under a federalism infrastructure grounded in states’ interests threaten the nation’s legal fabric at a precarious time. This column explores judicial shifts in 3 key public health contexts — reproductive rights, vaccinations, and national security — and their repercussions.

Fins and colleagues rightly note that “clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems” for which “progress in developing standards for q...

The article by Professor Fiester (2015) expresses concern about the long-term moral distress or negative moral emotions, both aspects of moral residue, that linger in some stakeholders’ experiences...

The widely accepted redating of the praetorship and propraetorship of Cornelius Sulla from the conventional years 93–92 to the years 97–96 B.C., proposed by E. Badian in an ingenious paper, involved the rearrangement of the story of the Cappadocian succession between c. 101 B.C. and 90 B.C. Badian proposed a much simpler reconstruction of the events recorded in the summary narratives of Justin, Appian, and Plutarch, than the version established by Th. Reinach which has hitherto held the field.

“Clinical ethics consultants” have been practicing in the United States for about 50 years. Most of the earliest consultants—the “pioneers”—were “outsiders” when they first appeared at patients' bedsides and in the clinic. However, if they were outsiders initially, they acclimated to the clinical setting and became “insiders” very quickly. Moreover, there was some tension between traditional academics and those doing applied ethics about whether there was sufficient “critical distance” for appropriate reflection about the complex medical ethics dilemmas of the day (...) if one were involved in the decision making. Again, the pioneers deflected concerns by identifying and instituting safeguards to assure professional objectivity in clinical ethics consultation services. One might suggest that in moving inside and establishing normative practices, the pioneer clinical ethics consultants anticipated adoption of their routines and professionalization of the field. (shrink)

As clinical ethics consultants move toward professionalization, the process of certifying individual consultants or accrediting programs will be discussed and debated. With certification, some entity must be established or ordained to oversee the standards and procedures. If the process evolves like other professions, it seems plausible that it will eventually include a written examination to evaluate the core knowledge competencies that individual practitioners should possess to meet peer practice standards. The American Society for Bioethics and Humanities has published core knowledge (...) competencies for many years that are accepted by experts as the prevailing standard. Probably any written examination will be based upon the ASBH core knowledge competencies. However, much remains to be done before any examination may be offered. In particular, it seems likely that a recognized examining board must create and validate examination questions and structure the examination so as to establish meaningful, defensible parameters after dealing with such challenging questions as: Should the certifying examination be multiple choice or short-answer essay? How should the test be graded? What should the pass rate be? How may the examination be best administered? To advance the field of health care ethics consultation, thought leaders should start to focus on the written examination possibilities, to date unaddressed carefully in the literature. Examination models—both objective and written—must be explored as a viable strategy about how the field of health care ethics consultations can grow toward professionalization. (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

There is great interest in understanding whether and how mood influences affective processing. Results in the literature have been mixed: some studies show mood-congruent processing but others do not. One limitation of previous work is that decision components for affective processing and responses biases are not dissociated. The present study explored the roles of affective processing and response biases using a drift-diffusion model of simple choice. In two experiments, participants decided if words were emotionally positive or negative while listening to (...) music that induced positive or negative mood. The behavioural results showed weak, inconsistent mood-congruency effects. In contrast, the DDM showed consistent effects that were selectively driven by an a-priori bias in response expectation, suggesting that music-induced mood influences expectations about the emotionality of upcoming stimuli, but not the emotionality of the stimuli themselves. Implications for future studies of emotional classification and mood are subsequently discussed. (shrink)

Individuals with high anxiety show bias for threatening information, but it is unclear whether this bias affects memory. Recognition memory studies have shown biases for recognising and rejecting threatening items in anxiety, prompting the need to identify moderating factors of this effect. This study focuses on the role of semantic similarity: the use of many semantically related threatening words could increase familiarity for those items and obscure anxiety-related differences in memory. To test this, two recognition memory experiments varied the proportion (...) of threatening words in lists to manipulate the semantic-similarity effects. When similarity effects were reduced, participants with high trait anxiety were biased to respond “new” to threatening words, whereas when similarity effects were strong there was no effect of anxiety on memory bias. Analysis of the data with the drift diffusion model showed that the bias was due to differences in processing of the threatening stimuli rather than a simple response bias. These data suggest that the semantic similarity of the threatening words significantly affects the presence or absence of anxiety-related threat bias in recognition memory. The results indicate that trait anxiety is associated with a bias to decide that threatening stimuli were not previously studied, but only when semantic-similarity effects are controlled. Implications for theories of anxiety and future studies in this domain are discussed. (shrink)

Most people, including those in academia and the media, view Darwin's theory of evolution as a fact, a concept so thoroughly established as to be beyond serious challenge. Yet almost no one today bothers to read what Darwin wrote, nor are they aware of the pseudo-scientific racism and eugenics that arose from his theories. More than that, Darwin's motivation in writing The Origin of the Species was not entirely "scientific." After his young daughter's death, he deliberately moved away from an (...) essentially Christian worldview and aimed to find an explanation for life that did not require anything Divine. Yet, in his last months of life, Darwin's atheism failed him and he evidently returned to faith in God. (shrink)

BackgroundBurnout is being experienced by medical students, residents, and practicing physicians at significant rates. Higher levels of Hardiness and Emotional Intelligence may protect individuals against burnout symptoms. Previous studies have shown both Hardiness and Emotional IntelIigence protect against detrimental effects of stress and can be adapted through training; however, there is limited research on how training programs affect both simultaneously. Therefore, the objective of this study was to define the association of Hardiness and Emotional Intelligence and their potential improvement through (...) hyper realistic immersion simulation training in military medical students.MethodsParticipants in this study consisted of 68 second year medical students representing five medical schools who were concurrently enrolled in the United States military scholarship program. During a six day hyper-realistic surgical simulation training course, students rotated through different roles of a medical team and responded to several mass-casualty scenarios. Hardiness and Emotional Intelligence were assessed using the Hardiness Resilience Gauge (HRG) and the Emotional Quotient Inventory (EQ-I 2.0) respectively, at two time points: on arrival (pre-event) and after completion of the course (post-event).ResultsHardiness and Emotional Intelligence scores and sub scores consistently improved from pre-event to post-event assessments. No difference in training benefit was observed between genders but differences were observed by age where age was more often associated with Emotional Intelligence. In addition, factor analysis indicated that the HRG and EQ-I 2.0 assessment tools measured predominately different traits although they share some commonalities in some components.ConclusionThis study indicates that Hardiness and Emotional Intelligence scores can be improved through immersion training in military medical students. Results from this study support the use of training course interventions and prompt the need for long term evaluation of improvement strategies on mitigating burnout symptoms. (shrink)

Rather than reading Plato's philosophy of arithmetic ‘charitably’, it is better to try to explain its failure to generate any fruitful ideas. Prominent in the explanation is Plato's focus on predicates assigning cardinalities and on ‘groups’ falling under them. This focus left Plato unable to envisage the possibility, emerging in Dedekind and Frege but which arithmetic in Plato's time would not easily have suggested, of regarding numbers as objects essentially ranged in the structure of a progression.

Nature contact has associations with emotional ill-being and well-being. However, the mechanisms underlying these associations are not fully understood. We hypothesised that increased adaptive and decreased maladaptive emotion regulation strategies would be a pathway linking nature contact to ill-being and well-being. Using data from a survey of 600 U.S.-based adults administered online in 2022, we conducted structural equation modelling to test our hypotheses. We found that (1) frequency of nature contact was significantly associated with lesser emotional ill-being and greater emotional (...) well-being, (2) effective emotion regulation was significantly associated with lesser emotional ill-being and greater emotional well-being, and (3) the associations of higher frequency of nature contact with these benefits were partly explained via emotion regulation. Moreover, we found a nonlinear relationship for the associations of duration of nature contact with some outcomes, with a rise in benefits up to certain amounts of time, and a levelling off after these points. These findings support and extend previous work that demonstrates that the associations of nature contact with emotional ill-being and well-being may be partly explained by changes in emotion regulation. (shrink)

In online social networks, the audience size commanded by an organization or an individual is a critical measure of that entity’s popularity and this measure has important economic and/or political implications. Such efforts to measure popularity of users or exploit knowledge about their audience are complicated by the presence of fake profiles on these networks. In this study, analysis of 62 million publicly available Twitter user profiles was conducted and a strategy to identify automatically generated fake profiles was established. Using (...) a combination of a pattern-matching algorithm on screen-names and an analysis of update times, a reasonable number of highly reliable fake user accounts were identified. Analysis of profile creation times and URLs of these fake accounts revealed their distinct behavior relative to a ground truth data set. The characteristics of friends and followers of users in the two data sets further revealed the very different nature of the two groups. The ratio of number of followers-to-friends for ground truth users was ∼1, consistent with past observations, while the fake profiles had a median ratio ∼30, indicating that the fake users we identified were primarily focused on gathering friends. An analysis of the temporal evolution of accounts over 2 years showed that the friends-to-followers ratio increased over time for fake profiles while they decreased for ground truth users. Our results, thus, suggest that a profile-based approach can be used for identifying a core set of fake online social network users in a time-efficient manner. (shrink)

The COVID-19 pandemic and its associated stressors have impacted the daily lives and sleeping patterns of many individuals, including university students. Dreams may provide insight into how the mind processes changing realities; dreams not only allow consolidation of new information, but may give the opportunity to creatively “play out” low-risk, hypothetical threat simulations. While there are studies that analyze dreams in high-stress situations, little is known of how the COVID-19 pandemic has impacted dreams of university students. The aim of this (...) study was to explore how the dream content of students was affected during the university COVID-19 lockdown period (March–July, 2020). Using online survey methods, we analyzed dream recall content (n= 71) using the Hall-Van de Castle dream coding system and Fisher's exact tests for sex comparisons. Preliminary results indicate that female students experienced more nightmares as compared to male students. Dream analysis found that, relative to normative American College Student (ACS) samples generated pre-COVID-19, women were more likely to experience aggressive interactions in their dream content, including increased physical aggression. Results indicate that university students did experience changes in dream content due to the pandemic lockdown period, with women disproportionally affected. These findings can aid universities in developing support programs for students by bringing forth an understanding of students' concerns and anxieties as they process the “new normal” of social distancing. (shrink)

Intuición y hermenéutica -- El ser de sí mismo en la identidad narrativa de Paul Ricoeur -- Fenomenología como hermenéutica de la existencia -- Filosofía de la religión -- Los fines de la educación -- Tema formadores y medios -- Las experiencias de aprendizaje artístico de los estudiantes.

In academic research on interracial relationships, as well as popular discourses such as film and television, Black women are often characterized as angry and opposed to interracial relationships. Yet the voices of Black women have been largely neglected. Drawing from focus group interviews with Black college women and in-depth interviews with Black women who are married interracially, the author explores Black women’s views on Black-white heterosexual relationships. Black women’s opposition to interracial dating is not simply rooted in jealousy and (...) anger toward white women but is based on white racism, Black internalization of racism, and what interracial relationships represent to Black women and signify about Black women’s worth. The impact of racism and sexism are clear, with Black women devalued by white standards of beauty and faced with a shortage of available Black men and a lack of “substantive opportunities” to date interracially. (shrink)