Health researchers working in low-resource settings routinely encounter serious unmet health needs for which research participants have, at best, limited treatment options through the local health system (Taylor, Merritt, and Mullany 2011). A recent case discussion features a study conducted in Bamako, Mali (Dickert and Wendler 2009). The study objective was to see whether children with severe malaria develop pulmonary hypertension in order to improve the general understanding of morbidity and mortality associated with malaria. In the study team's interactions (...) with participating children, they encountered not only malaria but also "eye infections, upper respiratory tract illnesses, rashes, pericardial effusions," .. (shrink)

We sought to assess formally the extent to which different control and elimination strategies for human African trypanosomiasis Trypanosoma brucei gambiense would exacerbate or alleviate experiences of societal disadvantage that traditional economic evaluation does not take into account. Justice-enhanced cost-effectiveness analysis is a normative approach under development to address social justice considerations in public health decision-making alongside other types of analyses. It aims to assess how public health interventions under analysis in comparative evaluation would be expected to influence the clustering (...) of disadvantage across three core dimensions of well-being: agency, association and respect. As a case study to test the approach, we applied it to five strategies for Gambiense HAT control and elimination, in combination with two different other evaluations: a cost-effectiveness analysis and a probability of elimination analysis. We have demonstrated how JE-CEA highlights the ethical importance of adverse social justice impacts of otherwise attractive options and how it indicates specific modifications to policy options to mitigate such impacts. JE-CEA holds promise as an approach to help decision makers and other stakeholders consider social justice more fully, explicitly and systematically in evaluating public health programs. (shrink)

Researchers conducting large community-based studies among underserved populations may collect data on health conditions that are little-acknowledged in the local setting, and for which there are few if any services for referral of participants who need follow-up diagnosis and care. In the design and planning of studies for such settings, investigators and research ethics committees may struggle to determine what constitutes effective referral and whether it is reasonably available. We offer a guiding framework for referral planning, informed by our experiences (...) of research in the field and of service on research ethics committees, to support evaluation of local referral resources and consideration of the benefits, burdens and risks of referral in the local setting. The framework addresses both the impact of referral on the well-being of the people who would be referred and the impact that referral of study participants would have on local people outside the study. We use a sustained discussion of three field-based case examples to illustrate the ethical concerns at issue and to demonstrate the use of the referral planning framework. (shrink)

Ethics guidance increasingly recognises that researchers and sponsors have obligations to consider provisions for post-trial access to interventions that are found to be beneficial in research. Yet, there is little information regarding whether and how such plans can actually be implemented. Understanding practical experiences of developing and implementing these plans is critical to both optimising their implementation and informing conceptual work related to PTA. This viewpoint is informed by experiences with developing and implementing PTA plans for six large-scale multicentre HIV (...) prevention trials supported by the HIV Prevention Trials Network. These experiences suggest that planning and implementing PTA often involve challenges of planning under uncertainty and confronting practical barriers to accessing healthcare systems. Even in relatively favourable circumstances where a tested intervention medication is approved and available in the local healthcare system, system-level barriers can threaten the viability of PTA plans. The aggregate experience across these HIV prevention trials suggests that simply referring participants to local healthcare systems for PTA will not necessarily result in continued access to beneficial interventions for trial participants. Serious commitments to PTA will require additional efforts to learn from future approaches, measuring the success of PTA plans with dedicated follow-up and further developing normative guidance to help research stakeholders navigate the complex practical challenges of realising PTA. (shrink)

This article proposes an action guide to making decisions regarding the ethical allocation of resources that affect access to healthcare services offered by community-based healthcare organizations. Using the filter of empirical data from a study of decision making in two community-based healthcare organizations, we identify potentially relevant conceptual guidance from a review of frameworks and action guides in the public health, health policy, and organizational ethics literature. We describe the development of this action guide. We used data from a prior (...) empirical study of the values that influence decision making about the allocation of resources in particular types of community-based healthcare organizations. We evaluated, organized, and specified the conceptual guidance we found in 14 frameworks for ethical decision making. The result is an action guide that includes four domains that are relevant to the context of the decision to be made, eight domains that are relevant to the process of the decision to be made, and 15 domains that are relevant to the criteria of the decision to be made. We demonstrate the potential use of this action guide by walking through an illustrative resource allocation decision. The action guide provides community-based healthcare organizations with a conceptually grounded, empirically informed framework for ethical decision making. (shrink)

Background: This article describes the types of community‐wide benefits provided by investigators conducting public health research in South Asia as well as their self‐reported reasons for providing such benefits.Methods: We conducted 52 in‐depth interviews to explore how public health investigators in low‐resource settings make decisions about the delivery of ancillary care to research subjects. In 39 of the interviews respondents described providing benefits to members of the community in which they conducted their study. We returned to our narrative dataset to (...) find answers to two questions: What types of community‐wide benefits do researchers provide when conducting public health intervention studies in the community setting, and what reasons do researchers give when asked why they provided community‐wide benefits?Findings: The types of community‐wide benefits delivered were directed to the health and well‐being of the population. The most common types of benefits delivered were the facilitation of access to health care for individuals in acute medical need and emergency response to natural disasters. Respondents' self‐reported reasons when asked why they provided such benefits fell into 2 general categories: intrinsic importance and instrumental importance. (shrink)

Background: This article describes the types of community-wide benefits provided by investigators conducting public health research in South Asia as well as their self-reported reasons for providing such benefits. Methods: We conducted 52 in-depth interviews to explore how public health investigators in low-resource settings make decisions about the delivery of ancillary care to research subjects. In 39 of the interviews respondents described providing benefits to members of the community in which they conducted their study. We returned to our narrative dataset (...) to find answers to two questions: What types of community-wide benefits do researchers provide when conducting public health intervention studies in the community setting, and what reasons do researchers give when asked why they provided community-wide benefits? Findings: The types of community-wide benefits delivered were directed to the health and well-being of the population. The most common types of benefits delivered were the facilitation of access to health care for individuals in acute medical need and emergency response to natural disasters. Respondents' self-reported reasons when asked why they provided such benefits fell into 2 general categories: intrinsic importance and instrumental importance. (shrink)

Biomedical research is increasingly globalized with ever more research conducted in low and middle-income countries. This trend raises a host of ethical concerns and critiques. While community engagement has been proposed as an ethically important practice for global biomedical research, there is no agreement about what these practices contribute to the ethics of research, or when they are needed.

In this paper I examine and reply to a deflationary challenge brought against virtue ethics. The challenge comes from critics who are impressed by recent psychological evidence suggesting that much of what we take to be virtuous conduct is in fact elicited by narrowly specific social settings, as opposed to being the manifestation of robust individual character. In answer to the challenge, I suggest a conception of virtue that openly acknowledges the likelihood of its deep, ongoing dependence upon particular social (...) relationships and settings. I argue that holding this conception will indeed cause problems for some important strands of thought in virtue ethics, most notably in the tradition of Aristotle's Nicomachean Ethics. But an approach to virtue ethics modeled on David Hume's treatment of virtue and character in A Treatise of Human Nature promises to escape these problems. (shrink)

I examine the Aristotelean conception of virtuous character as firm and unchangeable, a normative ideal endorsed in the currently influential, broadly Aristotelean school of thought known as 'virtue ethics'. Drawing on central concepts of Aristotle's Nicomachean Ethics, I offer an account of how this ideal is supposed to be realized psychologically. I then consider present-day empirical findings about relevant psychological processes, with special attention to interpersonal processes. The empirical evidence suggests that over time, the same interpersonal processes that sometimes help (...) to sustain character may also disrupt it, even among agents who have the right values in principle. Fortunately, the evidence also suggests some remedial measures. An important philosophical measure, I conclude, is for advocates of virtue ethics to address agents' psychological need for a systematic decision procedure that will focus attention primarily on substantive ethical considerations, rather than characterological assessment. (shrink)

N- and O-linked glycan structures of cell surface and secreted glycoproteins serve a variety of functions related to cell–cell communication in systems affecting development and disease. The more sophisticated N-glycan biosynthesis pathway of metazoans diverges from that of yeast with the appearance of the medial-Golgi β-N-acetylglucosaminyltransferases (GlcNAc-Ts). Tissue-specific regulation of medial- and trans-Golgi glycosyltransferases contribute structural diversity to glycoproteins in metazoans, and this can affect their molecular properties including localization, half-life, and biological activity. Null mutations in glycosyltransferase genes positioned later (...) in the biosynthetic pathway disrupt expression of smaller subsets of glycan structures and are progressively milder in phenotype. In this review, we examine data on targeted mutations affecting glycosylation in mice and congenital mutations in man, with a view to understanding the molecular functions of glycan structures as modulators of glycoprotein activity. Finally, pathology associated with the expression of GlcNAc-Ts in cancer and diabetes-induced cardiac hypertrophy suggest that inhibitors of these enzymes may have therapeutic value. BioEssays 21:412–421, 1999. © 1999 John Wiley & Sons, Inc. (shrink)

What critical characteristics do firms have that determine the scale and scope of corporate social responsibility activities they undertake? This paper examines two disparate predictors of corporate social performance. First, using the lens of the resource-based view, we examine the role of alliance network centrality on corporate social performance. We find that centrality enhances corporate social performance. Second, we investigate how board composition affects corporate social performance. Specifically, drawing on stakeholder theory, we find that the percentage of female directors predicts (...) greater corporate social performance. In addition, we look at the influence of outside directors on this relationship. Our findings show that the presence of more outside directors positively moderates the relationship between female directors and corporate social performance. (shrink)

The focus on negative attitudes toward other groups has led to a dichotomy between the prejudice reduction and the collective action approach. To solve the resulting problems identified by Dixon et al., we suggest analyzing the psychological processes underlying the construction of relationships between own and other groups.

Firearms were associated with 30, 136 deaths in the United States in 2003. Most guns are initially sold to the public through a network of retail dealers. Licensed firearm dealers are an important source of guns for criminals and gun traffickers. Just one percent of licensed dealers were responsible for more than half of all guns traced to crime. Federal law makes it difficult for ATF to inspect and revoke the licenses of problem gun dealers. State licensing systems, however, are (...) a greatly under-explored opportunity for firearm dealer oversight. We identify and categorize these state systems to identify opportunities for interventions to prevent problem dealers from supplying guns to criminals, juveniles, or gun traffickers. Just seventeen states license gun dealers. Twenty-three states permit routine inspections of dealers but only two mandate that those inspections occur on a regular basis. Twenty-six states impose record-keeping requirements for gun sales. Only thirteen states require some form of store security measures to minimize firearm theft. We conclude with recommendations for a comprehensive system of state licensing and oversight of gun dealers. Our findings can be useful for the coalition of more than fifty U.S. mayors that recently announced it would work together to combat illegal gun trafficking. (shrink)

Firearms were associated with 30,136 deaths in the United States in 2003; of these, 11,920 were homicides. For every firearm homicide, there are four people who suffer non-fatal firearm assaults. Like many other consumer products in the US, most guns are initially sold to the public through a network of retail dealers. Persons in the business of selling firearms must obtain a federal firearm dealer's license. There were more than 54,000 federally licensed gun dealers in the United States in 2005, (...) though this reflects a seventy-eight percent decline since 1994. Some states also require a state license to sell firearms.Licensed firearm dealers are an important source of guns for criminals and gun traffickers. In one analysis of gun trafficking investigations conducted by the Bureau of Alcohol, Tobacco and Firearms, licensed dealers accounted for a plurality of all guns diverted to the illegal market. (shrink)

This authoritative new book details the most recent advances in clinical neuroscience, from neurogenetics to the study of consciousness.

This paper travels into what De Sardan calls the unexplored "social mechanisms of corruption" . One of the great contemporary assignments for ethics, sociology and ethnography scholarships is accounting for the enormous distance between judicial, political and donor condemnation of African "corruption" on one hand and their frequency, banalisation and outright cultural legitimacy by ordinary people on the other. To do this the paper is set within the unremitting colonialism that is the African tragedy. It depicts the current interventions by (...) the West into African "corruption" as the third wave of colonialism, and anticipates two further waves. Using the outlooks of a post-colonial ethnography I explore the western takeover of the management of African corruption and consider the motives that drive this new colonialism. (shrink)

The current assessment of behaviors in the inventories to diagnose autism spectrum disorders (ASD) focus on observation and discrete categorizations. Behaviors require movements, yet measurements of physical movements are seldom included. Their inclusion however, could provide an objective characterization of behavior to help unveil interactions between the peripheral and the central nervous systems. Such interactions are critical for the development and maintenance of spontaneous autonomy, self-regulation and voluntary control. At present, current approaches cannot deal with the heterogeneous, dynamic and stochastic (...) nature of development. Accordingly, they leave no avenues for real-time or longitudinal assessments of change in a coping system continuously adapting and developing compensatory mechanisms. We offer a new unifying statistical framework to reveal re-afferent kinesthetic features of the individual with ASD. The new methodology is based on the non-stationary stochastic patterns of minute fluctuations (micro-movements) inherent to our natural actions. Such patterns of behavioral variability provide re-entrant sensory feedback contributing to the autonomous regulation and coordination of the motor output. From an early age, this feedback supports centrally driven volitional control and fluid, flexible transitions between intentional and spontaneous behaviors. We show that in ASD there is a disruption in the maturation of this form of proprioception. Despite this disturbance, each individual has unique adaptive compensatory capabilities that we can unveil and exploit to evoke faster and more accurate decisions. Measuring the kinesthetic re-afference in tandem with stimuli variations we can detect changes in their micro-movements indicative of a more predictive and reliable kinesthetic percept. Our methods address the heterogeneity of ASD with a personalized approach grounded in the inherent sensory-motor abilities that the individual has already developed. (shrink)

This book offers both the theoretical background behind the minority effect, teachers' personal experiences as they experienced being a minority, and their analyses and insights for teaching diverse learners. This book uses real-life experiences of diverse people to illustrate that, if not understood and addressed, situational minorities at school or work are unlikely to perform at their highest potentials.

This book seeks to resolve an issue that has divided psychoanalysts and other scholars of aggression for decades, namely the nature of aggression. The work expands and unifies the Freudian drive-based explanation of aggression into contemporary psychoanalytic theory and practice and brings Freudian theory into the 21st Century.

This book seeks to resolve an issue that has divided psychoanalysts and other scholars of aggression for decades, namely the nature of aggression. The work expands and unifies the Freudian drive-based explanation of aggression into contemporary psychoanalytic theory and practice and brings Freudian theory into the 21st Century.

Directional deep brain stimulation contacts provide greater spatial flexibility for therapy than traditional ring-shaped electrodes, but little is known about longitudinal changes of impedance and orientation. We measured monopolar and bipolar impedance of DBS contacts in 31 patients who underwent unilateral subthalamic nucleus deep brain stimulation as part of a randomized study. At different follow-up visits, patients were assigned new stimulation configurations and impedance was measured. Additionally, we measured the orientation of the directional lead during surgery, immediately after surgery, and (...) 1 year later. Here we contrast impedances in directional versus ring contacts with respect to local anatomy, active stimulation contact, and over time. Directional contacts display larger impedances than ring contacts. Impedances generally increase slightly over the first year of therapy, save for a transient decrease immediately post-surgery under general anesthesia during pulse generator placement. Local impedances decrease at active stimulation sites, and contacts in closest proximity to internal capsule display higher impedances than other anatomic sites. DBS leads rotate slightly in the immediate postoperative period but otherwise remain stable over the following year. These data provide useful information for setting clinical stimulation parameters over time. (shrink)

Beyond the observation that both speakers and listeners rapidly inspect the visual targets of referring expressions, it has been argued that such gaze may constitute part of the communicative signal. In this study, we investigate whether a speaker may, in principle, exploit listener gaze to improve communicative success. In the context of a virtual environment where listeners follow computer-generated instructions, we provide two kinds of support for this claim. First, we show that listener gaze provides a reliable real-time index of (...) understanding even in dynamic and complex environments, and on a per-utterance basis. Second, we show that a language generation system that uses listener gaze to provide rapid feedback improves overall task performance in comparison with two systems that do not use gaze. Aside from demonstrating the utility of listener gaze in situated communication, our findings open the door to new methods for developing and evaluating multi-modal models of situated interaction. (shrink)