Objective: There is a demonstrated link between the mental health and substance use comorbidities experienced by young adults, however the vast majority of psychological interventions are disorder specific. Novel psychological approaches that adequately acknowledge the psychosocial complexity and transdiagnostic needs of vulnerable young people are urgently needed. A modular skills-based program for emotion regulation and impulse control addresses this gap. The current one armed open trial was designed to evaluate the impact that 12 weeks exposure to ERIC alongside usual care (...) had on young people's ability to regulate emotions, as well as examine potential moderating mechanisms.Methods: Seventy nine young people were enrolled to the 12 week intervention period. Twenty one practitioners from youth and community health services delivered relevant ERIC modules adjunct to usual care. Linear mixed effects regression was used to examine change over time across the primary outcome of emotion dysregulation and secondary outcomes of depression, anxiety, stress, experiential avoidance and mindfulness. Moderation analyses were conducted to test whether the magnitude of change in emotion dysregulation moderated change over time in secondary outcomes.Results: Analyses revealed significant improvement in the primary outcome of emotion dysregulation with a moderate effect size, in addition to decreases in the secondary outcomes of depression, anxiety, stress and experiential avoidance. No improvements in mindfulness were reported. Moderation analyses revealed that the residualised change over time in emotion dysregulation moderated the change over time in symptoms of distress, depression, anxiety, stress, experiential avoidance, and mindfulness.Conclusion: Reductions in the severity of emotion dysregulation, depression, anxiety, stress and experiential avoidance are promising, and were evident despite the complexity of the participants and the diversity of the service setting. The improvements found in each outcome were only observed for those young people whose emotion regulation also improved, providing preliminary evidence for the role of emotion regulation as a key treatment target in this population. (shrink)

We live in an era where our health is linked to that of others across the globe, and nothing brings this home better than the specter of a pandemic. This paper explores the findings of town hall meetings associated with the Canadian Program of Research on Ethics in a Pandemic , in which focus groups met to discuss issues related to the global governance of an influenza pandemic. Two competing discourses were found to be at work: the first was (...) based upon an economic rationality and the second upon a humanitarian rationality. The implications for public support and the long-term sustainability of new global norms, networks, and regulations in global public health are discussed. (shrink)

What is the relationship between evolutionary contingency and diversity? The evolutionary contingency thesis emphasizes dependency relations and chance as the hallmarks of evolution. While contingency can be destructive of, for example, the fragile and complex dynamics in an ecosystem, I will mainly focus on the productive or causal aspect of contingency for a particular sort of diversity. There are many sorts of diversities: Gould is most famous for his diversity-to-decimation model, which includes disparate body plans distinguishing different phyla. However, structural (...) diversity construed more broadly spans scales, such as organization in and among cells, structural arrangements and biomechanics on various scales, and even the profile of ancestor-descendent relationships or community structure of interactions within ecosystems. By focusing on stochastic processes in contingent evolution, I argue that contingency causes structural diversity. Specifically, I focus on the plurality of structural types of cells, genetic codes, and phyla diversity as case studies. (shrink)

Recently, philosophers have sought to determine the nature of individuals relevant to evolution by natural selection or evolutionary individuals. The Evolutionary Contingency Thesis is a claim about evolution that emphasizes the role of contingency or dependency relations and chance-based factors in how evolution unfolds. In this article, I argue that if we take evolutionary contingency seriously, then we should be pluralists about the types of individuals in selection.

‘Gouldian arguments’ appeal to the contingency of a scientific domain to establish that domain’s autonomy from some body of theory. For instance, pointing to evolutionary contingency, Stephen Jay Gould suggested that natural selection alone is insufficient to explain life on the macroevolutionary scale. In analysing contingency, philosophers have provided source-independent accounts, understanding how events and processes structure history without attending to the nature of those events and processes. But Gouldian Arguments require source-dependent notions of contingency. An account of contingency is (...) source-dependent when it is indexed to some pattern and some process. Positions like Gould’s do not turn on the mere fact of life’s contingency—that life’s shape could have been different due to its sensitivity to initial conditions, path-dependence or stochasticity. Rather, Gouldian arguments require that the contingency is due to particular kinds of processes: in this case, those which microevolutionary theory cannot account for. This source-dependent perspective clarifies both debates about the nature and importance of contingency, and empirical routes for testing Gould’s thesis. (shrink)

In this dissertation, I explore the reach of the Evolutionary Contingency Thesis—a view that emphasizes the role of dependency relations and chance in evolution. Contingency produces diverse biological entities, processes, and mechanisms. I analyze the implications of evolution’s contingency in three areas. First, I address the problem of evolutionary individuality, which concerns the nature of entities that selection acts on. If we accept Lewontin’s 1970 view that individuals are selected, then what exactly are these individuals? I argue that evolutionary contingency (...) and its diversity of outcomes causes a plurality of individuality types. These types of individuals emerge, evolve, and disappear through evolution. Second, I defend a disunified model of major transitions in evolution. Major transitions mark pivotal turning points in life’s history, such as the transition from unicellularity to multicellularity. Philosophers and biologists aim to unify evolution’s transitions by establishing a property all major events share. I argue that evolutionary contingency’s emphasis on diversity supports a disunified model of transitions. That is, we should expect numerous kinds of major transitions given the diverse sets of outcomes caused by evolutionary contingency. Finally, I extend the contingency analysis to a topic in philosophy of medicine: The nature of cancer. It is common to view cancer as a by-product of our evolution as multicelled creatures. However, Lean and Plutynski argue that cancer is also a direct product of evolution by selection. In both cases, cancer is characterized in terms of how it functions as an object of selection. I argue that the diversity among cancers suggests philosophers should shift their focus to cancers’ structural differences rather than only their functional similarities. (shrink)

George G. Simpson (1902–1984) and Stephen J. Gould (1941–2002) were both engaged with the normative – i.e., social, cultural, political, and even ethical – consequences of their evolutionary theorizing. However, there is a normative point of departure between Simpson and Gould’s work in that regard that has received little attention. Yet, their motivations converge into a larger program of resistance and social protection from misconstrued and illegitimate overreaches of the biological sciences leading up to and after the peak of the (...) modern synthesis. (shrink)

This article evaluates the oversight of drugs and medical devices by the U.S. Food and Drug Administration using an integration of public policy, law, and bioethics approaches and employing multiple assessment criteria, including economic, social, safety, and technological. Criteria assessment and expert elicitation are combined with existing literature, case law, and regulations in an integrative historical case studies approach. We then use our findings as a tool to explore possibilities for effective oversight and regulatory mechanisms for nanobiotechnology. Section I describes (...) oversight mechanisms for human drugs and medical devices and presents current nanotechnology products. Section II describes the results of expert elicitation research. Section III highlights key criteria and relates them to the literature and larger debate. We conclude with broad lessons for the oversight of nanobiotechnology informed by Sections I-III in order to provide useful analysis from multiple disciplines and perspectives to guide discussions regarding appropriate FDA oversight. (shrink)

This article evaluates the oversight of drugs and medical devices by the U.S. Food and Drug Administration using an integration of public policy, law, and bioethics approaches and employing multiple assessment criteria, including economic, social, safety, and technological. Throughout, assessments employing both the multiple criteria and a method of expert elicitation are combined with the existing literature, case law, and regulations providing an integrative historical case study approach. The goal is to provide useful information from multiple disciplines and perspectives to (...) guide discussions regarding appropriate oversight frameworks for nanobiotechnology applications under the FDA’s purview. (shrink)

For medical interventions there is a gap between what clinical scientific research has established as likely to carry clinical benefit and what the National Institute for Clinical Excellence (NICE) has judged as cost-effective. This gap is the affordability gap. It is created by a value judgement made by NICE and affirmed by the Secretary of State for Health. This value judgement operates to affect other value judgements made in actual clinical situations where at least one choice of treatment falls into (...) the affordability gap. This paper considers how the creation of this affordability gap impacts upon actual clinical decisions. It explores these issues in the context of the choice between a drug-eluting stent and a bare metal stent for elective coronary angioplasty. It also argues that the option of an NHS procedure with a top-up fee to cover the cost of the affordability gap is a genuine one; that this option could improve clinical outcomes; that it is morally acceptable; and that the rules that prevent the utilization of this option should be relaxed. (shrink)

A large proportion of hospital inpatients are affected by cognitive impairment, posing challenges in the provision of their care in busy, fast-paced acute wards. Signs and symbols, known as visual identifiers, are employed in many U.K. hospitals with the intention of helping healthcare professionals identify and respond to the needs of these patients. Although widely considered useful, these tools are used inconsistently, have not been subject to full evaluation, and attract criticism for acting as a shorthand for a routinized response. (...) In order for visual identifiers to be used effectively in acute care settings, thorough consideration must be given to the ethical and legal issues that are engaged in this context, and their potential benefits and harms must be weighed and balanced. This paper proposes a set of legal and ethical principles that can be used to guide the implementation of visual identifiers. Together, these principles provide a framework applicable in the design and implementation phases to systematically identify relevant considerations arising from the use of these tools. We outline some tensions that arise between principles and conclude that selecting a preferred moral framework could help to guide decision-making, as does clarity around the purpose and objectives of the identifier. (shrink)

The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert Advisory Group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since (...) the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs Programme. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating and integrating evidence to identify causes of human cancer. The advancements adopted include strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention. (shrink)

It is argued that genuinely subsentential phrases, such as a discourse-initial utterance of “From France” to indicate the provenance of an item, provide evidence for the reality of the pragmatic process of free enrichment. I consider recent attempts to treat such discourse-initial fragments as linguistic ellipsis of some kind while accommodating the difference between these cases and accepted types of ellipsis such as sluicing and gapping. I claim that the mechanisms they posit to save an ellipsis story have no role (...) in an account of performance. An argument against the enrichment approach from the indeterminacy of the content of subsentential utterances is discussed, and refuted, and it is shown how this indeterminacy is accommodated in a contextualist pragmatic theory. (shrink)

Abstract: A current debate in semantics and pragmatics is whether all contextual effects on truth-conditional content can be traced to logical form, or 'unarticulated constituents' can be supplied by the pragmatic process of free enrichment. In this paper, I defend the latter position. The main objection to this view is that free enrichment appears to overgenerate, not predicting where context cannot affect truth conditions, so that a systematic account is unlikely (Stanley, 2002a). I first examine the semantic alternative proposed by (...) Stanley and others, which assumes extensive hidden structure acting as a linguistic trigger for pragmatic processes, so that all truth-conditional effects of context turn out to be instances of saturation. I show that there are cases of optional pragmatic contributions to the proposition expressed that cannot plausibly be accounted for in this way, and that advocates of this approach will therefore also have to appeal to free enrichment. The final section starts to address the question of how free enrichment is constrained: I argue that it involves only local development or adjustment of parts of logical form, any global developments being excluded by the requirement for the proposition expressed to provide an inferential warrant for the intended implications of the utterance. (shrink)

This study examined the role of reflection on personal cases for making ethical decisions with regard to new ethical problems. Participants assumed the position of a business manager in a hypothetical organization and solved ethical problems that might be encountered. Prior to making a decision for the business problems, participants reflected on a relevant ethical experience. The findings revealed that application of material garnered from reflection on a personal experience was associated with decisions of higher ethicality. However, whether the case (...) was viewed as positive or negative, and whether the outcomes, processes, or outcomes and processes embedded in the experience were examined, influenced the application of case material to the new problem. As expected, examining positive experiences and the processes involved in those positive experiences resulted in greater application of case material to new problems. Future directions and implications for understanding ethical decision making are discussed. (shrink)

This paper examines the outcomes of Preserving the Past Together, a workshop series designed to build the capacity of local heritage managers to engage in collaborative and community-based approaches to archaeology and historic preservation. Over the past two decades practitioners of these approaches have demonstrated the interpretive, methodological, and ethical value of integrating Indigenous perspectives and methods into the process and practice of heritage management and archaeology. Despite these benefits, few professional resources exist to support the development of collaborative relationships (...) between local heritage managers and Tribal nations. Filling this need, Preserving the Past Together’s interactive workshops and keynote lectures involved participants in a discussion of the central themes in collaborative and Indigenous approaches to archaeology today, highlighting the local challenges and opportunities that exist for archaeologists, heritage managers, and Tribal nations to work together to care for the past. This paper presents an overview of the event series’ goals, the strategies it used to foster collaboration among the diverse stakeholders of the Salish Sea, and the next steps the project’s co-directors are taking to further support communication and collaboration between stewards and stakeholders in the Pacific Northwest. (shrink)

**No longer the current version available on SEP; see revised version by Sharon Crasnow** -/- Feminists have a number of distinct interests in, and perspectives on, science. The tools of science have been a crucial resource for understanding the nature, impact, and prospects for changing gender-based forms of oppression; in this spirit, feminists actively draw on, and contribute to, the research programs of a wide range of sciences. At the same time, feminists have identified the sciences as a source as (...) well as a locus of gender inequalities: the institutions of science have a long tradition of excluding women as practitioners; feminist critics of science find that women and gender (or, more broadly, issues of concern to women and sex/gender minorities) are routinely marginalized as subjects of scientific inquiry, or are treated in ways that reproduce gender-normative stereotypes; and, closing the circle, scientific authority has frequently served to rationalize the kinds of social roles and institutions that feminists call into question. -/- Feminist perspectives on science therefore reflect a broad spectrum of epistemic attitudes toward and appraisals of science. Some urge the reform of gender inequities in the institutions of science and call for attention to neglected questions with the aim of improving the sciences in their own terms; they do not challenge the standards and practices of the sciences they engage. Others pursue jointly critical and constructive programs of research that, to varying degrees, aim at transforming the methodologies, substantive content, framework assumptions, and epistemic ideals that animate the sciences. The content of these perspectives, and the degree to which they generate transformative critique, depends not only on the types of philosophical and political commitments that inform them but also on the nature of the sciences and subject domains on which they bear. Feminist perspectives have had greatest impact on sciences that deal with inherently gendered subjects—the social and human sciences—and, secondarily, on sciences that study subjects characterized in gendered terms, metaphorically or by analogy (projectively gendered subjects), chiefly the biological and life sciences. Feminist perspectives are relevant to sciences that deal with non-gendered subject matters, but perspectives vary substantially in content and in critical import depending on the sciences and the particular research programs they engage. (shrink)

My mother is losing her mother to Alzheimer's disease. Although my mother feels loss, I am connecting through my grandmother to our ancestors, including a deceased father and paternal grandmother. I am also connecting to a daughter who has lost her mother, through a grandmother who, through her loss of memory, is more open to kin networks than my mother. Through deepening connections to my maternal grandmother and to my daughter, I feel I am losing my mother. I look to (...) revolutionary mothering as a way to reconnect shattered bonds and find lost mothers. This article honors the important work of Saidiya Hartman, Dorothy Roberts, and countless revolutionary mothers. (shrink)

The college hookup scene is a profoundly gendered and heteronormative sexual field. Yet the party and bar scene that gives rise to hookups also fosters the practice of women kissing other women in public, generally to the enjoyment of male onlookers, and sometimes facilitates threesomes involving same-sex sexual behavior between women. In this article, we argue that the hookup scene serves as an opportunity structure to explore same-sex attractions and, at least for some women, to later verify bisexual, lesbian, or (...) queer sexual identities. Based on quantitative and qualitative data and combining queer theory and identity theory, we offer a new interpretation of women’s same-sex practices in the hookup culture. Our analysis contributes to gender theory by demonstrating the utility of identity theory for understanding how non-normative gender and sexual identities are negotiated within heteronormatively structured fields. (shrink)

The UK launch of the Science Enterprise Challenge in 1999 has stimulated interest in the evolutions of science-based firms and this paper argues that Popper’s seminal diverse contributions to philosophy are directly relevant to them. It begins by commenting on the applications of both Kuhn’s and Popper’s concepts to technological (as against) scientific evolutions. It then suggests how Popper’s approaches are applicable to the development and assessment of new technology within the framework of Freeman’s stakeholders approach. Monsanto’s development of GMOs (...) is used as an illustrative case. (shrink)

Increasing genetic knowledge over the last decade has enabled hundreds of genetic variants associated with inherited cardiac conditions to be identified, many of which cause increased risk of sudden cardiac death. While individually these conditions are rare, taken together they impose a significant burden. The severity of these conditions—the possibility that they might cause sudden unheralded death of a teenager or young adult—juxtaposed with uncertainty about the pathology linked with many of the genetic variants is significant in terms of professional (...) practice because, increasingly, clinicians have been encouraged to cascade out genetic testing from the proband or consultand to other family members who may be at risk of developing the same condition. This process often involves sharing human tissue samples, DNA or personal information. This paper reviews the legal and regulatory frameworks which may apply when tissue and DNA samples are collected, used and retained, both for the purpose of diagnosis and for benefiting other family members, when a suspected or definitive diagnosis of an inherited cardiovascular condition is made. Sometimes the interests of family members may conflict, and it may be difficult for practitioners to reconcile the interests of one family member with another, particularly if the balance of benefits and harms from testing is unclear. The paper then examines some of the ethical tensions which may arise in practice and concludes that all involved should be conversant with the legal and ethical frameworks that apply. (shrink)

Developments in neuroscience have raised the possibility that pharmaceuticals may be used to enhance memory, mood, and attention in people who do not have an illness or disorder, a practice known as “cognitive enhancement.” We describe historical experiences with two medicinal drugs for which similar enhancement claims were made, cocaine in the late 19th and early 20th centuries, and amphetamines in the mid 20th century. These drugs were initially introduced as medicinal agents in Europe and North America before becoming more (...) widely used for a variety of purposes, including what would nowadays be considered cognitive enhancement. Their trajectory of use conformed to the typical use cycle of psychotropic drugs. There was an initial steep rise in prescribing for medical use, followed by expanded nonmedical use that was fueled by enthusiasm for the drugs’ effects. As the number of regular users increased, problems related to use (such as addiction) became apparent, societal concern increased, and laws were passed banning nonmedical use and eventually, medical use. This historical experience draws attention to the adverse side effects of enhancement use that only become apparent with regular, wide-scale use of a drug. We highlight the similarities between the enthusiasms for cocaine and amphetamines and the current enthusiasms for using prescription stimulants for cognitive enhancement. We argue bioethicists should not encourage the cognitive enhancement use of drugs such as methylphenidate in the absence of evidence on the efficacy and safety of their use for cognitive enhancement purposes. (shrink)

CITATION: Ewuoso, C., Hall, S. & Dierickx, K. 2017. How do healthcare professionals manage ethical challenges regarding information in healthcare professional/patient clinical interactions? a review of concept- or argument-based articles and case analyses. South African Journal of Bioethics and Law, 10:75-82, doi:10.7196/SAJBL.2017.v10i2.610.

As part of a larger research study, we present model language for disclosing financial interests in clinical research to potential research participants, and we describe the empirical basis and theoretical assumptions used in developing the language. The empirical process for creating appropriate disclosure language resulted in a generic disclosure statement for cases in which no risk to participants’ welfare or the scientific integrity of the research is expected, and nine more specific disclosure statements for cases in which some risk is (...) expected. The disclosure statements are not meant to be canonical, but were instead designed to reflect the typical situations in which disclosure of financial interest might be considered by an institutional review board or conflict of interest committee. Individual institutions could modify key phrases to suit their purposes, and others could use the language in future empirical work on informed consent to better refine the options for disclosing financial interests in clinical research. (shrink)

Previous meta-analyses support a female advantage in decoding non-verbal emotion (Hall, 1978, 1984), yet the mechanisms underlying this advantage are not understood. The present study examined whether the female advantage is related to greater female attention to the eyes. Eye-tracking techniques were used to measure attention to the eyes in 19 males and 20 females during a facial expression recognition task. Women were faster and more accurate in their expression recognition compared with men, and women looked more at the (...) eyes than men. Positive relationships were observed between dwell time and number of fixations to the eyes and both accuracy of facial expression recognition and speed of facial expression recognition. These results support the hypothesis that the female advantage in facial expression recognition is related to greater female attention to the eyes. (shrink)

BackgroundThere is concern in the academic publishing community that it is becoming more difficult to secure reviews for peer-reviewed manuscripts, but much of this concern stems from anecdotal and rhetorical evidence.MethodsWe examined the proportion of review requests that led to a completed review over a 6-year period (2009–2015) in a mid-tier biology journal (Molecular Ecology). We also re-analyzed previously published data from four other mid-tier ecology journals (Functional Ecology, Journal of Ecology, Journal of Animal Ecology, and Journal of Applied Ecology), (...) looking at the same proportion over the period 2003 to 2010.ResultsThe data from Molecular Ecology showed no significant decrease through time in the proportion of requests that led to a review (proportion in 2009 = 0.47 (95 % CI = 0.43 to 0.52), proportion in 2015 = 0.44 (95 % CI = 0.40 to 0.48)). This proportion did decrease for three of the other ecology journals (changes in proportions from 2003 to 2010 = −0.10, −0.18, and −0.09), while the proportion for the fourth (Functional Ecology) stayed roughly constant (change in proportion = −0.04).ConclusionsOverall, our data suggest that reviewer agreement rates have probably declined slightly but not to the extent suggested by the anecdotal and rhetorical evidence. (shrink)