Professional directives are unwavering: educational intimate exams should only ever occur with patients’ explicit consent. This article describes the current clinical, educational, and ethical landscape of educational pelvic examinations under anesthesia, underscores the imperative that these exams only ever occur with patients’ explicit consent, and offers accessible modifications to students’ involvement in these exams.

Recent media articles have stirred controversy over anecdotal reports of medical students practising educational pelvic examinations on women under anaesthesia without explicit consent. The understandable public outrage that followed merits a substantive response from the medical community. As medical students, we offer a unique perspective on consent for trainee involvement informed by the transitional stage we occupy between patient and physician. We start by contextualising the role of educational pelvic examinations under anaesthesia (EUAs) within general clinical (...) skill development in medical education. Then we analyse two main barriers to achieving explicit consent for educational pelvic EUAs: ambiguity within professional guidelines on how to operationalize ‘explicit consent’ and divergent patient and physician perspectives on harm which prevent physicians from understanding what a reasonable patient would want to know before a procedure. To overcome these barriers, we advocate for more research on patient perspectives to empower the reasonable patient standard. Next, we call for minimum disclosure standards informed by this research and created in conjunction with students, physicians and patients to improve the informed consent process and relieve medical student moral injury caused by performing ‘unconsented’ educational pelvic exams. (shrink)

Patient consent has been formulated in terms of radical individualism rather than shared benefits. Medical education relies on the provision of patient consent to provide medical students with the training and experience to become competent doctors. Pelvic examination represents an extreme case in which patients may legitimately seek to avoid contact with inexperienced medical students particularly where these are male. However, using this extreme case, this paper will examine practices of framing and obtaining consent as perceived by medical students. (...) This paper reports findings of an exploratory qualitative study of medical students and junior doctors. Participants described a number of barriers to obtaining informed consent. These related to misunderstandings concerning student roles and experiences and insufficient information on the nature of the examination. Participants reported perceptions of the negative framing of decisions on consent by nursing staff where the student was male. Potentially coercive practices of framing of the decision by senior doctors were also reported. Participants outlined strategies they adopted to circumvent patients’ reasons for refusal. Practices of framing the information used by students, nurses and senior doctors to enable patients to decide about consent are discussed in the context of good ethical practice. In the absence of a clear ethical model, coercion appears likely. We argue for an expanded model of autonomy in which the potential tension between respecting patients’ autonomy and ensuring the societal benefit of well-trained doctors is recognised. Practical recommendations are made concerning information provision and clear delineations of student and patient roles and expectations. (shrink)

It is argued here that the practice of medical students performing pelvic exams on women who are under anesthetic and have not consented is immoral and indefensible. This argument begins by laying out the ethical justification for the practice of informed consent, which can be found in autonomy and basic rights. Foregoing the process of consent within medicine can result in violations of both autonomy and basic rights, as well as trust, forming the basis of the wrong of unauthorized (...) pelvic examinations. Several objections to this argument are considered, all of which stem from the idea that this practice constitutes an exception to the general requirement of informed consent. These objections suggest that nonconsensual pelvic examinations on women under anesthetic are ethically acceptable on utilitarian grounds, in that they offer benefits either to the patient or to society, or on the grounds of triviality, in that consent is already presumed, or the practice is insignificant. Each of these objections is rejected and the practice is deemed indefensible. (shrink)

Unconsented pelvic exams under anesthesia are assaults cloaked in defense of healthcare education. Preemptive linguistic qualifiers “presumed” or “implied” attempt to justify such violations with flippancy toward their oxymoronic implications: to suggest a priori that consent can be assumed undermines its otherwise standalone social, ethical, and medico-legal reverence. In this paper I conceptualize “medical sexual assault” and argue that presumed consent for intimate exams exemplifies its definition. By bluntly describing pelvic exams as “penetration,” this work aims to reify (...) the intimate reality of the clinical label “pelvic exam” and to call attention to cisheteronormative and androcentric assumptions involved in its practice. Additionally, this scholarship seeks to create a foundation toward broader work in conceptualizing clinical rape culture. Given recent national survey data indicating a surprising frequency of unconsented intimate exams, detailed language as to their problematics is necessary for ongoing legal and ethical efforts. Explicit consent for intimate exams must be the standard of care for conscious and unconscious patients. (shrink)

IntroductionThe pelvic floor muscles are active during motor tasks that increase intra-abdominal pressure, but little is known about how the PFM respond to dynamic activities, such as gait. The purpose of this study was to characterize and compare PFM activity during walking and jogging in continent adults across the entire gait cycle.Methods17 able-bodied individuals with no history of incontinence participated in this study. We recorded electromyography from the abdominal muscles, gluteus maximus, and PFM while participants performed attempted maximum voluntary (...) contractions of all muscles and completed 60–70 strides in four gait conditions: slow walk ; regular walk ; transition walk ; jog. We quantified activity throughout the whole gait cycle and during periods of bursting for each participant, and analyzed the timing of PFM bursting periods to explore when the PFM were most active in the gait cycle. We also conducted a phase metric analysis on the PFM and GM burst timings. We performed a Spearman's rank-order correlation to examine the effect of speed on %aMVCGC, %aMVCBR, and phase metric score, and used the Wilcoxon Signed-Rank test to evaluate the effect of gait modality, matched for speed, on these variables.ResultsThe PFM were active throughout the gait cycle, with bursts typically occurring during single-leg support. The PFM and GM were in phase for 44–69% of the gait cycle, depending on condition. There was a positive correlation between gait speed and both %aMVCGC and %aMVCBR. Phase metric scores were significantly higher during jogging than transition walking, but there was no difference between gait modality on %aMVCGC or %aMVCBR. Where possible we disaggregated data by sex, although were unable to make statistical comparisons due to low sample sizes.ConclusionThe PFM are active during walking and jogging, with greater activity at faster speeds and with bursts in activity around single-leg support. The PFM and GM co-activate during gait, but are not completely in phase with each other. (shrink)

There have been many reports of medical students performing pelvic exams on anaesthetised patients without the necessary consent being provided or even sought. These cases have led to an ongoing discussion regarding the need to ensure informed consent has been secured and furthermore, how it might be best obtained. We consider the importance of informed consent, the potential harm to both the patient and medical student risked by the suboptimal consent process, as well as alternatives to teaching pelvic (...) examinations within medical school. The subsequent discussion focuses on whether medical students should perform pelvic examinations on anaesthetised patients without personally ensuring that they have given their explicit consent. Whilst we question the need to conduct pelvic examinations on anaesthetised patients in any circumstance, we argue that medical students should not perform such exams without personally securing the patients informed consent. (shrink)

Studies have recently begun to attend to the ways paid labor is embodied. However, the literature on embodied labor has not adequately addressed occupations for which the site of labor is the worker’s own body. One such occupation is that of gynecological educators—female-bodied instructors who teach breast and pelvic examinations to medical students using their own bodies as models. Drawing on interviews with current and former gynecological educators and professional directors, I ask how workers use their bodies to (...) produce legitimated forms of knowledge and how workers navigate gendered meanings attached to bodies. Gynecological educators use a distancing technique I call strategic dualism, which draws on using constructions of the body as an object while simultaneously relying on subjective experiences. This technique allows them to maintain their knowledge and authority, and suggests that workers are able to selectively draw on gendered meanings about the female body to pursue their goals. (shrink)

Hastings Center Report, Volume 52, Issue 2, Page 7-9, March‐April 2022.

Hastings Center Report, Volume 52, Issue 1, Page 28-31, January/February 2022.

In lieu of an abstract, here is a brief excerpt of the content:Removing the Mask: Hopeless Isolation to Intersex AdvocacyAlexandra von KlanStrangers undoubtedly perceive me as female, but I identify as an intersex woman. My karyotype is 46,XY, a typically defined marker of male biological sex, and I was born with undeveloped, non–functioning gonads. As an intersex person, I know firsthand the negative consequences of pathologizing intersex people’s lived experience by categorizing otherwise healthy, functioning organs and bodies as abnormal. The (...) following narrative recounts conversations and interactions with medical providers during my diagnosis and subsequent treatment of pure XY gonadal dys-genesis, sometimes referred to as Swyer Syndrome. I hope to elaborate upon emotionally significant actions and inactions of medical care providers to expose consequential effects on my emotional processing, physical health, and self–actualization.In December 1988, I was born with “typical” female genitalia. No one knew I was an intersex woman with 46,XY karyotype. Thus, there was no hesitation in the announcement of the birth of a girl in the delivery room or later, on my birth certificate. My parents raised me as a girl and dressed their firstborn in culturally normative feminine garments and accessories: lace frilly frocks, oversized bows, white stockings, and black patent leather Mary Jane’s. I embraced femininity and expressed this gender identity throughout my childhood and adolescence. I’m the eldest of six children split between two households.In January 2005, a month after my sixteenth birthday, delayed puberty and absent menstruation prompted an appointment to a local women’s health center. Nurses collected blood samples and administered an MRI scan on my pelvic region. A week later, my father received a perplexing phone call. An inexperienced doctor told him “there must be something wrong” with me, because lab results revealed I was “chromosomally male.” My father recalls the information presented like, based on the evidence, “your daughter may not be completely female,” and that is that. His impression was that she knew little about the subject and was a bit clueless. She did not mention Swyer Syndrome, or any diagnosis for that matter.Up to this point, I was unaware that a member of my extended family also had Swyer Syndrome. Born in the 1950s, secrecy engulfed her medical treatment and doctors warned her parents against revealing her true chromosomal sex in order to prevent the hysterical panic and depression they [End Page E14] thought the truth would bring. Years later, she sought her medical records and unearthed the truth. Shortly after my father received that dubious phone call, my relative’s endocrinologist provided a referral to his mentor, “Doctor A,” a clinical reproductive endocrinologist.Under Doctor A’s care, I experienced the first of many pelvic exams. Much to my discomfort, Doctor A inspected my semi–clothed body with a male resident in the room. As a people–pleasing teen, I granted permission for his presence; I didn’t voice my preference for a female alternative. Doctor A’s cold hands pressed around each undeveloped breast, pulled a gown away from my hips to inspect a sparse patch of pubic hair, and conducted an examination of my vaginal canal.Shortly after the examination, Doctor A charted Swyer Syndrome as the official diagnosis. Speaking to my father and me, he described my condition as an extremely rare genetic mutation. He told us that Swyer Syndrome was an intersex condition, a group of congenital disorders impacting a person’s internal or external reproductive systems, including endocrine function and genitalia. He explained I had atypical streak gonads instead of ovaries and that, despite having typical male sex chromosomes, I was still very much a girl. He disclosed that my vaginal canal was moderate in length, perhaps further evidence—or consolation—that my body possessed normative female reproductive attributes after all.Next, Doctor A identified a pressing medical concern—golf–ball–sized benign tumors had developed on each streak gonad; if allowed to remain, they would pose an increasing risk of malignancy. We scheduled an appointment for laparoscopic gonadectomy six months later. I left his office with a 3–month prescription for estrogen and progesterone oral tablets. On the way home, we drove to an electronics store where my father... (shrink)

Introducción: La ablación o mutilación genital femenina incluye una amplia variedad de prácticas que suponen la extirpación total o parcial de los genitales externos o su alteración por razones que no son de índole médica. Causa daños irreversibles y pone en peligro la salud, e incluso la vida de la mujer o niña afectada. Objetivo: Caracterizar la mutilación genital femenina y sus complicaciones a largo plazo en la comunidad de Fajikunda, Gambia, entre marzo y septiembre de 2012. Método: Se realizó (...) un estudio descriptivo prospectivo a 117 mujeres que asistieron al centro de salud por cualquier motivo que requiriera examen ginecológico y se estudiaron las variables grupo de edades, tipo de mutilación, grupo étnico y complicaciones. Resultados: Del total, 98 mujeres eran de 45 años de edad o menos; la clitoridectomía fue la práctica más frecuente; la inflamación pélvica crónica y el dolor en los genitales fueron las complicaciones a largo plazo que mayor asociación estadística demostraron con relación a la mutilación. La anorgasmia presentó una alta incidencia en la población estudiada. Conclusiones: La prevalencia de la mutilación genital femenina en Fajikunda es aproximadamente la misma que en Gambia, la tipo I es la más practicada y generalmente en jóvenes de la etnia Mandinga. Introduction: The ablation or female genital mutilation includes a wide variety of practices dealing with total or partial extirpation of the external genitalia or its alterations for reasons other than of medical nature. It causes irreversible damages and puts in danger the health or even the life of the woman or child involved. Objective: The aim of the present study is to characterize female genital mutilation and its long-term complications in Fajikunda community, Gambia, between March and September 2012. Method: A descriptive prospective study was performed to 117 women that attended the health unit for reasons requiring gynecological examination and the variables age group, mutilation type, ethnic group and complications were studied. Results: Of the total, 98 women were 45 years old or less; the clitoridectomy was the most frequent practice; cronical pelvic and genital pains were the long-term complications that showed a major statistical association with relation to mutilation. Conclusions: The prevalence of female genital mutilation in Fajikunda is approximately the same as in Gambia, the type I is the most performed and generally within young women belonging to Mandinga ethnic group. (shrink)

The pelvic exam is used to assess the health of female reproductive organs and so involves digital penetration by a physician. However, it is common practice for medical students to acquire experience in administering pelvic exams by performing them on unconscious patients without prior authorization. In this article, we argue that such unauthorized pelvic exams (UPEs) are sexual assault. Our argument is simple: in any other circumstance, unauthorized digital penetration amounts to sexual assault. Since there are no (...) morally significant differences between UPEs and other instances of digital penetration, UPEs are sexual assault. So, insofar as one is against sexual assault, one should be against UPEs. (shrink)

BackgroundGait Analysis of healthy people, imitating pathological conditions while walking, has increased our understanding of biomechanical factors. The influence of the pelvis as a biomechanical constraint during gait is not specifically studied. How could mimicking a pelvic attitude influence the dynamic mechanical interaction of the body segments? We proposed an investigation of the pelvic attitude role on the gait pattern of typically developed people when they mimicked pelvic anteversion and posteroversion.Materials and methodsSeventeen healthy volunteers were enrolled in (...) this study. They simulated a pelvic anteversion and posteroversion during walking, exaggerating these postures as much as possible. 3D gait analysis was conducted using an optoelectronic system with eight cameras and two force plates. The kinematic, kinetic, and spatio-temporal parameters were compared between the three walking conditions.ResultsIn Pelvic Anteversion gait we found: increased hip flexion, increased knee flexion during stance, and reduction of ankle flexion-extension Range of Motion compared with Pelvic Normal gait. In Pelvic Posteroversion gait compared with PN, we found: decreased hip flexion-extension RoM with a tendency to hip extension, decreased knee maximum extension in stance, and increased ankle maximum dorsiflexion in stance.ConclusionThe configuration of PA contains gait similarities and differences when compared with pathologic gait where there is an anteversion as seen in children with Cerebral Palsy or Duchenne Muscular Dystrophy. Similarly, attitudes of PP have been described in patients with Charcot-Marie-Tooth Syndrome or patients who have undergone Pelvic Osteotomy. Understanding the dynamic biomechanical constraints is essential to the assessment of pathological behavior. The central nervous system adapts motor behavior in interaction with body constraints and available resources. (shrink)

Many women are initially unable to contract the pelvic floor muscles (PFMs) properly, activating other muscle groups before, or instead of, PFM. Numerous authors have proved that biofeedback can be an ideal tool supporting learning of the PFM contraction. However, there is currently a lack of scientific data on how many biofeedback sessions are necessary in this educational process. In this study we aimed at assessing the effects of one-time electromyography (EMG) biofeedback session on the order in which PFM (...) are activated (so called firing order) during conscious contractions in relation to selected synergistic muscles in pregnant, continent women. A randomized controlled trial was conducted in 90 healthy nulliparous women with uncomplicated pregnancies and without diagnosed urinary incontinence. We divided the participants into a biofeedback group (50) and a control group (40). They were, respectively: 30 ± 4 and 30 ± 4 years old, at their 23 ± 5 or 25 ± 7 week of gestation and presented 23 ± 5 or 24 ± 5 kg/m2 BMI value (M + SD). Surface EMG with vaginal probes has been used to assess the PFM firing order in selected tasks: in five 3-s maximal contractions (quick flicks), five 10-s contractions, and in a 60-s contraction (static hold). We used the 1–5 scale, where “1” meant the best score, awarded when PFM was activated first in order. The most important finding of our study is that a single EMG biofeedback substantially improved the PFM contractions in pregnant women. First, when applying one-time biofeedback session, more women maintained correct technique or improved it in the second assessment, compared to the control group (73 vs. 65%). Secondly, using the quantitative and qualitative analysis with the Chi-square McNamara B/C test, in the biofeedback group we observed a statistically significant improvement of PFM firing order in four tasks: in the first quick flicks (p = 0.016), third quick flicks (p = 0.027), fifth quick flicks (p = 0.008), and in the first 10-s contractions (p = 0.046). In the control group we observed better outcome only in one motor task: in the fourth 10-s contraction (p = 0.009). Given the positive effects of a single session of EMG biofeedback on the firing order in the PFM contractions, it should be recommended for pregnant women without urinary incontinence to teach them how to perform PFM exercises correctly. (shrink)

Medical students commonly learn how to administer pelvic exams by practicing on unconscious patients, often without first obtaining explicit consent from patients to do so. While twenty-one states currently have laws that require teaching hospitals to obtain consent from patients to participate in this educational experience, opposition from the medical community has stymied legislative progress. In this paper, I respond to the two most common reasons offered to oppose legislation, which appeal to (1) the educational benefits of these exams, (...) or (2) protecting institutional autonomy. Kantian ideas about autonomy help to illuminate the problematic ways in which these arguments supplant the importance of women’s choices over how their bodies are used while seeking medical treatment. Ultimately, neither argument offers sufficient reason to oppose laws that require explicit consent before administering training pelvic exams. (shrink)

BackgroundThe Basal ganglia (BG) played a crucial role in the brain-level mechanisms of chronic pain disorders. However, the functional changes of BG in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are still poorly understood. This study investigated the BG subregions’ resting-state functional connectivity (rs-FC) in CP/CPPS patients compared with healthy controls.MethodsTwenty eight patients with CP/CPPS and 28 age- and education-matched healthy males underwent clinical measurements and 3T brain MR imaging, including T1-weighted structural images and resting-state functional imaging. The data were (...) analyzed by the seeded-based rs-FC analysis. Then, a machine learning method was applied to assess the feasibility of detecting CP/CPPS patients through the changed rs-FC.ResultsCompared with healthy males, patients presented decreased rs-FC between the BG subregions and right middle cingulate cortex, and correlated with pain (r = 0.51, p-uncorrected = 0.005) and urinary symptoms (r = –0.4, p-uncorrected = 0.034). The left superior temporal gyrus and right supramarginal gyrus showed decreased rs-FC with the BG subregions as well. The area under the receiver operating characteristic curve of 0.943 (accuracy = 80%, F1-score = 80.6%) was achieved for the classification of CP/CPPS patients and healthy males with support vector machine (SVM) based on the changed rs-FC.ConclusionThese findings provide evidence of altered BG subregions’ rs-FC in CP/CPPS, which may contribute to our understanding of the BG’s role in CP/CPPS. (shrink)

The case of chronic pelvic pain in women is presented as an example to explore firstly, the problem of medical knowledge on, and interventions for, chronic pain; secondly, current new developments at the intersection of neuroscience and phenomenology, in particular Varela's proposal for a 'neurophenomenology'; and thirdly, methodological issues of significance for social interpretive sciences to enable their active contribution to this research programme. This paper argues that a non-dualistic concept of embodiment is fundamental to developing understandings of chronic (...) pain, and that contributions from critical phenomenology need to be augmented with analyses from socio-political and cultural research. The social interpretive sciences, to contribute to a fully interdisciplinary neurophenomenology, need a methodology for analysing meanings within a theorization of language that is commensurate with critical phenomenological accounts of embodiment. (shrink)

BackgroundMental stress and imbalance of its two neural stress systems, the autonomic nervous system and the hypothalamic–pituitary–adrenal axis, are associated with chronic prostatitis/chronic pelvic pain syndrome and erectile dysfunction. However, the comprehensive analyses of psychological stress and stress systems are under-investigated, particularly in CP/CPPS patients complicated by lower urinary tract symptoms and ED.Materials and methodsParticipants were 95 patients in CP/CPPS+ED group, 290 patients in CP/CPPS group, 124 patients in ED group and 52 healthy men in control group. The National (...) Institutes of Health Chronic Prostatitis Symptom Index, the International Index of Erectile Function-5 and the International Prostate Symptom Score were used for assessing the disease severity of CP/CPPS, LUTS and ED. Psychometric self-report questionnaires including the Beck Anxiety Inventory, Perceived Stress Scale, Type A Personality Test and Symptom Checklist 90 were completed for distress from physical symptoms. Twenty-five subjects per group were randomly selected for further investigating the changes of the HPA axis and ANS. Saliva samples were taken on 3 consecutive days at 8 specific times with strict reference to time of morning awakening for evaluation of free cortisol. Heart rate variability as marker of the ANS was measured using 24 h electrocardiography, and time-and frequency-domain variables were analyzed.ResultsThe BAI and SCL-90 scores were significantly higher in the CP/CPPS+ED, CP/CPPS and ED groups compared with the control group. The PSS scores of both groups with ED were significantly higher than the control group. Compared with the CP/CPPS group, the differences of PSS, SCL-90 and TAPT scores were statistically significant in CP/CPPS+ED patients. The IPSS scores were shown to have significantly positive correlations with BAI, PSS and SCL-90 in the CP/CPPS patients. However, in all subjects, the IIEF-5 scores were shown to have significantly negative correlations with BAI, PSS, SCL-90 and quality of life score in NIH-CPSI. Cortisol awakening response parameters and diurnal cortisol levels did not significantly vary between the four groups. Time-dependent parameters of HRV also did not differ significantly across groups. In the frequency domain analysis, low frequency was significantly lower in ED patients when compared with CP/CPPS+ED patients and healthy controls, high frequency power was significantly higher in healthy controls compared to patients with ED, CP/CPPS and CP/CPPS+ED, and the CP/CPPS+ED group had significantly higher LF/HF ratio than the control group.ConclusionCP/CPPS and ED patients score exceedingly high on most psychosocial variables. The symptom scores of LUTS and ED positively correlate with the severity of psychological stress. Our findings also suggest that the ANS sympathovagal imbalance is associated with ED and LUTS in CP/CPPS, whereas HPA axis activity is not. (shrink)

Background: Concern has been growing in the academic literature and popular media about the licensing, introduction and adoption of surgical devices before full effectiveness and safety evidence is available to inform clinical practice. Our research will seek empirical survey evidence about the roles, responsibilities, and information and policy needs of the key stakeholders in the introduction into clinical practice of new surgical devices for pelvic floor surgery, in terms of the underlying ethical principals involved in the economic decision-making process, (...) using the example of pelvic floor procedures.Methods/DesignOur study involves three linked case studies using, as examples, selected pelvic floor surgery devices representing Health Canada device safety risk classes: low, medium and high risk. Data collection will focus on stakeholder roles and responsibilities, information and policy needs, and perceptions of those of other key stakeholders, in seeking and using evidence about new surgical devices when licensing and adopting them into practice. For each class of device, interviews will be used to seek the opinions of stakeholders. The following stakeholders and ethical and economic principles provide the theoretical framework for the study:Stakeholders - federal regulatory body, device manufacturers, clinicians, patients, health care institutions, provincial health departments, and professional societies. Clinical settings in two centres (in different provinces) will be included.Ethics - beneficence, non-maleficence, autonomy, justice.Economics - scarcity of resources, choices, opportunity costs.For each class of device, responses will be analysed to compare and contrast between stakeholders. Applied ethics and economic theory, analysis and critical interpretation will be used to further illuminate the case study material.DiscussionThe significance of our research in this new area of ethics will lie in providing recommendations for regulatory bodies, device manufacturers, clinicians, health care institutions, policy makers and professional societies, to ensure surgical patients receive sufficient information before providing consent for pelvic floor surgery. In addition, we shall provide a wealth of information for future study in other areas of surgery and clinical management, and provide suggestions for changes to health policy. (shrink)

In this paper I assess the labour ward admission policies introduced by some National Health Service trusts during the COVID-19 pandemic, arguing that these intersected with other policies in a manner which may have coerced birthing people into consenting to vaginal examinations they might have otherwise refused. In order to fully understand the potential severity of these policies, I situate this critique in the historical and contemporary context of the problematic relationship between consent and vaginal examinations. Identifying the (...) legal wrongs associated with performing coerced vaginal examinations, I highlight that the law is inadequately equipped to provide appropriate redress. Further, I illustrate that the issue explored in this paper reflects broader problems which exist with regard to the focus of, and the investment in, the maternity services. (shrink)

Adaptation and stress are two main concepts useful for better understanding the phases of illness and health-related human behavior. The two faces of adaptation, adaptation as a process and adaptation as a product, have raised the question of how long the adaptation process will take in cancer trajectories. The care setting transition from clinical-based into home-based cancer care has stressed the role of family caregivers (FCG) in cancer management. This study examines how types of demanded healthcare information affect the FCG’s (...) role in catalyzing the adaptation of female cancer patients. The mindsponge theory was used in conceptual development and results interpretation. Bayesian Mindsponge Framework (BMF) analytics was used for statistical analysis on a dataset of 48 spouses (husbands) and 12 other family members in five congested communities of Surabaya, Indonesia. Results showed that among the six types of demanded healthcare information, FCGs with a higher tendency to demand cancer-specific information are more likely to need support in catalyzing the adaptation of female cancer patients. Meanwhile, FCGs with a higher demand for information on alternative therapies are less likely to need support in catalyzing cancer adaptation. Other types of healthcare information have ambiguous effects on the need for support in cancer adaptation assistance. This study reveals that the demanded cancer-specific information, e.g., cancer’s prognosis or likely outcome, must be prioritized to assist FCG’s role in catalyzing adaptation among female cancer patients. Cancer prognosis and outcomes reflect the future of cancer care results. (shrink)

Socrates' cross-examination of Callicles in the 'Gorgias' has traditionally been viewed as a paradigm of the Socratic method. I argue that, when he cross examines Callicles, Socrates behaves out of character. In fact, he acts like a Sophist and violates the very principles of persuasion that he advocates in the 'Gorgias'. I offer an explanation of Socrates' temporary transformation into a Sophist, and suggest that his role-reversal reinforces Plato's representation of Socrates as the model of the virtuous philosopher.

Extant literature suggests a positive correlation between social trust (also called generalized trust) and life satisfaction. However, the psychological pathways underlying this relationship can be complex. Using the Bayesian Mindsponge Framework (BMF), we examined the influence of social trust in a high-violence environment. Employing Bayesian analysis on a sample of 1237 adults in Cali, Colombia, we found that in a linear relationship, generalized trust is positively associated with life satisfaction. However, in a model including the interactions between trust and education (...) level as well as between trust and socioeconomic status, generalized trust is found to be negatively associated with life satisfaction. In this non-linear relationship, both education level and socioeconomic status have moderating effects against the negative association between generalized trust and life satisfaction. In other words, less educated people living in worse socioeconomic conditions are more likely to have lower life satisfaction when they have higher levels of social trust. In contrast, highly educated people living in better socioeconomic conditions are more likely to have higher life satisfaction when they have higher levels of social trust. Due to the facilitating function of trust in information processing, lowering the rigor of the filtering system in a high-violence social environment will likely put an individual at risk. Based on our findings, we suggest that policymakers should consider the impacts of social contexts when advocating for increasing social trust. We also recommend that researchers carefully examine the psychological mechanism underlying an observed association before making suggestions for policymaking. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work.This work is in the public domain in (...) the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work.As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Extant literature suggests a positive correlation between social trust (also called generalized trust) and life satisfaction. However, the psychological pathways underlying this relationship can be complex. Using the Bayesian Mindsponge Framework (BMF), we examined the influence of social trust in a high-violence environment. Employing Bayesian analysis on a sample of 1237 adults in Cali, Colombia, we found that in a linear relationship, generalized trust is positively associated with life satisfaction. However, in a model including the interactions between trust and education (...) level as well as between trust and socioeconomic status, generalized trust is found to be negatively associated with life satisfaction. In this non-linear relationship, both education level and socioeconomic status have moderating effects against the negative association between generalized trust and life satisfaction. In other words, less educated people living in worse socioeconomic conditions are more likely to have lower life satisfaction when they have higher levels of social trust. In contrast, highly educated people living in better socioeconomic conditions are more likely to have higher life satisfaction when they have higher levels of social trust. Due to the facilitating function of trust in information processing, lowering the rigor of the filtering system in a high-violence social environment will likely put an individual at risk. Based on our findings, we suggest that policymakers should consider the impacts of social contexts when advocating for increasing social trust. We also recommend that researchers carefully examine the psychological mechanism underlying an observed association before making suggestions for policymaking. (shrink)

Academic literature addressing the topic of business ethics has paid little attention to cross-cultural studies of business ethics. Uncertainty exists concerning the effect of culture on ethical beliefs. The purpose of this research is to compare the ethical beliefs of managers operating in South Africa and Australia. Responses of 52 managers to a series of ethical scenarios were sought. Results indicate that despite differences in socio-cultural and political factors there are no statistically significant differences between the two groups regarding their (...) own ethical beliefs. Results thus support the view that culture has little or no impact on ethical beliefs. (shrink)

Background Various authorities recommend the participation of patients in promoting patient safety, but little is known about health care professionals' (HCPs') attitudes towards patients' involvement in safety-related behaviours. Objective To investigate how HCPs evaluate patients' behaviours and HCP responses to patient involvement in the behaviour, relative to different aspects of the patient, the involved HCP and the potential error. Design Cross-sectional fractional factorial survey with seven factors embedded in two error scenarios (missed hand hygiene, medication error). Each survey included two (...) randomized vignettes that described the potential error, a patient's reaction to that error and the HCP response to the patient. Setting Twelve hospitals in Switzerland. Participants A total of 1141 HCPs (response rate 45%). Measurements Approval of patients' behaviour, HCP response to the patient, anticipated effects on the patient–HCP relationship, HCPs' support for being asked the question, affective response to the vignettes. Outcomes were measured on 7-point scales. Results Approval of patients' safety-related interventions was generally high and largely affected by patients' behaviour and correct identification of error. Anticipated effects on the patient–HCP relationship were much less positive, little correlated with approval of patients' behaviour and were mainly determined by the HCP response to intervening patients. HCPs expressed more favourable attitudes towards patients intervening about a medication error than about hand sanitation. Conclusions This study provides the first insights into predictors of HCPs' attitudes towards patient engagement in safety. Future research is however required to assess the generalizability of the findings into practice before training can be designed to address critical issues. (shrink)

I explored the association between components constituting the basis for moral and optimal human functioning, i.e., moral reasoning, moral identity, empathy, and purpose, via network analysis. I employed factor scores instead of composite scores that most previous studies used for better accuracy in score estimation in this study. Then, I estimated the network structure among collected variables and centrality indicators. For additional information, the structure and indicators were compared between two groups, participants who engaged in civic activities highly versus lowly. (...) The results demonstrated significant intra- and inter-scale associations in the network. The network structure was invariant across the two groups. Despite the network invariance, I found that the global connectivity between and centrality indicators of examined factors were higher among the high civic engagement group in general. I discussed the implications of the findings in research on moral functioning based on moral psychology and virtue ethics. (shrink)

Since its publication, the Psychopathic Personality Inventory and its revision (Lilien- feld & Andrews, 1996; Lilienfeld & Widows, 2005) have become increasingly popular such that it is now among the most frequently used self-report inventories for the assessment of psychopathy. The current meta-analysis examined the relations between the two PPI factors (factor 1: Fearless Dominance; factor 2: Self-Centered Impulsivity), as well as their relations with other validated measures of psychopathy, internalizing and externalizing forms of psychopathology, general personality traits, and antisocial (...) personality disorder symptoms. Across 61 samples reported in 49 publications, we found support for the convergent and criterion validity of both PPI factor 2 and the PPI total score. Much weaker validation was found for PPI factor 1, which manifested limited convergent validity and a pattern of correlations with central criterion variables that was inconsistent with many conceptualizations of psychopathy. (shrink)

This research examines the association between attitudes on cheating and cognitive moral development. In this research, we use Rest's (1979a) Defining Issues Test, the Attitudes on Honesty Scale (Authors) and Academic Integrity Index (Authors); the last two are adaptations of the DIT. A total of 220 students from three universities participated in the study (66 psychology majors and 154 business majors). The data indicate that 66.4 percent of the students reported that they cheated in high school, college, or both high (...) school and college. Psychology majors scored higher than business majors on both the Defining Issues Test (Rest, 1979a) and the Attitudes on Honesty Scale (AHS, Authors). Using factor analysis, we found significant associations between students' ratings of the importance considerations present in the three cheating scenarios and their estimates of whether cheating would occur (i.e., the Academic Integrity Index). Finally, using logistic regression, we found that the scores on the Attitudes on Honesty Scale and Academic Integrity Index associate with the self-reported cheating behavior of college students. (shrink)

In this paper, I examined whether evidence from the neuroscience of morality supports the standard models of phronesis, i.e., Jubilee and Aretai Centre Models. The standard models explain phronesis as a multifaceted construct based on interaction and coordination among functional components. I reviewed recent neuroscience studies focusing on brain networks associated with morality and their connectivity to examine the validity of the models. Simultaneously, I discussed whether the evidence helps the models address challenges, particularly those from the phronesis eliminativism. Neuroscientific (...) evidence supported the importance of brain networks, i.e., the default mode, salience, and central executive functioning networks, in moral functioning in general. The findings favorably supported the multifaceted and integrative nature of phronesis proposed by the standard models. Finally, I considered how the two models could explain the mechanisms of phronesis more integratively based on neuroscientific findings. At the end of this paper, with the evidence, I proposed several practical ideas to promote the cultivation of phronesis, e.g., the consideration of coordination among components for moral functioning and the use of moral exemplars. (shrink)

In recent years, scholars have sought to investigate the impact that ethical leaders can have within organisations. Yet, only a few theoretical perspectives have been adopted to explain how ethical leaders influence subordinate outcomes. This study therefore draws on social rules theory (SRT) to extend our understanding of the mechanisms linking ethical leadership to employee attitudes. We argue that ethical leaders reduce disengagement, which in turn promotes higher levels of job satisfaction and organisational commitment, as well as lower turnover intentions. (...) Co-worker social undermining is examined as a moderator of the relationship between ethical leadership and disengagement, as we suggest that it is difficult for ethical leaders to be effective when co-worker undermining prevails. To test the proposed model, questionnaires were administered to 460 nurses in Romanian hospital settings over three time points separated by two-week intervals and the hypotheses were tested using generalised multilevel structural equation modeling (GSEM) with STATA. The findings revealed that ethical leadership has a beneficial effect on employee attitudes by reducing disengagement. However, the relationship between ethical leadership and disengagement was moderated by co-worker social undermining, such that when undermining was higher, the significance of the mediated relationships disappeared. These results suggest that while ethical leaders can promote positive employee attitudes, their effectiveness is reduced in situations where co-worker undermining exists. (shrink)

_This study primarily focused the EFL undergraduate students at a public university in Pakistan. In this study, task-based language assessment (TBLA) was used to assess reading skills because it is one of the most assessed language skills in Pakistan. Reading is an academic skill. Supposedly, students should have good reading skills at higher education. Thus, there are three courses taught specifically focusing on English language at higher education and reading is a prime focus in all three of them. However, the (...) reading test items are criticized for testing rather the writing skills instead of reading. Thus, a Task-based Language Assessment (TBLA) was used to check its backwash effect. TBLA has not been adopted in the local context yet, specifically in a reading context. Therefore, the present study was conducted to examine the backwash effect of TBLA on reading skills. In this study, action research design was followed within the qualitative research paradigm. Sample was drawn using convenient sampling. The participants were 12 undergraduate students. Students’ reading journals, exit slips and teacher’s diary were used as data collection instruments. The findings revealed that TBLA has a positive backwash effect on both teaching and learning in the EFL context. Further pedagogical implications are proposed in the study._. (shrink)

Recent perspectives on corporate social responsibility have called for increased research on how CSR affects individuals. Research is needed to examine whether individual differences affect the relationship between CSR and individual reactions to CSR. In response, this experimental study examined how perceptions of corporate citizenship influence job applicant attraction and work role definitions. Personal values and education concerning CSR are considered as interactive factors affecting the influence of perceptions of corporate citizenship. Results indicate that perceived corporate citizenship had a greater (...) impact on job applicant attraction for those individuals who received prior education regarding CSR and for those who were higher in other-regarding value orientation. Furthermore, perceived corporate citizenship had a positive impact on the extent to which participants defined CSR as a personal work role responsibility. The authors also discuss the practical implications of these results for job applicant attraction and employee socialization. (shrink)

An exploration of topics of everyday importance in the Socratic tradition.

... all probability, Plato's own statement; made indeed to be read by friends in Syracuse in explanation of the role he had played ...

This study examines the relationships of servant leadership to organizational commitment, voice behaviors, and antisocial behaviors. Adopting a multifaceted approach to commitment, we hypothesized that servant leadership would be positively related to affective, normative, and perceived sacrifice commitment, but unrelated to few alternatives commitment. We further hypothesized that affective commitment would be positively related to voice behaviors, controlling for the other commitment components, and would mediate a positive relationship between servant leadership and voice behaviors. Similarly, we hypothesized that normative commitment (...) would be negatively related to antisocial behaviors, controlling for the other commitment components, and would mediate a negative relationship between servant leadership and antisocial behaviors. These predictions were tested using matched data from a sample of 181 Canadian customer service employees and their managers. Results largely supported the above predictions. Importantly, affective commitment mediated a positive relationship between servant leadership and voice behaviors. Yet, while servant leadership was positively related to normative commitment and the latter was negatively related to antisocial behaviors, the indirect effect of servant leadership on these behaviors through normative commitment was nonsignificant. Theoretical implications and future research directions are discussed. (shrink)

Examining the historical development of scientific concepts is important for understanding the structured routines within which these concepts are currently used as goal-directed tools in experiments. To illustrate this claim, I will outline how the concepts of mental imagery and hallucinations each draw on an older interdependent set of associations that, although nominally-discarded, continues to structure their current independent uses for pursuing discrete experimental goals. In doing so, I will highlight how three strands of literature offer mutually instructive insights for (...) understanding how the uses of our current scientific concepts contribute to experimental practices. The first strand of literature includes recent scholarship examining how the uses of scientific concepts can enable scientific practices (e.g., Boon 2012; Brigandt 2012; Feest 2010; Steinle 2012). In this context, scientific concepts have been described as tools that function in ways that contribute to empirical knowledge; contributions that extend beyond their traditionally recognized roles in mental and linguistic representation. The second strand of literature can be glimpsed within the technoscientific studies focus on non-human agency; a focus that supports an account of the disciplined routines within which concepts are used as acting in analogous ways to the routinized participation of machines in experiments (Pickering 1995). The third strand of the literature draws attention to how the functions of concepts are grounded by the set of historically-contingent experimental practices (e.g., Canguilhem 2008; Tiles 1984). Although maintaining valuable differences, the focus of these three strands of literature are mutually instructive. Together, they offer a view of the uses of concepts as taken-for-granted tools that function within networks of subterranean associations; associations that are grounded by historically contingent experimental practices that structure how they act (in concert with human and material participants) within the temporally dynamic processes of scientific practice. Through examples drawn from a comparison of the concepts of mental imagery and hallucinations, I aim to demonstrate the value that the converging insights of these three strands of literature offer for studying the role of scientific concepts in experimental practices. (shrink)