BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Despite its importance, abnormal interactions between the proximal and distal upper extremity muscles of stroke survivors and their impact on functional task performance has not been well described, due in part to the complexity of upper extremity tasks. In this pilot study, we elucidated proximal–distal interactions and their functional impact on stroke survivors by quantitatively delineating how hand and arm movements affect each other across different phases of functional task performance, and how these interactions are influenced by stroke. Fourteen subjects, (...) including nine chronic stroke survivors and five neurologically-intact subjects participated in an experiment involving transport and release of cylindrical objects between locations requiring distinct proximal kinematics. Distal kinematics of stroke survivors, particularly hand opening, were significantly affected by the proximal kinematics, as the hand aperture decreased and the duration of hand opening increased at the locations that requires shoulder abduction and elbow extension. Cocontraction of the extrinsic hand muscles of stroke survivors significantly increased at these locations, where an increase in the intermuscular coherence between distal and proximal muscles was observed. Proximal kinematics of stroke survivors was also affected by the finger extension, but the cocontraction of their proximal muscles did not significantly increase, suggesting the changes in the proximal kinematics were made voluntarily. Our results showed significant proximal-to-distal interactions between finger extension and elbow extension/shoulder abduction of stroke survivors exist during their functional movements. Increased cocontraction of the hand muscles due to increased neural couplings between the distal and proximal muscles appears to be the underlying mechanism. (shrink)

Shame and shame reactions are two of the most delicate and difficult issues of psychotherapy and are among the most likely to defy our usual dynamic, systemic, and behavioral theories. In this groundbreaking new collection, _The Voice of Shame_, thirteen distinguished authors show how use of the Gestalt model of self and relationship can clarify the dynamics of shame and lead us to fresh approaches and methods in this challenging terrain. This model shows how shame issues become pivotal in therapeutic (...) and other relationships and how healing shame is the key to transformational change. The contributors show how new perspectives on shame gained in no particular area transfer and generalize to other areas and settings. In so doing, they transform our fundamental understanding of psychotherapy itself. Grounded in the most recent research on the dynamics and experience of shame, this book is a practical guide for all psychotherapists, psychologists, clinicians, and others interested in self, psychotherapy, and relationship. This book contains powerful new insights for the therapist on a full-range of topics from intimacy in couples to fathering to politics to child development to gender issues to negative therapeutic reactions. Filled with anecdotes and case examples as well as practical strategies, _The Voice of Shame_ will transform your ideas about the role of shame in relationships - and about the potential of the Gestalt model to clarify and contextualize other approaches. (shrink)

Much more than an obligation to protect our clients' rights, ethics is better understood as the very fabric that underpins and supports our most basic efforts in working with clients and interacting with others in our everyday lives. Robert Lee brings together a diverse group of voices in the Gestalt field to demonstrate the interrelations between the ethics of the therapeutic endeavor and the Gestalt tradition, from theory to practice to extensions beyond the analytic setting.

Research has found many positive benefits to person‐organization (PO) fit, for both individuals and the organization. However, PO misfit has received far less attention in the literature. In this article, we look specifically at PO misfit caused by the differing political values and beliefs of the CEO and employee. We argue that CEO activism influences employee perceptions of ideological misfit (IM), whereby differing political beliefs between employees and their activist CEO can impact workplace outcomes. We consider how peer group reactions, (...) ethical climate, external needs fulfillment, and moral identity serve as boundary conditions for perceptions of PO misfit and related organizational outcomes. We also examine antecedents of CEO activism. Drawing on academic literature from both the micro and macro perspectives of management research, we introduce a conceptual model and discuss implications for the firm and its employees. (shrink)

While across the animal kingdom offspring are born smaller than their parents, notable exceptions exist. Several dipteran species belonging to the Hippoboscoidea superfamily can produce offspring larger than themselves. In this essay, the blood‐feeding tsetse is focused on. It is suggested that the extreme reproductive strategy of this fly is enabled by feeding solely on highly nutritious blood, and producing larval offspring that are soft and malleable. This immense reproductive expenditure may have evolved to avoid competition with other biting flies. (...) Tsetse also transmit blood‐borne parasites that cause the fatal diseases called African trypanosomiases. It is discussed how tsetse life history and reproductive strategy profoundly influence the type of vector control interventions used to reduce fly populations. In closing, it is argued that the unusual life history of tsetse warrants their preservation in the areas where human and animal health is not threatened. (shrink)

Introduction Future HIV vaccine efficacy trials with adolescents will need to ensure that participants comprehend study concepts in order to confer true informed assent. A Hepatitis B vaccine trial with adolescents offers valuable opportunity to test youth understanding of vaccine trial requirements in general. Methods Youth reviewed a simplified assent form with study investigators and then completed a comprehension questionnaire. Once enrolled, all youth were tested for HIV and confirmed to be HIV-negative. Results 123 youth completed the questionnaire (mean age=15 (...) years; 63% male; 70% Hispanic). Overall, only 69 (56%) youth answered all six questions correctly. Conclusions Youth enrolled in a Hepatitis B vaccine trial demonstrated variable comprehension of the study design and various methodological concepts, such as treatment group masking. (shrink)

A growing literature testifies to the persistence of place as an incorrigible aspect of human experience, identity, and morality. Place is a common ground for thought and action, a community of experienced particulars that avoids solipsism and universalism. It draws us into the philosophy of the ordinary, into familiarity as a form of knowledge, into the wisdom of proximity. Each of these essays offers a philosophy of place, and reminds us that such philosophies ultimately decide how we make, use, and (...) understand places, whether as accidents, instruments, or fields of care. (shrink)

In the 1790s, a close-knit group of German philosophers published several garden theory texts. These works are unique in that a close-knit group of philosophers had never before--and has not since--produced so many works on the topic of garden design. In essence, this cohort sought to imbue the most visionary concepts that had been inherited from the German garden tradition with the intellectual resources that were newly available through Kant’s critical philosophy. The most important of these concepts was the prescription (...) for a new Mittelweg, or "middle path," garden that would mediate between the perceived excesses of French formalism and the English picturesque. In close analysis, the author demonstrates that Kant used similar "middle path" techniques in the design of his own "critical path" between dogmatism and skepticism. This similarity is most apparent when he uses topographical metaphors to describe the organizational principles of his system. By interpreting Kant’s topographical metaphors in relation to contemporary garden theories, this book offers new insights into the structural similarities between his "critical path" and the German garden’s "middle path" between French formalism and the English picturesque. (shrink)

In the 1790s, a close-knit group of German philosophers published several garden theory texts. These works are unique in that a close-knit group of philosophers had never before--and has not since--produced so many works on the topic of garden design. In essence, this cohort sought to imbue the most visionary concepts that had been inherited from the German garden tradition with the intellectual resources that were newly available through Kant’s critical philosophy. The most important of these concepts was the prescription (...) for a new Mittelweg, or "middle path," garden that would mediate between the perceived excesses of French formalism and the English picturesque. In close analysis, the author demonstrates that Kant used similar "middle path" techniques in the design of his own "critical path" between dogmatism and skepticism. This similarity is most apparent when he uses topographical metaphors to describe the organizational principles of his system. By interpreting Kant’s topographical metaphors in relation to contemporary garden theories, this book offers new insights into the structural similarities between his "critical path" and the German garden’s "middle path" between French formalism and the English picturesque. (shrink)

Life‐threatening illness is associated with financial burden among families. During this time, care‐related expenses often increase. The concept of financial burden has not fully been explored nor conceptually described in the literature. Our study coalesces the empirical literature on financial burden into a more comprehensive multidimensional theoretical framework to understand financial burden among patients and families dealing with serious illness. Using Jabareen's phased approach for building conceptual frameworks, we synthesized the existing scientific literature (including existing measures of financial burden) to (...) construct an empirically derived model. Definitions of financial burden are overlapping with similarities, but also inconsistencies. Many studies have focused more on objective and operational definitions, than subjective and conceptual aspects. Regarding measures for financial burden, many studies have only used a few items. The financial burden is dependent on the illness trajectories and duration. By considering multidimensionality, we illustrate potential financial burden factors (objective, coping, and subjective). Although anticipation and expectations about future financial issues are important, patients and caregivers generally experience objective aspects of burden, followed by subjective impressions of burden. Coping skills likely reduce subjective burden. Based on the results, we redefine the financial burden among patients with life‐threatening illness and caregivers. (shrink)

I have not seen the papyrus, but if β and μ are correctly reported, and if the space between would admit three letters, I tentatively suggest . sed haec quidem uituperatio.