Background and AimsEnd-of-life discussions can be difficult for seriously ill adolescents and young adults. Researchers aimed to determine whether completing Voicing My CHOiCES —a research-informed advance care planning guide—increased communication with family, friends, or health care providers, and to evaluate the experience of those with whom VMC was shared.MethodsFamily, friends, or HCPs who the AYAs had shared their completed VMC with were administered structured interviews to assess their perception of the ACP discussion, changes in their relationship, conversation quality, and whether (...) the discussion prompted changes in care. Open-ended responses underwent thematic analysis.ResultsOne-month post-completion, 65.1% of AYA had shared VMC completion with a family member, 22.6% with a friend, and 8.9% with an HCP. Among a sample of respondents, family and friends reported a positive change in their relationship with the AYA. Participant descriptions of the experience fell into five themes: positive experience, difficult experience, appreciated a guide to facilitate discussion, provided relief, and created worry/anxiety. Only 1 HCP noted a treatment change. Family, friends, and HCP did not think the AYA would have discussed EoL preferences without completing VMC.ConclusionsVMC has potential to enhance communication about ACP between AYA and their family and friends, though less frequently with HCPs. Participants reported a positive change in their relationship with the AYA after discussing VMC, and described experiencing the conversation as favorable, even when also emotionally difficult. (shrink)

Volume 20, Issue 7, July 2020, Page 150-152.

Responding to a major pandemic and planning for allocation of scarce resources under crisis standards of care requires coordination and cooperation across federal, state and local governments in tandem with the larger societal infrastructure. Maryland remains one of the few states with no state-endorsed ASR plan, despite having a plan published in 2017 that was informed by public forums across the state. In this article, we review strengths and weaknesses of Maryland’s response to COVID-19 and the role of (...) the Maryland Healthcare Ethics Committee Network in bridging gaps in the state’s response to prepare health care facilities for potential implementation of ASR plans. Identified “lessons learned” include: Deliberative Democracy Provided a Strong Foundation for Maryland’s ASR Framework; Community Consensus is Informative, Not Normative; Hearing Community Voices Has Inherent Value; Lack of Transparency & Political Leadership Gaps Generate a Fragmented Response; Pandemic Politics Requires Diplomacy & Persistence; Strong Leadership is Needed to Avoid Implementing ASR … And to Plan for ASR; An Effective Pandemic Response Requires Coordination and Information-Sharing Beyond the Acute Care Hospital; and The Ability to Correct Course is Crucial: Reconsidering No-visitor Policies. (shrink)

Since the turn of the century, the number of small-scale farmers in the U.S. and farmlands they owned have declined very sharply (structural change). Although the decrease in number is generally true for both white and Black farm operators, it has been more significant for Blackfarm operators than whites. The declining trend in the number of Blackfarm operators in the country is derived from individual state experiences that resulted from a combination of various political and economic factors. Using the census (...) of agriculture data from 1900 to 1987, this paper gives a brief historical overview of Black farm operators in Maryland. The census data for the study period shows that at their peak number in 1910, there were 6,382 Blackfarmers in the state of Maryland. However, by 1987, only 371 of that number remained, representing a loss of 94 percent since 1910. According to the 1987 census data almost all Black operated farms in Maryland were not only small-scale but also in the lower sales class, less than $20,000 a year. Their household net family income is below that of non-metropolitan median household income. This concentration of Blacks in the lower economic class of farm operators in the state, for the most part, is closely related to their resource endowments, patterns of tenure, type of farm enterprises, and government farm programs and policies. On the average, Blackfarmers in Maryland have less land, capital and management skills than their white counterparts. Government policies and programs had, and continue to have, a devastating effect on Maryland Black farmers because they were tied to productive resources rather than farm income needs. Under conditions of low income, years of neglect by federal and state programs and policies, and limited resources Blackfarmers were unable to adopt capital intensive production practices and expand their farm operations. This resulted in most of them leaving agriculture, in the past and today, at a faster rate than whites. To avert or at least lessen the unfortunate situation of Black farm operators, projections and possible solutions are offered. This includes how the 1890 Land-Grant institutions because of their tradition, expertise and experience of research, teaching and outreach can take the leadership role in shaping the future direction of these farmers and their operations. (shrink)

Local food systems are growing, and little is known about how the constellation of farms and markets change over time. We trace the evolution of two local food systems over six years, including a dataset of over 2690 market connections between 1520 locations. Longitudinal social network analysis reveals how the architecture, actor network centrality, magnitude, and spatiality of these supply chains shifted during the 2012–2018 time period. Our findings demonstrate that, despite growth in the number of farmers’ markets, grocery stores, (...) farms and restaurants in both counties, each local food system also experienced high turnover rates. Over 80% of the market connections changed during the study period. Farms, farmers’ markets, and grocery stores showed a 40–50% ‘survival’ rate, indicating their role in sustaining local food systems over longer time periods. Other actors, such as restaurants, had a much higher turnover rate within the network. Both food systems became more close-knit and consolidated as the center of gravity for both local food systems pulled away from urban areas toward rural farmland. Evidence of both growth and decay within local food systems provides a new understanding of the social networks behind local food markets. (shrink)

The Genetic Privacy Act is a comprehensive effort to protect individuals from unauthorized analysis of their DNA and from unauthorized disclosure of information resulting from genetic analysis. Irrespective of merit, every bill must survive legislative scrutiny. This is a considerable challenge, particularly for a bill as complex and far-reaching as the GPA. To illustrate my point, I describe the fate of two bills introduced into the Maryland Senate in 1995 by Senator Jennie Forehand. The first, also entitled the Genetic (...) Privacy Act, was a slightly modified version of the model legislation prepared by Annas, Glantz, and Roche. After a hearing, the bill received a 9-2 unfavorable vote from the Economic and Environmental Affairs Committee. The second was a much shorter bill, DNA Testing – Informed Consent and Confidentiality, which simply stated that “DNA analysis may only be performed with the informed consent of the person being analyzed” and that the results of such analysis “are the exclusive property of the person tested, are confidential, and may not be disclosed without the consent of the person being tested.” This bill had a hearing but was never put to a vote by the Judicial Proceedings Committee. My principal aim is to examine the testimony on these bills. I will conclude with some suggestions about accomplishing the goals of genetic privacy legislation. (shrink)

ABSTRACTThis review essay of Shawn Loht’s new book, Phenomenology of Film: A Heideggerian Account of the Film Experience, not only offers an ontological reading of the filmic experience inspired by Heidegger’s philosophy but also contributes substantially to the ongoing debate of whether or not film is a medium that is legitimately philosophical. In addition to confronting unique ideas about film that emerge from Loht’s analysis of Heidegger’s phenomenological ontology of Dasein, including a reading of later Heidegger of the “Turn,” this (...) essay also seeks to think with and then beyond Loht in a way that might inspire readers to further pursue these issues in relation to a potentially reconceived understanding of the practice of film-as-philosophy. (shrink)

A relatively healthy forty-six-year-old woman with mild hypertension receives a prescription for an antihypertensive medication. One of the medication's adverse effects is its potential to cause severe depression. Four months later, she is diagnosed with anxiety, an early manifestation of depression. An antianxiety drug is prescribed, but her anxiety worsens. Her physician then diagnoses her as having a depressive disorder, and prescribes a new antidepressant medication. She is still on the same antihypertensive.A seventy-two-year-old man is given furosemide and digoxin to (...) control a mild case of congestive heart failure and hypertension. Because furosemide deletes potassium from the body, his physician also places him on a potassium supplement. Six months later, the physician tells the patient to stop taking the furosemide and prescribes an angiotensin converting enzyme inhibitor. An effect of ACE inhibitors is to reduce the body's excretion of potassium thereby reducing the digoxin's effectiveness. (shrink)

A relatively healthy forty-six-year-old woman with mild hypertension receives a prescription for an antihypertensive medication. One of the medication's adverse effects is its potential to cause severe depression. Four months later, she is diagnosed with anxiety, an early manifestation of depression. An antianxiety drug is prescribed, but her anxiety worsens. Her physician then diagnoses her as having a depressive disorder, and prescribes a new antidepressant medication. She is still on the same antihypertensive.A seventy-two-year-old man is given furosemide and digoxin to (...) control a mild case of congestive heart failure and hypertension. Because furosemide deletes potassium from the body, his physician also places him on a potassium supplement. Six months later, the physician tells the patient to stop taking the furosemide and prescribes an angiotensin converting enzyme inhibitor. An effect of ACE inhibitors is to reduce the body's excretion of potassium thereby reducing the digoxin's effectiveness. (shrink)

Existuje překvapivě málo knih, které by se pokoušely o syntetizující pohled na analytickou filosofii. Je ovšem pravda, že ve druhé polovině našeho století se soubor filosofů, kteří se k analytické filosofii hlásí nebo kteří k ní bývají řazeni, stává natolik různorodý, že se jakákoli syntéza stává problematickou; překvapivě málo syntetizujících prací existuje ale i o ‘klasické’ analytické filosofii, to jest o analytické filosofii období zhruba od konce devatenáctého století do poloviny století dvacátého. Dejnožkova kniha je jednou z těch mála, které (...) se o něco takového pokouší, a to je třeba přivítat. Dejnožka se ovšem nesnaží podat všestranný rozbor názorů klasiků analytické filosofie; soustředí se pouze jeden aspekt jejich učení, totiž na jejich ontologii. Hned v úvodu své knihy k tomu vysvětluje, jaké opodstatnění může mít hovořit o ontologii u takového druhu filosofie, která se programově distancuje od metafyziky. Podle něj je tomu tak, že i když se někteří analytičtí filosofové někdy více či méně úspěšně vyhýbali otázkám metafyzickým (to jest otázkám po nejzákladnějších kategoriích bytí), ontologickým otázkám (to jest otázkám po povaze bytí jako takového) se v podstatě vyhnout nelze. A Dejnožka se snaží ukázat, že klasikové analytické filosofie se těmito otázkami zabývali mnohdy velice do hloubky. To je patrné zejména u Frega a Russella, kterým autor věnuje největší pozornost; avšak k těm, kteří podle Dejnožky berou ústřední otázku ontologie za svou, řadí Dejnožka i Wittgensteina i Quina (jimž se však věnuje na pouze velice omezeném prostoru - každému asi na dvanácti stránkách). (shrink)

Foundations of Relational Realism: A Topological Approach to Quantum Mechanics and the Philosophy of Nature by Michael Epperson and Elias Zafiris sets out to achieve three goals: to develop a version of Whiteheadian metaphysics that the authors call “relational realism”; to formalize relational realism in terms of category theory, in particular sheaf theory; and to use relational realism to solve the interpretative problems of quantum mechanics. These goals are ambitious, to say the least, and all this is leaving aside those (...) sections of FRR which argue that relational realism yields the key to understanding quantum gravity!The text is 388 pages long and comprises two parts. Part I, by Epperson, introduces relational realism and its application to quantum mechanics. Part II, by Zafiris, develops the sheaf theory formalism for relational realism. As the authors say, their exposition is “nonlinear”, and this feature of FRR, alon .. (shrink)

As an institution serving “the youth of Maryland of the colored race,” the evolution of Princess Anne Academy as a land grant school depicts the problems and successes of the early black land grant schools of the South. It responded to the prevailing economic and social forces of its time. Despite the rhetoric of the federal 1890 Land Grant Act, Princess Anne Academy, like other 1890 schools, did not enjoy the equal financial support accorded the 1862 schools. A hostile (...) community and an indifferent legislature prevented Princess Anne Academy from actively participating in the educational life on the Eastern Shore. (shrink)

We think recent work in linguistics tells against the traditional claim that a string of words like (1) Every girl pushed some truck has two readings, indicated by the following formal language sentences (with restricted quantifiers): (1a) [!x:Gx]["y:Ty]Pxy (1b) ["y:Ty][!x:Gx]Pxy. In our view, (1) does not have any b-reading in which ‘some truck’ has widest scope.1 The issue turns on details concerning syntactic transformations and terms like ‘every’. This illustrates an important point for the study of natural language: ambiguity hypotheses (...) are indeed hypotheses—i.e., theoretical claims to be justified in light of various considerations, not theses whose truth can be directly observed by speakers. (shrink)

It is, I suppose, a truism that an adequate theory of meaning for a natural language L will associate each sentence of L with its meaning. But the converse does not hold. A theory that associates each sentence with its meaning is not, by virtue of that fact, an adequate theory of meaning. For it is also a truism that a semantic theory should explain the (interesting and explicable) semantic facts. And one cannot decree that the relevant facts are all (...) reportable with instances of schemata like ‘S means that p’ or ‘S, by virtue of its meaning, is true iff p’. Investigation suggests that there is much more for semanticists to explain: natural languages exhibit synonymies, ambiguities, and entailments; for any string of words, there are endlessly many meanings it cannot have; there are semantic generalizations, including crosslinguistic generalizations, that go uncaptured and unexplained by merely associating sentences with their meanings; etc. Initially, one might think these facts are “peripheral” and can thus be ignored if the aim is to explain why sentences mean what they do. But the study of natural language suggests otherwise. (One can’t tell, in advance of investigation, which facts are peripheral to a given domain. It was initially tempting to think that one could ignore falling bodies, and the tides, if the aim was to explain why planets move as they do.). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Response to Lawrence Ferrara’s Chapter Four in R. Phelps, R. Sadoff, E. Warburton, and L. Ferrara, A Guide to Research in Music Education, 5th Edition (Lanham, Maryland: Scarecrow Press, Inc., 2005)Jack HellerIt is curious that Lawrence Ferrara disagrees with Jack Heller and Edward. J. P. O'Connor's view1 that "philosophy" is not "research," yet in the chapter headings in the book A Guide to Research in Music Education, (...) 5th Edition, Chapter 4 is labeled "Philosophical Inquiry," while other chapters are labeled "Qualitative Research," "Nonexperimental Research," "Quantitative Research," and "Historical Research" (italics added). Why not "Philosophical Research?" Maybe he, too, believes that philosophy is not research.In our Handbook Chapter2 we pointed out that research should be systematic and based on "empirical observation." To make things worse we said that research should try to provide "unbiased evidence." Ferrara ascribes to us a positivistic view that we did not make nor believe. That view, according to Ferrara is that the "key reason for their [our] dismissal of philosophical inquiry (notice inquiry not research) as a bona fide research design is the invariable criterion that they [we] assign to all research if it is indeed research: to present 'unbiased evidence.'" [End Page 89] We still believe that research should try to be as objective as possible while realizing that all observations are researcher dependent and have error. Research should strive to reduce error as much as possible.My reading of Kuhn's The Structure of Scientific Revolutions does not conflict with what was written in our Chapter. We did not claim that data are unbiased but rather that research should try to limit bias and try to interpret observations that can be supported by specific behavior.Philosophy, or more properly model building, should lead research. Assumptions that appear in a model are just that. They are assumptions. Not fact; not unbiased opinion. But these assumptions or philosophical conclusions should not be called research in music education because they do not provide any behavioral evidence as support. The deductive process used in philosophy (syllogistic reasoning, for example) should help to develop hypotheses that can be investigated by an inductive process (data collection). Philosophy is a time honored scholarly activity. We certainly do not mean to diminish its importance. All research should have a philosophical underpinning that should produce a theoretical model. This model then should be tested by research. Our Handbook Chapter takes this position. Philosophy is philosophy, not research.Ferrara paraphrases Rom Harre3 by stating thatthere are at least three realms of scientific research and theory: the first realm is marked by ordinary perception in which what is known is based on observable and empirically verifiable facts; in the second realm, perception may catch up with conception–there is a promise of technological development... through which researchers will eventually be able to 'observe' and empirically verify what they only conceived (as in philosophical inquiry) as the probable explanation; and in the third realm there are genuine theoretical acts of imagination... that will never be directly (italics added) perceived, for example, empirically observed or verified.Ferrara points out that this "positivist dictum [the Harre quote above]... is unrealistic in relation to actual (italics added) scientific research and practice."4 It is not clear to which "actual scientific research and practice" Ferrara refers. This entire view is misguided. Ferrara does not believe "the methodology of the natural sciences can appropriately be utilized in the human sciences and arts research, retaining the level of objectivity (italics added) achieved in the natural sciences." Who does Ferrara believes carries out natural science research? Are they not humans, constrained by the same problems of observation that all humans encounter? Are their observations more "objective" as Ferrara seems to believe? The natural scientist, like all other researchers, faces the issue of error in observing phenomena that all researchers face. (See the many examples of [End Page 90] this view in Jacques Barzun and Henry Graff.5 ) Neither philosophical inquiry, nor logical positivism, nor the "new realism" approach that Ferrara proposes for research is free from observational error. The role of all research is to minimize error.A quick romp through some... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Response to Lawrence Ferrara’s Chapter Four in R. Phelps, R. Sadoff, E. Warburton, and L. Ferrara, A Guide to Research in Music Education, 5th Edition (Lanham, Maryland: Scarecrow Press, Inc., 2005)Jack HellerIt is curious that Lawrence Ferrara disagrees with Jack Heller and Edward. J. P. O'Connor's view1 that "philosophy" is not "research," yet in the chapter headings in the book A Guide to Research in Music Education, (...) 5th Edition, Chapter 4 is labeled "Philosophical Inquiry," while other chapters are labeled "Qualitative Research," "Nonexperimental Research," "Quantitative Research," and "Historical Research" (italics added). Why not "Philosophical Research?" Maybe he, too, believes that philosophy is not research.In our Handbook Chapter2 we pointed out that research should be systematic and based on "empirical observation." To make things worse we said that research should try to provide "unbiased evidence." Ferrara ascribes to us a positivistic view that we did not make nor believe. That view, according to Ferrara is that the "key reason for their [our] dismissal of philosophical inquiry (notice inquiry not research) as a bona fide research design is the invariable criterion that they [we] assign to all research if it is indeed research: to present 'unbiased evidence.'" [End Page 89] We still believe that research should try to be as objective as possible while realizing that all observations are researcher dependent and have error. Research should strive to reduce error as much as possible.My reading of Kuhn's The Structure of Scientific Revolutions does not conflict with what was written in our Chapter. We did not claim that data are unbiased but rather that research should try to limit bias and try to interpret observations that can be supported by specific behavior.Philosophy, or more properly model building, should lead research. Assumptions that appear in a model are just that. They are assumptions. Not fact; not unbiased opinion. But these assumptions or philosophical conclusions should not be called research in music education because they do not provide any behavioral evidence as support. The deductive process used in philosophy (syllogistic reasoning, for example) should help to develop hypotheses that can be investigated by an inductive process (data collection). Philosophy is a time honored scholarly activity. We certainly do not mean to diminish its importance. All research should have a philosophical underpinning that should produce a theoretical model. This model then should be tested by research. Our Handbook Chapter takes this position. Philosophy is philosophy, not research.Ferrara paraphrases Rom Harre3 by stating thatthere are at least three realms of scientific research and theory: the first realm is marked by ordinary perception in which what is known is based on observable and empirically verifiable facts; in the second realm, perception may catch up with conception–there is a promise of technological development... through which researchers will eventually be able to 'observe' and empirically verify what they only conceived (as in philosophical inquiry) as the probable explanation; and in the third realm there are genuine theoretical acts of imagination... that will never be directly (italics added) perceived, for example, empirically observed or verified.Ferrara points out that this "positivist dictum [the Harre quote above]... is unrealistic in relation to actual (italics added) scientific research and practice."4 It is not clear to which "actual scientific research and practice" Ferrara refers. This entire view is misguided. Ferrara does not believe "the methodology of the natural sciences can appropriately be utilized in the human sciences and arts research, retaining the level of objectivity (italics added) achieved in the natural sciences." Who does Ferrara believes carries out natural science research? Are they not humans, constrained by the same problems of observation that all humans encounter? Are their observations more "objective" as Ferrara seems to believe? The natural scientist, like all other researchers, faces the issue of error in observing phenomena that all researchers face. (See the many examples of [End Page 90] this view in Jacques Barzun and Henry Graff.5 ) Neither philosophical inquiry, nor logical positivism, nor the "new realism" approach that Ferrara proposes for research is free from observational error. The role of all research is to minimize error.A quick romp through some... (shrink)