Medical-legal partnerships connect legal advocates to healthcare providers and settings. Maintaining effectiveness of medical-legal partnerships and consistently identifying opportunities for innovation and adaptation takes intentionality and effort. In this paper, we discuss ways in which our use of data and quality improvement methods have facilitated advocacy at both patient (client) and population levels as we collectively pursue better, more equitable outcomes.

Motivational and emotional changes across adulthood have a profound impact on cognition. In this registered report, we conducted an experimental investigation of motivational influence on remembering intentions after a delay (prospective memory; PM) in younger, middle-aged, and older adults, using gain- and loss-framing manipulations. The present study examined for the first time whether motivational framing in a PM task has different effects on younger and older adults’ PM performance (N = 180; age range: 18–85 years) in a controlled laboratory setting. (...) Based on lifespan theories of motivation, we assumed that the prevention of losses becomes more relevant with increasing age: We expected that older adults show relatively higher PM performance in a task with loss-related consequences following PM failure than in a task in which successful PM leads to gains. The opposite pattern of performance was expected for younger adults. The findings suggest that the relevance of reward and positive gain-related consequences for successful remembering appears to decrease with age. As hypothesised, a motivational framing × age interaction indicated that age differences in memory performance were smaller with loss-related than gain-related consequences, supporting a loss-prevention view on motivated cognition. (shrink)

ABSTRACTIt has become standard to treat Kant’s characterization of pure apperception as involving the claim that questions about what I think are transparent to questions about the world. By contra...

In this commentary, we consider how Balcetis’s proposals may interface with the study of motivation and emotion in lifespan developmental psychology, pointing to open questions regarding the distance perception of long-term chronic goals as well as age-related shifts from informational to emotional goals.

Processing the motivational relevance of a visual scene and reacting accordingly is crucial for survival. Previous work suggests the emotional content of naturalistic scenes affects response speed, such that unpleasant content slows responses whereas pleasant content accelerates responses. It is unclear whether these effects reflect motor-cognitive processes, such as attentional orienting, or vary with the function/outcome of the motor response itself. Four experiments manipulated participants’ ability to terminate the picture and, thereby, the response’s function and motivational value. Attentive orienting was (...) manipulated via picture repetition, which diminishes orienting. A total of N = 81 participants completed versions of a go/no-go task, discriminating between distorted versus intact pictures drawn from six content categories varying in positive, negative, or neutral valence. While all participants responded faster with repetition, only participants without offset control exhibited slower responses to unpleasant and accelerated responses to pleasant content. Emotional engagement, measured by the late positive potential, was not modulated by attentional orienting, suggesting that the interaction between repetition and offset control is not due to altered emotional engagement. Together, results suggest that response time changes as a function of emotional content and sensitivity to attention orienting depends on the motivational function of the motor response. (shrink)

Contemporary approaches to adolescent development are framed by positive youth development models. A key outcome of these models is that healthy and positively developing youth are more likely to contribute to their family, schools, and communities. However, little work on contribution and its antecedents has been conducted with youth of color. As high achieving youth of color often become leaders in their communities, it is important to consider malleable predictors of contribution within this population. Therefore, through a cross-sectional design, we (...) examined the relations between youth critical reflection, hopeful future expectations, and mentoring relationship quality and youth contribution in a sample of 177 youth of color (60% Black, 40% Latinx) attending an afterschool college preparation program at six sites around the U.S. Results indicated that youth critical reflection, hopeful future expectations, and mentoring relationship quality significantly predicted contribution. Exploratory analyses suggested that these relations were significant for Black youth but not Latinx youth. Implications of these findings for future scholarship are discussed. (shrink)

Most studies investigating the relationship between cultural constructs and ethical perception have focused on individual- and societal-level values without much attention to other type of cultural constructs such as social beliefs. In addition, we need to better understand how social beliefs are linked to ethical perception and the level of analysis at which social beliefs may best predict ethical perceptions. This research contributes to the cross-cultural ethical perception literature by examining the relationship of individual-level social cynicism belief, one of five (...) universally endorsed social beliefs, together with individual social dominance orientation and the perception of unethical behavior. By means of two studies, we examine these relationships across societies that significantly differ on societal-level social cynicism belief. Using 371 business students from Russia and the U.S. in Study 1 and 268 professionals from Portugal and the U.S. in Study 2, we found that individual-level social cynicism belief was positively associated with social dominance orientation. Social dominance orientation, in turn, mediated the relationship between individual social cynicism belief and the perception of unethical behavior. Although we found significant societal-level differences in social cynicism belief in both studies, the relationships between individual-level social cynicism belief, social dominance orientation, and the perception of unethical behavior were structurally equivalent across societies in both studies, suggesting that societal-level differences did not significantly affect these relationships. Implications for cross-cultural business ethics research and practice are discussed. (shrink)

Recruiting research participants based on genetic information generated about them in a prior study is a potentially powerful way to study the functional significance of human genetic variation, but it also presents ethical challenges. To inform policy development on this issue, we conducted a survey of U.S. institutional review board chairs concerning the acceptability of recontacting genetic research participants about additional research and their views on the disclosure of individual genetic results as part of recruitment. Our findings suggest there is (...) unlikely to be a “one-size-fits-all” solution, but rather several ethically acceptable approaches to genotype-driven recruitment, depending on context. Disclosures made during the consent process for the original study and the clinical validity of the results are key considerations. Researchers must be prepared to communicate and answer questions in clear lay language about what is known and not known regarding the role of genetics in their proposed area of research. (shrink)

In the classroom, philosophers face not only the perennial problems of philosophy, but the problems of _teaching_ philosophy, and specifically the problems of teaching philosophy today: how to make philosophy interesting and relevant to students who are resistant to, or unfamiliar with, the discipline; how to bring classic texts to life within our current socio-cultural context; how to serve all students regardless of their abilities, backgrounds, or declared majors; how to sustain our discipline in light of support for more "vocational" (...) pursuits. In these essays, 24 of our most celebrated professors of philosophy offer perspectives on and solutions to these questions and more. Selected and introduced by three leaders in the world of philosophical education, the insights contained in this inspiring collection illuminate the challenges and possibilities of teaching the academy’s oldest discipline. (shrink)

Overdiagnosis is an emerging problem in health policy and practice: we address its definition and ethical implications. We argue that the definition of overdiagnosis should be expressed at the level of populations. Consider a condition prevalent in a population, customarily labelled with diagnosis A. We propose that overdiagnosis is occurring in respect of that condition in that population when the condition is being identified and labelled with diagnosis A in that population ; this identification and labelling would be accepted as (...) correct in a relevant professional community; but the resulting label and/or intervention carries an unfavourable balance between benefits and harms. We identify challenges in determining and weighting relevant harms, then propose three central ethical considerations in overdiagnosis: the extent of harm done, whether harm is avoidable and whether the primary goal of the actor/s concerned is to benefit themselves or the patient, citizen or society. This distinguishes predatory, misdirected and tragic overdiagnosis; the degree of harm moderates the justifiability of each type. We end with four normative challenges: methods for adjudicating between professional standards and identifying relevant harms and benefits should be procedurally just; individuals, organisations and states are differently responsible for addressing overdiagnosis; overdiagnosis is a matter for distributive justice: the burdens of both overdiagnosis and its prevention could fall on the least-well-off; and communicating about overdiagnosis risks harming those unaware that they may have been overdiagnosed. These challenges will need to be addressed as the field develops. (shrink)

Intervening on causal systems can illuminate their underlying structures. Past work has shown that, relative to adults, young children often make intervention decisions that appear to confirm a single hypothesis rather than those that optimally discriminate alternative hypotheses. Here, we investigated how the ability to make informative causal interventions changes across development. Ninety participants between the ages of 7 and 25 completed 40 different puzzles in which they had to intervene on various causal systems to determine their underlying structures. Each (...) puzzle comprised a three‐ or four‐node computer chip with hidden wires. On each trial, participants viewed two possible arrangements of the chip's hidden wires and had to select a single node to activate. After observing the outcome of their intervention, participants selected a wire configuration and rated their confidence in their selection. We characterized participant choices with a Bayesian measurement model that indexed the extent to which participants selected nodes that would best disambiguate the two possible causal structures versus those that had high causal centrality in one of the two causal hypotheses but did not necessarily discriminate between them. Our model estimates revealed that the use of a discriminatory strategy increased through early adolescence. Further, developmental improvements in intervention strategy were related to changes in the ability to accurately judge the strength of evidence that interventions revealed, as indexed by participants' confidence in their selections. Our results suggest that improvements in causal information‐seeking extend into adolescence and may be driven by metacognitive sensitivity to the efficacy of previous interventions in discriminating competing ideas. (shrink)

BackgroundThe ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines are widely endorsed but compliance is limited. We sought to determine whether journal-requested completion of an ARRIVE checklist improves full compliance with the guidelines.MethodsIn a randomised controlled trial, manuscripts reporting in vivo animal research submitted to PLOS ONE (March–June 2015) were randomly allocated to either requested completion of an ARRIVE checklist or current standard practice. Authors, academic editors, and peer reviewers were blinded to group allocation. Trained reviewers performed outcome adjudication (...) in duplicate by assessing manuscripts against an operationalised version of the ARRIVE guidelines that consists 108 items. Our primary outcome was the between-group differences in the proportion of manuscripts meeting all ARRIVE guideline checklist subitems.ResultsWe randomised 1689 manuscripts (control: n = 844, intervention: n = 845), of which 1269 were sent for peer review and 762 (control: n = 340; intervention: n = 332) accepted for publication. No manuscript in either group achieved full compliance with the ARRIVE checklist. Details of animal husbandry (ARRIVE subitem 9b) was the only subitem to show improvements in reporting, with the proportion of compliant manuscripts rising from 52.1 to 74.1% (X2 = 34.0, df = 1, p = 2.1 × 10−7) in the control and intervention groups, respectively.ConclusionsThese results suggest that altering the editorial process to include requests for a completed ARRIVE checklist is not enough to improve compliance with the ARRIVE guidelines. Other approaches, such as more stringent editorial policies or a targeted approach on key quality items, may promote improvements in reporting. (shrink)

In the United States, final amendments to the Federal Policy for the Protection of Human Subjects (“the Common Rule”) were published on January 19, 2017, and they will take effect on January 21, 2019. One of the most widely discussed provisions is that for the first time, federal regulations governing research with humans authorize the use of broad consent for future, unspecified research on individually identifiable biospecimens and associated data. Many questions have been raised about broad consent, including what effect (...) it will have on research and whether it adequately protects the interests of research participants.There are lessons to be learned for the U.S. and other countries by looking to countries that already have experience with broad consent for biobank collection and with the storage and subsequent use of the biospecimens and data. This article describes how broad consent works in five countries—Canada (in Quebec), Israel, Nigeria, Taiwan, and the United Kingdom—and with different types of biobanks: national biobanks, federated biobanks, and regional biobanks. Evaluating the provisions and challenges of the broad consent approaches in these countries can inform policies for this increasingly used approach to biobank regulation. (shrink)

© 2017. The American Astronomical Society. All rights reserved.We present new observations of the low-mass companion to HD 984 taken with the Gemini Planet Imager as a part of the GPI Exoplanet Survey campaign. Images of HD 984 B were obtained in the J and H bands. Combined with archival epochs from 2012 and 2014, we fit the first orbit to the companion to find an 18 au orbit with a 68% confidence interval between 14 and 28 au, an eccentricity (...) of 0.18 with a 68% confidence interval between 0.05 and 0.47, and an inclination of 119°with a 68% confidence interval between 114°and 125°. To address the considerable spectral covariance in both spectra, we present a method of splitting the spectra into low and high frequencies to analyze the spectral structure at different spatial frequencies with the proper spectral noise correlation. Using the split spectra, we compare them to known spectral types using field brown dwarf and low-mass star spectra and find a best-fit match of a field gravity M6.5 ±1.5 spectral type with a corresponding temperature of K. Photometry of the companion yields a luminosity of log=2.88 ± 0.07 dex with DUSTY models. Mass estimates, again from DUSTY models, find an age-dependent mass of 34 ±1 to 95 ±4 M Jup. These results are consistent with previous measurements of the object. (shrink)

A complement clause is used instead of a noun phrase; for example one can say either I heard [the result] or I heard [that England beat France]. Languages differ in the grammatical properties of complement clauses, and the types of verbs which take them. Some languages lack a complement clause construction but instead employ other construction types to achieve similar ends; these are called complementation strategies. The book explores the variety of types of complementation found across the languages of the (...) world, their grammatical properties and meanings. Detailed studies of particular languages, including Akkadian, Israeli, Jarawara, and Pennsylvania German, are framed by R. M. W. Dixon's introduction, which sets out the range of issues, and his conclusion, which draws together the evidence and the arguments. This book will interest scholars of typology, language universals, syntax, information structure, and language contact in departments of linguistics and anthropology, as well as advanced and graduate students taking courses in these subjects. (shrink)

The number of children with chronic critical illness (CCI) is a growing population in the United States. A defining characteristic of this population is a prolonged hospital stay. Our study assessed the proportion of pediatric patients with chronic critical illness in U.S. hospitals at a specific point in time, and identified a subset of children whose hospital stay lasted for months to years. The potential harms of a prolonged hospitalization for children with CCI, which include over treatment, infection, disruption of (...) family life, and the intensive utilization of resources—combined with the moral distress experienced by the clinicians who care for the children, suggest the need for ethical analysis of this growing issue to identify actions that could be taken at the clinical and health systems levels to reduce the harms associated with prolonged hospital stay.In this article we present three real cases from our study that involved a very long hospital stay. We applied a framework developed by Mackenzie, Rogers, and Dodds to analyze inherent, situational, and pathogenic vulnerabilities to examine the ways that interventions intended to remedy one source of harm for the children in our cohort inadvertently created other harms. We examined the complex ways that children with protracted hospitalization are vulnerable to the choices made by their family and clinicians, as well as by healthcare systems and communities. Finally, we used this analysis to summarize actions and ethical responses to this growing patient population. Such an understanding is essential to making clinical and ethical decisions that arise for children who are at risk for a very long stay in the hospital. (shrink)

This study examined the extent to which concussion management plans at National Collegiate Athletic Association member schools were in line with NCAA Concussion Policy and best practice recommendations in absence of any process to ensure compliance. Most schools' concussion management plans were in compliance with 3 or 4 of the NCAA's 4 required components. Annual athlete education and acknowledgement was the requirement least often included, representing an area for improvement. Further, schools tended to more often include best practices that were (...) more medically-oriented, compared to best practices that were less medical in nature. (shrink)

La investigación actual referida al "burnout" está ampliando su campo de estudio. De las primeras investigaciones centradas en profesionales de ayuda se ha pasado al estudio del burnout en otros profesionales. Por otro lado, la preocupación de las universidades por ofrecer una enseñanza de calidad s..

We describe the structure, operation, and experience of the Massachusetts General Hospital ethics committee, formally called the Edwin H. Cassem Optimum Care Committee, from January 2007 through December 2013. Founded in 1974 as one of the nation’s first hospital ethics committees, this committee has primarily focused on the optimum use of life-sustaining treatments. We outline specific sociodemographic and clinical characteristics of consult patients during this period, demographic differences between the adult inpatient population and patients for whom the ethics committee was (...) consulted, and salient features of the consults themselves. We include three case studies that illustrate important consult themes during this period. Our findings expand knowledge about the structure and workings of hospital ethics committees and illustrate how one ethics committee has developed and utilized policies on end-of-life care. More generally, we model a sociological approach to the study of clinical ethics consultation that could be utilized to contextualize institutional practices over time. (shrink)

Most studies investigating the relationship between cultural constructs and ethical perception have focused on individual- and societal-level values without much attention to other type of cultural constructs such as social beliefs. In addition, we need to better understand how social beliefs are linked to ethical perception and the level of analysis at which social beliefs may best predict ethical perceptions. This research contributes to the cross-cultural ethical perception literature by examining the relationship of individual-level social cynicism belief, one of five (...) universally endorsed social beliefs, together with individual social dominance orientation and the perception of unethical behavior. By means of two studies, we examine these relationships across societies that significantly differ on societal-level social cynicism belief. Using 371 business students from Russia and the U.S. in Study 1 and 268 professionals from Portugal and the U.S. in Study 2, we found that individual-level social cynicism belief was positively associated with social dominance orientation. Social dominance orientation, in turn, mediated the relationship between individual social cynicism belief and the perception of unethical behavior. Although we found significant societal-level differences in social cynicism belief in both studies, the relationships between individual-level social cynicism belief, social dominance orientation, and the perception of unethical behavior were structurally equivalent across societies in both studies, suggesting that societal-level differences did not significantly affect these relationships. Implications for cross-cultural business ethics research and practice are discussed. (shrink)

BackgroundPhysical activity is known to improve mental health, and is regarded as safe and desirable for uncomplicated pregnancy. In this novel study, we aim to evaluate whether there are associations between maternal physical activity during pregnancy and neonatal brain cortical development.MethodsForty-four mother/newborn dyads were included in this longitudinal study. Healthy pregnant women were recruited and their physical activity throughout pregnancy were documented using accelerometers worn for 3–7 days for each of the 6 time points at 4–10, ∼12, ∼18, ∼24, ∼30, (...) and ∼36 weeks of pregnancy. Average daily total steps and daily total activity count as well as daily minutes spent in sedentary/light/moderate/vigorous activity modes were extracted from the accelerometers for each time point. At ∼2 weeks of postnatal age, their newborns underwent an MRI examination of the brain without sedation, and 3D T1-weighted brain structural images were post-processed by the iBEAT2.0 software utilizing advanced deep learning approaches. Cortical surface maps were reconstructed from the segmented brain images and parcellated to 34 regions in each brain hemisphere, and mean cortical thickness for each region was computed for partial correlation analyses with physical activity measures, with appropriate multiple comparison corrections and potential confounders controlled.ResultsAt 4–10 weeks of pregnancy, mother’s daily total activity count positively correlated (FDR corrected P ≤ 0.05) with newborn’s cortical thickness in the left caudal middle frontal gyrus (rho = 0.48, P = 0.04), right medial orbital frontal gyrus (rho = 0.48, P = 0.04), and right transverse temporal gyrus (rho = 0.48, P = 0.04); mother’s daily time in moderate activity mode positively correlated with newborn’s cortical thickness in the right transverse temporal gyrus (rho = 0.53, P = 0.03). At ∼24 weeks of pregnancy, mother’s daily total activity count positively correlated (FDR corrected P ≤ 0.05) with newborn’s cortical thickness in the left (rho = 0.56, P = 0.02) and right isthmus cingulate gyrus (rho = 0.50, P = 0.05).ConclusionWe identified significant relationships between physical activity in healthy pregnant women during the 1st and 2nd trimester and brain cortical development in newborns. Higher maternal physical activity level is associated with greater neonatal brain cortical thickness, presumably indicating better cortical development. (shrink)

Wearing facial masks became a common practice worldwide during the COVID-19 pandemic. This study investigated (1) whether facial masks that cover adult faces affect 4- to 6-year-old children’s recognition of emotions in those faces and (2) whether the duration of children’s exposure to masks is associated with emotion recognition. We tested children from Switzerland (N = 38) and Brazil (N = 41). Brazil represented longer mask exposure due to a stricter mandate during COVID-19. Children had to choose a face displaying (...) a specific emotion (happy, angry, or sad) when the face wore either no cover, a facial mask, or sunglasses. The longer hours of mask exposure were associated with better emotion recognition. Controlling for the hours of exposure, children were less likely to recognise emotions in partially hideen faces. Moreover, Brazilian children were more accurate in recognising happy faces than Swiss children. Overall, facial masks may negatively impact children’s emotion recognition. However, prolonged exposure appears to buffer the lack of facial cues from the nose and mouth. In conclusion, restricting facial cues due to masks may impair kindergarten children’s emotion recognition in the short run. However, it may facilitate their broader reading of facial emotional cues in the long run. (shrink)

One of the main theorems of the paper states the following. Let R-K-M be finite extensions of a rational one variable function field R over a finite field of constants. Let S be a finite set of valuations of K. Then the ring of elements of K having no poles outside S has a Diophantine definition over its integral closure in M.

The article analyzes the types of "meek" and "proud" female images in the works of F.M. Dostoevsky in connection with the typologies of the images of the writer among the literary critics N.A. Dobrolyubov, V.F. Pereverzev and A.A. Gizetti. The article refers to the classical authors of the early critical understanding of Dostoevsky's works, who divided female images into two opposite types of the "meek" and "proud". At the same time, the article emphasizes the idea that in Dostoevsky's polyphonic world (...) every literary hero has a multidimensional consciousness, which is why the direct dichotomous division into the "proud" and "meek" can only be a rough generalization. The first part of the article examines the typologies of N.A. Dobrolyubov, as well as one of V.F. Pereverzev, who creates the most ambitious and significant typology, considering female images. He sensitively notices the ambiguity and tragedy of Dostoevsky's heroines and introduces the term "the doppelgngerwoman" into the typology of female images, on the basis of which each heroine somehow contains a certain internal conflict, the solution of which in the course of a novel allows her character to develop towards one of the indicated subtypes. The second part of the article analyzes the typology of A.A. Gizetti, who in his research focuses on such type of Dostoevsky's female images as the "proud", highlighting a new, "mysterious" subtype of the Dostoevsky's proud heroine. In the performed comparison of "meek" and "proud" types of female images it is considered to distinguish positive and negative ethical meanings of them. The article formulates conclusions about the various subtypes of "meek" and "proud" characters in the writer's artistic world, and outlines the grounds for further system of understanding of meekness and pride on a scale of correlation with vice and virtue. (shrink)

Strengths, Opportunities, Aspirations, and Results is a strengths-based framework for strategic thinking, planning, conversations, and leading that focuses on strengths, opportunities, aspirations, and results. The SOAR framework leverages and integrates Appreciative Inquiry to create a transformation process through generative questions and positive framing. While SOAR has been used by practitioners since 2000 as a framework for generating positive organizational change, its use in empirical research has been limited by the absence of reliable and valid measures. We report on the reliability, (...) construct validity, and measurement invariance of the SOAR Scale, a 12-item self-report survey organized into four first-order factors. Data from a sample of 285 U.S. professionals were analyzed in Mplus using confirmatory factor analysis and exploratory structural equation modeling. The Four-Factor first-order exploratory structure equation modeling had the best model fit. Measurement invariance tests found the scalar invariance of the SOAR Scale across gender and education groups. Implications are discussed for using the SOAR Scale to build resilience at the individual, the team, and the organizational levels. (shrink)

Objective:Prior research examining sexual and intimacy concerns among metastatic breast cancer patients and their intimate partners is limited. In this qualitative study, we explored MBC patients’ and partners’ experiences of sexual and intimacy-related changes and concerns, coping efforts, and information needs and intervention preferences, with a focus on identifying how the context of MBC shapes these experiences.Methods:We conducted 3 focus groups with partnered patients with MBC [N = 12; M age = 50.2; 92% White; 8% Black] and 6 interviews with (...) intimate partners [M age = 47.3; 83% White; 17% Black]. Participants were recruited through the Fox Chase Cancer Center Tumor Registry and the Cancer Support Community. Qualitative data were analyzed using the Framework Method and Dedoose software.Results:Qualitative analyses revealed several key themes reflecting ways in which MBC shapes experiences of sex/intimacy: the heavy disease/treatment burden leads to significant, long-term sexual concerns and consequent heightened emotional distress for both patients and partners ; viewing the relationship as having “an expiration date” influences patients’ and partners’ concerns related to sex/intimacy and complicates coping efforts; and information needs extend beyond managing sexual side effects to include emotional aspects of intimacy and the added strain of the life-limiting nature of the disease on the relationship. The heightened severity of sexual concerns faced by patients with MBC, compounded by the terminal nature of the disease, may place patients and partners at risk for significant adverse emotional and interpersonal consequences.Conclusion:Findings suggest unique ways in which sex and intimate relationships change after a diagnosis of metastatic breast cancer from both patients’ and partners’ perspectives. Consideration of the substantial physical and emotional burden of MBC and the broader context of the relationship and intimacy overall is important when developing a sexuality-focused intervention in this population. Addressing sexual concerns is a critical part of cancer care with important implications for patients’ health and quality of life. (shrink)

We investigate the issues of Diophantine definability over the non-finitely generated version of non-degenerate modules contained in the infinite algebraic extensions of the rational numbers. In particular, we show the following. Let k be a number field and let K inf be a normal algebraic, possibly infinite, extension of k such that k has a normal extension L linearly disjoint from K inf over k. Assume L is totally real and K inf is totally complex. Let M inf be a (...) non-degenerate O k -module, possibly non-finitely generated and contained in O Kinf . Then M inf contains a submodule M¯ inf such that M inf /M¯ inf is torsion and O k has a Diophantine definition over M¯ inf. (shrink)

A growing body of research has demonstrated significant heterogeneity of hospital ethics committee (HEC) size, membership and training requirements, length of appointment, institutional support, clinical and policy roles, and predictors of self identified success. Because these studies have focused on HECs at a single point in time, however, little is known about how the composition of HECs changes over time and what impact these changes have on committee utilization. The current study presents 20 years of data on the evolution of (...) the Massachusetts General Hospital HEC. Between 1993 and 2012, the average number of committee members per year was 38 ± 3 and the average length of membership was 4.8 ± 0.4 years. During that time, the committee performed 934 consults, averaging 47 ± 3 per year. Attendance rates fell from 61.5 to 23.8 % over the study period and were inversely correlated with the total number of members. Between 1993 and 2012, the committee saw substantial growth in the diversity of the professional backgrounds of its members. Multivariate analysis, however, suggests that substantial changes in committee composition did not impact its utilization and that other factors are more likely to explain fluctuations in consultation volume. (shrink)

In this paper we argue that the arts (visual arts) constitute a kind of an expressive gesture (as conceived by the French philosopher M. Merleau-Ponty), and on the basis of this hypothesis, we shall try to show that they can fulfill the presuppositions required to be addressed in comprehensive and meaningful school programs. Our central argument is that artistic activity is an expressive activity par excellence: it is an “advent”, an original operation, i.e., which, constitutes a sign as a sign, (...) implants a meaning in that which did not have one and thus, inaugurates an order and founds an institution or tradition. Accordingly, this meaning is on principle a meaning in genesis, ever to be re-created and re-interpreted. Given that, we claim that just as the arts are an attempt to visually articulate meanings, to create meaningful forms, correspondingly art education is an attempt to cultivate children’s ability to grasp, understand and respond to such meanings available from art’s expressive forms. We maintain that the role of art education is to facilitate access to various artistic approaches and to help to the development of a reflective attitude towards their significance as expressive advents. (shrink)

Research concerning the link between morality and education-related variables is scarce. Thus, the present study addressed this issue by focusing on the connection between moral disengagement and academic engagement and the moderating roles of educational anti-mattering and psychological distress. Our sample comprised 363 university students aged 18 to 29 (M = 20.86, SD = 1.57) from Bachelor’s and Master’s programs. Correlation analysis suggested that academic engagement was negatively associated with psychological distress and educational anti-mattering. Moderation analyses suggested that moral disengagement (...) predicted academic engagement only at high levels of psychological distress (i.e. depression, anxiety, and stress). Educational anti-mattering, however, did not significantly moderate the link between moral disengagement and academic engagement. We discuss the theoretical and practical implications of the results in addressing students’ academic engagement. (shrink)

Let K be a function field of one variable over a constant field C of finite transcendence degree over C. Let M/K be a finite extension and let W be a set of primes of K such that all but finitely many primes of W do not split in the extension M/K. Then there exists a set W' of K-primes such that Hilbert's Tenth Problem is not decidable over $O_{K,W'} = \{x \in K\mid ord_\mathfrak{p} x \geq 0, \forall\mathfrak{p} \notin W'\}$ (...) , and the set (W' $\backslash$ W) ∪ (W $\backslash$ W') is finite. Let K be a function field of one variable over a constant field C finitely generated over Q. Let M/K be a finite extension and let W be a set of primes of K such that all but finitely many primes of W do not split in the extension M/K and the degree of all the primes in W is bounded by b ∈ N. Then there exists a set W' of K-primes such that Z has a Diophantine definition over O K ,W', and the set (W' $\backslash$ W) ∪ (W $\backslash$ W') is finite. (shrink)

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)

A standard view in philosophy is that knowledge entails justification. Yet recent research suggests otherwise. We argue that this admirable and striking research suffers from an important limitation: participants were asked about knowledge but not justification. Thus it is possible that people attributed knowledge partly because they thought the belief was justified. Perhaps though, if given the opportunity, people would deny justification while still attributing knowledge. It is also possible that earlier findings were due to perspective taking. This paper reports (...) further research that directly addresses these questions. Our findings support the hypothesis that knowledge entails justification on the ordinary view. (shrink)

Cet article propose la première publication complète d’un monument consacré par les Thespiens aux Muses dans leur sanctuaire au pied de l’Hélicon, dont les éléments constitutifs sont connus depuis le xixe s., et notamment depuis les fouilles de P. Jamot au Val des Muses. Les statues en bronze de petite taille des neuf Muses se dressaient sur une base en arc de cercle d’une ampleur de ca 10 m, placée dans un écrin architectural largement ouvert sur l’extérieur. Un nouveau lustre (...) est donné à ce groupe statuaire hellénistique exceptionnel à l’époque d’Auguste par la gravure, sous chacune des figures, d’une épigramme descriptive et érudite signée par le poète corinthien Honestos. Est ainsi conservé l’un des rares exemples archéologiques de recueil de poèmes décrivant des œuvres d’art figuré. L’analyse des épigrammes et l’observation détaillée des mortaises de fixation visibles à la face supérieure des blocs de la base permettent d’émettre des hypothèses sur les types utilisés pour la représentation des Muses, mais aussi d’assurer, au‑delà de tout doute, que les statues prenaient place au milieu d’ornements végétaux en bronze qui évoquaient le paysage du Val des Muses. La représentation de la nature comme élément non plus secondaire, mais essentiel d’un groupe sculpté correspond aux recherches nouvelles de la basse époque hellénistique. Faute de fouilles exhaustives du sanctuaire des Muses, l’emplacement du monument ne peut être déterminé avec certitude. Des lettres de remontage nous apprennent en revanche qu’il a été déplacé, peut‑être à l’époque où furent gravés les poèmes d’Honestos. (shrink)

According to a consensus view in philosophy, “deciding” and “intending” are synonymous expressions. Researchers have recently challenged this view with the discovery of a counterexample in which ordinary speakers attribute deciding without intending. The aim of this paper is to investigate the strengths and limits of this discovery. The result of this investigation revealed that the evidence challenging the consensus view is strong. We replicate the initial finding against consensus and extend it by utilizing several new measures, materials, and procedures. (...) Together this evidence strongly suggests that “deciding” is not synonymous with “intending” in ordinary language and that the consensus view should be rejected. (shrink)

The endoplasmic reticulum (ER) uses various mechanisms to ensure that only properly folded proteins enter the secretory pathway. For proteins that oligomerize in the ER, the proper tertiary and quaternary structures must be achieved before their release. Although some proteins fold before oligomerization, others initiate oligomerization cotranslationally. Here, we discuss these different strategies and some of the unique problems they present for the ER quality control system. One mechanism used by the ER is thiol retention. Thiol retention operates by monitoring (...) the redox state of specific cysteine residue(s) and was discovered in studies on the assembly of IgM, a complex oligomeric glycoprotein. This system is also involved in retaining other unassembled proteins in the ER. Mutations that result in uneven numbers of cysteine residues can subject yet other proteins to thiol retention, altering their oligomerization status and function. The implications of these results on the effects of thiol retention on protein function and cell fate are discussed. BioEssays 20:546–554, 1998. © 1998 John Wiley & Sons Inc. (shrink)