Rumination is a maladaptive form of emotion regulation associated with psychopathology. Research with adults suggests that rumination covaries with diurnal cortisol rhythms, yet this has not been examined among adolescents. Here, we examine the day-to-day covariation between rumination and cortisol, and explore whether trait rumination is associated with alterations in diurnal cortisol rhythms among adolescent girls. Participants provided saliva samples 3 times per day over 3 days, along with daily reports of stress and rumination, questionnaires assessing trait rumination related to (...) peer stress, and diagnostic interviews assessing depression and anxiety. Greater rumination than usual during the day was associated with lower cortisol awakening responses the following morning, but this effect was not significant after accounting for wake time and an objective measure of adherence to the saliva sampling protocol. Trait rumination was associated with lower average cortisol levels at waking and flatter diurnal slopes, accounting for wake time, protocol compliance, and other factors. These patterns may help to explain why rumination is related to the development of psychopathology. (shrink)

During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift—to some degree—from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by “crisis standards of care,” but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude (...) certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities. (shrink)

Activists’ investigations of animal cruelty expose the public to suffering that they may otherwise be unaware of, via an increasingly broad-ranging media. This may result in ethical dilemmas and a wide range of emotions and reactions. Our hypothesis was that media broadcasts of cruelty to cattle in Indonesian abattoirs would result in an emotional response by the public that would drive their actions towards live animal export. A survey of the public in Australia was undertaken to investigate their reactions and (...) responses to. The most common immediate reaction was feeling pity for the cattle. Women were more likely than men to feel sad or angry. Most people discussed the media coverage with others afterwards but fewer than 10 % contacted politicians or wrote to newspapers. We conclude that the public were emotionally affected by the media coverage of cruelty to cattle but that this did not translate into significant behavioral change. We recommend that future broadcasts of animal cruelty should advise the public of contact details for counseling and that mental health support contacts, and information should be included on the websites of animal advocacy groups to acknowledge the disturbing effect animal cruelty exposes can have on the public. (shrink)

This article presents a study of corporate-stakeholder relationships using an empirical technique called Data Envelopment Analysis (DEA) to assess company "best practices" with respect to five primary stakeholders at an industry level of analysis. Five key stakeholder domains are considered: community relations, employee relations, environment, customer (product category), and stockholders (financial performance). These data reflect the relationships between companies and these five primary stakeholders; these relationships are considered to be important elements of corporate social performance. About 15% of companies, on (...) average, are found to be operating at the multidimensional "best practices frontier" that DEA establishes. Differences in treatment of stakeholders within industries and between industries are observed. (shrink)

Severe staffing shortages have emerged as a prominent threat to maintaining usual standards of care during the COVID-2019 pandemic. In dire settings of crisis capacity, healthcare systems assume the ethical duty to maximise aggregate population-level benefit of existing resources. To this end, existing plans for rationing mechanical ventilators and intensive care unit beds in crisis capacity focus on selecting individual patients who are most likely to survive and prioritising these patients to receive scarce resources. However, staffing capacity is conceptually different (...) from availability of these types of discrete resources, and the existing strategy of identifying and prioritising patients with the best prognosis cannot be readily adapted to fit this real-world scenario. We propose that two alternative approaches to staffing resource allocation offer a better conceptual fit: prioritise the worst off: restrict access to acute care services and hospital admission for patients at relatively low clinical risk and prioritise staff interventions with high near-term value: universally restrict selected interventions and treatments that require substantial staff time and/or energy but offer minimal near-term patient benefit. These strategies—while potentially resulting in care that deviates from usual standards–support the goal of maximising the aggregate benefit of scarce resources in crisis capacity settings triggered by staffing shortages. This ethical framework offers a foundation to support institutional leaders in developing operationalisable crisis capacity policies that promote fairness and support healthcare workers. (shrink)

The progression of research and scholarly inquiry does not occur in isolation and is wholly dependent on accurate reporting of methods and results, and successful replication of prior work. Without mechanisms to correct the literature, much time and money is wasted on research based on a crumbling foundation. These guidelines serve to outline the respective responsibilities of researchers, institutions, agencies, and publishers or editors in maintaining the integrity of the research record. Delineating these complementary roles and proposing solutions for common (...) barriers provide a foundation for best practices. (shrink)

Background Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients’ views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians. Methods We analyzed 57 semi-structured interviews conducted (...) at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American (n = 28), Hispanic/Latina (n = 22), or Haitian (n = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant’s language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about “respect.” After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes. Results Results from this study grouped into two overarching classifications: respect manifested in physicians’ orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider’s orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy. Conclusions Findings suggest a more robust conception of what ‘respect for persons’ entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery. (shrink)

Classroom discussion practices that can lead to reasoned participation by all students are presented and described by the authors. Their research emphasizes the careful orchestration of talk and tasks in academic learning. Parallels are drawn to the philosophical work on deliberative discourse and the fundamental goal of equipping all students to participate in academically productive talk. These practices, termed Accountable TalkSM, emphasize the forms and norms of discourse that support and promote equity and access to rigorous academic learning. They have (...) been shown to result in academic achievement for diverse populations of students. The authors outline Accountable Talk as encompassing three broad dimensions: one, accountability to the learning community, in which participants listen to and build their contributions in response to those of others; two, accountability to accepted standards of reasoning, talk that emphasizes logical connections and the drawing of reasonable conclusions; and, three, accountability to knowledge, talk that is based explicitly on facts, written texts, or other public information. With more than fifteen years research into Accountable Talk applications across a wide range of classrooms and grade levels, the authors detail the challenges and limitations of contexts in which discourse norms are not shared by all members of the classroom community. (shrink)

The authors surveyed hospitals across the country on their policies regarding overlapping surgery, and found large variation between hospitals in how this practice is regulated. Specifically, institutions chose to define “critical portions” in a variety of ways, ultimately affecting not only surgical efficiency but also the autonomy of surgical trainees and patient experiences at these different hospitals.

Motor development – traditionally studied in WEIRD populations – falls victim to assumptions of universality similar to other domains described by Henrich et al. However, cross-cultural research illustrates the extraordinary diversity that is normal in motor skill acquisition. Indeed, motor development provides an important domain for evaluating cultural challenges to a general behavioral science.

Because of the importance of board members’ resource provision and monitoring, a substantial body of research has been devoted to ascertaining how directors can be incented to perform their responsibilities. We use social exchange theory to empirically examine how board members’ resource provision and monitoring are affected by their perceptions of the CEOs’ trustworthiness. Our findings suggest that board members’ perceptions of the CEO’s ability, benevolence, and integrity have different effects on the board members’ resource provision and monitoring. Our results (...) further suggest that board members’ governance behaviors are moderated by the board’s performance evaluation practices. (shrink)

Firearm injuries are a significant public health problem. Prior studies have analyzed firearm death data or adult firearm injury data, but few studies have analyzed firearm injury data specifically among youth. To inform the current debate surrounding gun policy in the United States, this study aims to provide an estimate of the immense burden of youth firearm injury and its associated risk factors. Therefore, we performed a descriptive analysis of the Nationwide Emergency Department Sample, the largest all-payer emergency department database (...) in the United States, from January 2006 to September 2015. All patients age < 21 who presented with any diagnosis of firearm-related injuries were included. There were an estimated 198,839 incidents of firearm-related emergency department visits for patients age < 21 from 2006 through 2015. After presenting to the ED, an estimated 11,909 cases resulted in death. The population adjusted rate of firearm-related emergency department visits was highest in the South and Midwest. This study demonstrates the significant burden of firearm injury among youth. Having a reliable estimate of the number of children harmed by firearms each year is a critical tool for policymakers — and may make common-sense gun safety measures more politically possible. (shrink)

This collection by some of the leading scholars of Strauss's work is the first devoted to Strauss's thought regarding education. It seeks to address his conception of education as it applies to a range of his most important concepts, such as his views on the importance of revelation, his critique of modern democracy and the importance of modern classical education.

Mobile devices with health apps, direct-to-consumer genetic testing, crowd-sourced information, and other data sources have enabled research by new classes of researchers. Independent researchers, citizen scientists, patient-directed researchers, self-experimenters, and others are not covered by federal research regulations because they are not recipients of federal financial assistance or conducting research in anticipation of a submission to the FDA for approval of a new drug or medical device. This article addresses the difficult policy challenge of promoting the welfare and interests of (...) research participants, as well as the public, in the absence of regulatory requirements and without discouraging independent, innovative scientific inquiry. The article recommends a series of measures, including education, consultation, transparency, self-governance, and regulation to strike the appropriate balance. (shrink)

A Scientific Integrity Consortium developed a set of recommended principles and best practices that can be used broadly across scientific disciplines as a mechanism for consensus on scientific integrity standards and to better equip scientists to operate in a rapidly changing research environment. The two principles that represent the umbrella under which scientific processes should operate are as follows: Foster a culture of integrity in the scientific process. Evidence-based policy interests may have legitimate roles to play in influencing aspects of (...) the research process, but those roles should not interfere with scientific integrity. The nine best practices for instilling scientific integrity in the implementation of these two overarching principles are Require universal training in robust scientific methods, in the use of appropriate experimental design and statistics, and in responsible research practices for scientists at all levels, with the training content regularly updated and presented by qualified scientists. Strengthen scientific integrity oversight and processes throughout the research continuum with a focus on training in ethics and conduct. Encourage reproducibility of research through transparency. Strive to establish open science as the standard operating procedure throughout the scientific enterprise. Develop and implement educational tools to teach communication skills that uphold scientific integrity. Strive to identify ways to further strengthen the peer review process. Encourage scientific journals to publish unanticipated findings that meet standards of quality and scientific integrity. Seek harmonization and implementation among journals of rapid, consistent, and transparent processes for correction and/or retraction of published papers. Design rigorous and comprehensive evaluation criteria that recognize and reward the highest standards of integrity in scientific research. (shrink)

If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.

This book provides original descriptive accounts of two schools of thought in the philosophy of beauty: the 20th-century "Anti-Aesethetic" movement and the 21st-century "Beauty Revival" movement. It also includes a positive defence of beauty as a lived experience extrapolated from Beauty-Revival position. Beauty was traditionally understood in the broadest sense as a notion that engages our sense perception and embraces everything evoked by that perception, including mental products and affective states. This book constructs and places in parallel with one another (...) the Anti-Aesthetic and Beauty-Revival movements. In the author's view, Anti-Aestheticism is devoted to a decisive negation of beauty-denying its importance as a philosophical notion and its significance as a lived experience. It suggests that beauty is a merely sensual experience, which can be used, at best, as a distraction from justice and, at worst, as an instrument of evil. Alternatively, the Beauty-Revival movement advances arguments for beauty as an experience that extends primarily to sensual experience, but which also calls forth mental products and cognitive and affective states evoked by that experience. After reconstructing these two positions, the author elaborates on the notion of beauty as a lived experience through three key moments which occur in the process of our experiencing beautiful objects. These moments are (a) the conditions that constitute an experience of beauty, (b) the attitudinal features most likely to lead to the experience of beauty, and (c) the results of the experience of beauty. The Revival of Beauty will be of interest to scholars and advanced students working in aesthetics, history of philosophy, and art history. (shrink)

RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

Community Partnered Participatory Research is grounded in the ethical principle of respect for persons participating in the research enterprise. The critical importance of respect for person...

The aim of UK-REACH (“The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers”) is to understand if, how, and why healthcare workers (HCWs) in the United Kingdom (UK) from ethnic minority groups are at increased risk of poor outcomes from COVID-19. In this article, we present findings from the ethical and legal stream of the study, which undertook qualitative research seeking to understand and address legal, ethical, and social acceptability issues around data protection, privacy, and information (...) governance associated with the linkage of HCWs’ registration data and healthcare data. We interviewed 22 key opinion leaders in healthcare and health research from across the UK in two-to-one semi-structured interviews. Transcripts were coded using qualitative thematic analysis. Participants told us that a significant aspect of Big Data research in public health is varying drivers of mistrust—of the research itself, research staff and funders, and broader concerns of mistrust within participant communities, particularly in the context of COVID-19 and those situated in more marginalised community settings. However, despite the challenges, participants also identified ways in which legally compliant and ethically informed approaches to research can be crafted to mitigate or overcome mistrust and establish greater confidence in Big Data public health research. Overall, our research indicates that a “Big Data Ethics by Design” approach to research in this area can help assure (1) that meaningful community and participant engagement is taking place and that extant challenges are addressed, and (2) that any new challenges or hitherto unknown unknowns can be rapidly and properly considered to ensure potential (but material) harms are identified and minimised where necessary. Our findings indicate such an approach, in turn, will help drive better scientific breakthroughs that translate into medical innovations and effective public health interventions, which benefit the publics studied, including those who are often marginalised in research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:John Dewey and the Question of Artful CommunicationScott R. StroudThe American pragmatist John Dewey included tantalizing sections of praise of the power of communication in his important work on community, experience, and their improvement, noting in 1925 that "of all aff airs, communication is the most wonderful" (1988a, LW 1:132) and in 1927 that communication plays an important part in the individual's attempt "to learn to become human" (1984, (...) LW 2:332).1 Some in the field of communication have sensed the important, but undeveloped, role that communication plays in his thought and have attempted to use Dewey's work in analyzing rhetorical practice, cultural studies, and the role of journalism in society.2 While such studies strive to clarify the value and process of communication in Dewey's thought, they fall short of explaining one seemingly simple thing that is implied in these passages—that communication can be experienced as aesthetic or artful. Nathan Crick identifies such a lacuna in the literature and notes that "beyond its utility as an argument against elite forms of academic criticism, the value of Dewey's aesthetic theory for communication studies remained underdeveloped" (2004, 303). Although he does an admirable job of tracing the relation of aesthetics to communication in Dewey's evolving thought, Crick comes no closer than others in answering the fundamental question of how communication can be artful or aesthetic—he merely argues for the general point that " communication, [End Page 153] whether it occurs in an oration, a conversation, or a television, is best understood as a form of art that has the potential to bring about aesthetic experience in its participants and open their eyes to the world of possibility embodied within each of us" (2004, 314). How exactly does this aesthetization of communication occur? Crick ends his article with the interesting claim that "in its aesthetic form communication becomes rhetorical. It turns communication into an art whose goal is a presentation that unites form and rhythm in a manner that can reach down into the experiences of the audience and literally transform them into something new" (2004, 317). How exactly does communication meet such standards? Does such a "high" art of communication as rhetoric fit everyday communication, the vast majority of human communicative practices?3 Although Crick's study is an important inquiry into the overall role of communication in Dewey's aesthetics, it still leaves open the fundamental question—How exactly can any given act of communication (beyond the eloquent and poetic oration) be rendered aesthetic or artful?This question was vitally important for Dewey, as he places artistic and aesthetic aspects of communicative practice at the very heart of his social and political philosophy. In describing the "Great Community," he announces that it will take place when two conditions hold: "The highest and most difficult kind of inquiry and a subtle, delicate, vivid and responsive art of communication must take possession of the physical machinery of transmission and circulation and breathe life into it.... Democracy will come into its own, for democracy is a name for a life of free and enriching communion.... It will have its consummation when free social inquiry is indissolubly wedded to the art of full and moving communication" (1984, LW 2:350). This is a vital passage for understanding Dewey's aims, as it clearly links a scientific method of thinking (his preferred method of "inquiry") with a form of communication that can be taken as an art.Yet scholars of communication systematically miss this part of the Deweyan equation. For instance, take Lary Belman's early study of Dewey's view of communication. He concludes by analyzing this same passage from Dewey on the two conditions of the Great Community and states, "The basic conditions for the creation of a Great Community... were, Dewey postulated, the presence of (a) vigorous, systematic, and continuous social inquiry to reveal the influential agencies at work in society and their mode of operation, and (b) widespread and rapid distribution of the findings of this inquiry in a form readily understood by those for whom these findings [End Page 154] have significance" (1977, 36–37). It is remarkable that the... (shrink)