BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...) objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)

Detecting contract cheating in written submissions can be difficult beyond direct plagiarism detectable via technology. Successfully identifying potential cases of contract cheating in written work such as essays and reports is largely dependent on the experience of assessors and knowledge of student. It is further dependent on their familiarity with the patterns and clues evident in sections of body text and reference materials to identify irregularities. Consequently, some knowledge of what the patterns and clues look like is required. This paper (...) documents how to identify some of the patterns and clues observed in essay and report submissions. Effective assessment design with specific contextual requirements make irregularities easier to detect and interpret. The irregularities identified were confirmed as instances of contract cheating through conversations held with postgraduate students. An essential element of the conversations was the evidence presented for discussion. Irregularities were noted on a pro-forma specifically developed for this purpose. Patterns identified include misrepresented bibliographic data, inappropriate references, irrelevant material and generalised text that did not address the assessment question or grading criteria. The validated patterns formed the basis of identifying potential instances of contract cheating in later submissions. Timely conversations with students before the end of semester are essential to determining whether the patterns and clues link to poor knowledge of academic writing conventions or classified as contract cheating necessitating the application of appropriate penalties under institutional policies and procedures. (shrink)

Over one-third of older adults in many countries have a companion animal, and pets may harbor health-promoting potential. Few studies have considered pet-ownership in relation to economic vulnerability, and pet-ownership has not been often considered within policy efforts to promote ageing-in-place. We conducted a mixed methods case study to understand perspectives of both community agencies that support ageing-in-place and older adults themselves. A shortage of affordable, appropriate pet-friendly housing emerged as a challenge, even when framed as a legitimate choice and (...) preference for many older adults. In this manuscript, we share the trajectories of three economically vulnerable older adults whose affordable housing needs became entangled with commitments to pets. Guided by dialogical narrative methodology, we offer each narrative as a short vignette to illustrate the extent to which older adults will practice ‘more-than-human solidarity’ for a pet, even when their own well-being is compromised as a result; and highlight incongruence between the underlying moral values that shape solidaristic practices of individuals versus solidaristic arrangements that shape affordable housing opportunities. We suggest that housing rules and legislation that disrupt, rather than confirm, more-than-human solidarity may render older adults susceptible to, rather than protected from, deteriorating physical, mental and social well-being. We propose that collective solidaristic practices must reflect and subsume the moral complexity of solidarity practiced by individuals, to enable fair and equitable ageing-in-place. (shrink)

A decade ago, conventional wisdom in the medical establishment was that physicians treating chronic pain with opioid analgesics were at a substantial risk of being sanctioned for overprescribing by state medical regulatory boards. Dozens of articles written since have alluded to this risk as an obstacle to effective pain re1ief. In the early 1990s, a number of high profile cases in which physicians were disciplined by regulatory boards for overprescribing to patients with chronic pain were reported in the press. Although (...) the board actions in many of these cases were eventually overturned by state judiciaries, the publicity heightened practitioners’. sensitivity to the regulatory risks associated with prescribing opioids.A review of the available data on state medical board actions nationwide for the period from 1990 to 1996 reveals that the perception of regulatory risk far exceeds the reality. Indeed, relatively few of the disciplinary actions taken for overprescribing by state medical boards in any given year directly concern the treatment of chronic pain—malignant or nonmalignant—in patients. (shrink)

Research on emotion and psychopathology has blossomed due in part to the translation of affective science theory and methods to the study of diverse disorders. This translational approach has helped the field to hone in more precisely on the nature of emotion deficits to identify antecedent causes and maintaining processes, and to develop promising new interventions. The future of emotion research in psychopathology will benefit from three inter-related areas, including an emphasis on emotion difficulties that cut across traditional diagnostic boundaries (...) (i.e., a transdiagnostic approach), the explicit linking of emotion and cognition in behavioral and neuroimaging studies in psychopathology, and continued translation of the latest conceptualizations of emotion to the study of psychopathology. (shrink)

This paper suggests that Dante’s writings on language provide elements for the construction of a philosophy of language. The main emphasis is on the theoretical treatment of language in De Vulgari Eloquentia, but it also considers La Vita Nouva and Il Convivio, earlier works providing insights into the development of Dante’s views on the nature and use of language. De Vulgari Eloquentia is an extended justification for the use of a vernacular language capable of treating the worthiest topics in a (...) manner appropriate to them. Two main purposes of language are to instruct and delight. Dante shows that others must be addressed in a language they understand, but if it is to lift them, it must have a beauty and power beyond them. (shrink)

The argument of this paper is that the Aristotelian analysis of justice and related concepts provides the best framework for understanding the structure and importance of justice in Dante’s Commedia. After giving a synopsis of the principle features of Aristotle’s account of justice in Book 5 of the Nicomachean Ethics, I consider a few scenes from the Inferno, the Purgatorio, and the Paradiso, showing how the punishments and rewards Dante describes are based on the Aristotelian analysis of justice. Finally, I (...) show that Dante, following Aristotle’s views on the metaphysics of the human person, recognizes that argument alone is inadequate to the task of educating the reader on the proper care of the soul, and that Dante’s effective use of images, makes the abstract Aristotelian concept of justice vivid and attractive, and its opposite repulsive. (shrink)

The demand for science trainees to have appropriate responsible conduct of research instruction continues to increase the attention shown by federal agencies and graduate school programs to the development of effective ethics curriculums. However, it is important to consider that the main learning environment for science graduate students and post-doctoral research fellows is within a laboratory setting. Here we discuss an internal laboratory program of weekly 15-minute ethics discussions implemented and used over the last 3 years in addition to the (...) graduate school’s program of scientific integrity training. During this time, the environment and culture within our laboratory has changed to place greater emphasis on the ethical implications of our own research and the research we evaluate. We still struggle with how to accurately assess this behavioral change; although, we present preliminary survey results on the evaluation and impact of this style of curriculum for ethics instruction in our laboratory. (shrink)

A translator and her science consultant, who have worked together on many books, consider the problems of translating primary and secondary texts in science. Various problems encountered in translating an ongoing documentary edition in the history of science are discussed using the collected works of Albert Einstein as a test case. For instance, each language has its own preferred sentence structure; moreover, not every historical term finds a perfect equivalent in modern usage, and historical accuracy is contextually bounded.

The United States National Preparedness System has evolved significantly in the recent past. These changes have affected the system structures and goals for disaster response. At the same time, actors such as private businesses have become increasingly involved in disaster efforts. In this paper, we begin to fill the gap in the cross-sector literature regarding interactions that have systemic impacts by investigating how the simultaneous processes of systemic change and intensifying cross-sector interaction worked and interacted in the context of the (...) preparedness system. We examine these inter-linkages through a qualitative study in the setting of Hurricane Sandy. Drawing from systems theory, we develop a grounded model that provides an explanation for the system change and highlights how cross-sector interaction relates to the changes observed in the system. (shrink)

The purpose of this study was to extend the previous research on ethics in retailing. Prior research of Dornoff and Tankersley, Gifford and Norris, Norris and Gifford, and Burns and Rayman examined the ethics orientation of retail sales persons, sales managers, and business school students. These studies found the college students less ethically-oriented than retail sales people and retail managers. The present study attempts to extend the research on ethics formation to a geographically and academically diverse sample, and to determine (...) if retail management experience in the form of a professional practicum or internship, or entry level management training programs, such as experienced by recent graduates, are critical factors in the formation of business ethics. The sample consisted of thirty-three students majoring in Human Ecology with a concentration in Retail Merchandising and 51 recent graduates of the retail Merchandising program. The series of fourteen vignettes developed by Dornoff and Tankersley was used. An acknowledged limitation of this study is the validity of the questionnaire developed by Dornoff and Tankersley due to the method of development and new laws concerning warranties and credit etc. which have occurred since 1976. The instrument was used, however, to maintain consistency with earlier studies for the purpose of comparison of groups. No significant differences were found in the students' perceptions of the fourteen actions presented in the vignettes, but the range of the responses in the post-internship tests increased in many cases. The alumni appeared to be slightly more ethical than the students but not as ethical as the managers surveyed in 1986 by Norris and Gifford. Indications are that the critical point of ethics formation may be at the mid-management level and that internships and management training programs have little effect on the ethical perceptions of participants. These findings are consistent with studies such as Gable and Topol, and Jordan and Davis which showed high Machiavellian scores among young retailing executives, often buyers, as opposed to upper level retailing management. Scales with measure Machiavellianism, or manipulativeness, have been used as an alternative method of examining business ethics. (shrink)

A decade ago, conventional wisdom in the medical establishment was that physicians treating chronic pain with opioid analgesics were at a substantial risk of being sanctioned for overprescribing by state medical regulatory boards. Dozens of articles written since have alluded to this risk as an obstacle to effective pain re1ief. In the early 1990s, a number of high profile cases in which physicians were disciplined by regulatory boards for overprescribing to patients with chronic pain were reported in the press. Although (...) the board actions in many of these cases were eventually overturned by state judiciaries, the publicity heightened practitioners’. sensitivity to the regulatory risks associated with prescribing opioids.A review of the available data on state medical board actions nationwide for the period from 1990 to 1996 reveals that the perception of regulatory risk far exceeds the reality. Indeed, relatively few of the disciplinary actions taken for overprescribing by state medical boards in any given year directly concern the treatment of chronic pain—malignant or nonmalignant—in patients. (shrink)

Nolan, Ann MC In the past fifty years there has been a stream of commentary on the documents of Vatican II. Have we not had so much commentary, so much interpretation, that further commentary is unnecessary? Fifty years on, one might ponder how to interpret the sixteen documents for the church of our times, indeed to wonder whether they continue to have any relevance at all. Faced with this thought, we could turn to one scholar whose works span almost the (...) whole of this fifty-year period, yet whose thought in relation to the documents has not remained static: the renaissance historian John O'Malley SJ. (shrink)

Déjà vu is the striking sense that the present situation feels familiar, alongside the realization that it has to be new. According to the Gestalt familiarity hypothesis, déjà vu results when the configuration of elements within a scene maps onto a configuration previously seen, but the previous scene fails to come to mind. We examined this using virtual reality technology. When a new immersive VR scene resembled a previously-viewed scene in its configuration but people failed to recall the previously-viewed scene, (...) familiarity ratings and reports of déjà vu were indeed higher than for completely novel scenes. People also exhibited the contrasting sense of newness and of familiarity that is characteristic of déjà vu. Familiarity ratings and déjà vu reports among scenes recognized as new increased with increasing feature-match of a scene to one stored in memory, suggesting that feature-matching can produce familiarity and déjà vu when recall fails. (shrink)

A central feature of our waking mental experience is that our attention naturally toggles back and forth between “external” and “internal” stimuli. In the midst of an externally demanding task, attention can involuntarily shift internally with no clear reason how or why thoughts momentarily shifted inward. In the case of external attention, we are typically exploring and encoding aspects of our external world, whereas internal attention often involves searching for and retrieving potentially relevant information from our memory networks. Cognitive science (...) has traditionally focused on understanding forms of internal and external attention separately, leaving a mystery about what sparks the seemingly automatic shifts between the two. Specifically, what shifts attentional focus from being outward‐directed to being inward‐directed? We present a candidate mechanism: Familiarity‐detection. (shrink)

BackgroundCRISPR-Cas9, a technology enabling modification of the human genome, is developing rapidly. There have been calls for public debate to discuss its ethics, societal implications, and governance. So far, however, little is known about public attitudes on CRISPR-Cas9. This study contributes to a better understanding of public perspectives by exploring the various holistic perspectives Dutch citizens have on CRISPR-Cas9.MethodsThis study used Q methodology to identify different perspectives of Dutch citizens (N = 30) on the use of CRISPR-Cas9. The Q-sort method (...) aims at segmenting audiences based on the structural characteristics of their perspectives. Participants individually ranked 32 statements about CRISPR-Cas9 and discussed their rankings in small groups. By-person factor analysis was performed using PQMethod. Participants’ contributions to the discussions were used to further make sense of the audience segments identified.ResultsFive perspectives on CRISPR-Cas9 were identified: (1) pragmatic optimism (2) concerned scepticism; (3) normative optimism; (4) enthusiastic support; and (5) benevolent generalism. Each perspective represents a unique position motivated by different ranking rationales. Sorting rationales included improving health, preventing negative impacts on society, and fear of a slippery slope. Overall, there is broad, but not universal support for medical uses of CRISPR-Cas9.ConclusionsResearch on CRISPR-Cas9 should prioritise the broadly supported applications of the technology. Research and public debates on CRISPR-Cas9, its uses, its broader implications, and the governance of CRISPR-Cas9 are recommended. A discourse that includes all perspectives can contribute to the embedding of future uses of CRISPR-Cas9 in society. This study shows that Q methodology followed by group discussions enables citizens to contribute meaningfully to discourses about research. (shrink)

How should nursing knowledge advance? This exploration contextualizes its evolution past and present. In addressing how it evolved in the past, a probable historical evolution of its development draws on the perspectives of Frank & Gills's World System Theory, Kuhn's treatise on Scientific Revolutions, and Foucault's notions of Discontinuities in scientific knowledge development. By describing plausible scenarios of how nursing knowledge evolved, I create a case for why nursing knowledge developers should adopt a post‐structural stance in prioritizing their research agenda(s). (...) Further, by adopting a post‐structural stance, I create a case on how nurses can advance their disciplinary knowledge using an engaging post‐colonial strategy. Given an interrupted history caused by influence(s) constraining nursing's knowledge development by power structures external, and internal, to nursing, knowledge development can evolve in the future by drawing on post‐structural interpretation, and post‐colonial strategy. The post‐structural writings of Deleuze & Guattari's understanding of ‘Nomadology’ as a subtle means to resist being constrained by existing knowledge development structures, might be a useful stance to understanding the urgency of why nursing knowledge should advance addressing the structural influences on its development. Furthermore, Bhabha's post‐colonial elucidation of ‘Hybridity’ as an equally discreet means to change the culture of those constraining structures is an appropriate strategy to enact how nursing knowledge developers can engage with existing power structures, and simultaneously influence that engagement. Taken together, ‘post‐structural stance’ and ‘post‐colonial strategy’ can refocus nursing scholarship to learn from its past, in order to develop relevant disciplinary knowledge in its future. (shrink)

Background: ICU patients’ family members are in a new, uncertain, and vulnerable situation due to the patient’s critical illness and complete dependence on the ICU nurses and physicians. Family members’ feeling of being cared for is closely linked to clinicians’ attitudes and behavior. Aim: To explore ICU nurses’ and physicians’ bedside interaction with critically ill ICU patients´ families and discuss this in light of the ethics of care. Research design: A qualitative study using participant observation, focus groups, and thematic narrative (...) analysis. Participants and research context: Data were gathered from July 2017 to August 2019, in four ICUs in Norway through 270 h of fieldwork and seven focus groups with ICU nurses and physicians. Ethical considerations: The Regional Committee for Medical and Health Research Ethics and the Norwegian Centre for Research Data approved the study. Findings: Quality of ICU family care depends on nurses’ and physicians’ attitudes, behavior, and personality traits. Three main themes were identified: being attentive, an active approach, and degree of tolerance. Discussion: The findings are discussed in light of the ethics of care and empirical research from the intensive care environment. Conclusions: This study shows that attentive, active, and tolerant clinicians represent a culture of ethical care that gives families greater freedom of action and active participation in patient care. Clinicians must not bear sole responsibility for this culture; it must have a firm basis in the hospital and ICU and be established through training, interprofessional reflection, and support of clinicians. (shrink)

The distinction between stakeholders and shareholders frequently employed in business ethics can illuminate challenges faced by a bioethics advisory panel. I use the distinction to reflect back on the work of an advisory panel on which I served, a panel on US transplant policy. The panel hearings were akin to a shareholders’ meeting, with many stakeholders absent. In addition to ‘hearing out’ the shareholders who were present, the panel had duties to absent stakeholders to insure their interests were included in (...) public discussion. While panel efforts to include stakeholder perspectives rightfully framed its report, such duties should have framed its operating procedures more robustly. The stakeholder/shareholder distinction also offers a critical prism on the actual evolution of organ allocation policy, which the panel failed to influence. Current policy embodies a compromise among shareholders that obscures major stakeholder interests. This results in under‐attention to likely medical benefit of transplant, compared to other allocation criteria. Recognition of duties to stakeholders amidst pressures of shareholders complicates the notion of ‘consensus’ for an advisory panel. Consensus framed on terms defined only by shareholders, not stakeholders, may be an inadequate measure of public interest. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Maurice Blondel on the Practice of Supernatural ReligionAnne M. CarpenterIntroductionMaurice Blondel attended daily Mass to the very end of his life.1 This essay is, in a way, a meditation on this fact. But it is more nearly a confrontation with Blondel's philosophical argument in defense of human action's capacity for affirming the infinite, for "containing" the infinite in its affirmation of the infinite, an affirmation achieved in action's finitude. (...) That is, this is an essay on Blondel's argument for a supernatural religion that can be literally practiced. Much like Blondel's larger philosophical works, this essay spends its time exploring the coordinating ground of supernatural religion, which is the natural world split open in two directions: in its very existence, which is a supposition of what absolutely outstrips its power; in its very action, which in ecstasy takes the shape of a desire for a reversal that it cannot offer itself. So the natural world presupposes the supernatural and desires the supernatural while remaining, of its own power, natural. Blondel makes a theoretical distinction in the universe that, concretely, is a natural–supernatural one committed to a single destiny. This theory and this concreteness cohere in order to make the literal practice of religion both possible and necessary, terms that this essay explains. [End Page 1305]Action: The Problem of Theory and PracticeBlondel's later writing in the 1930s expands on an important paradox that appears in the very early L'Action (1893). That paradox has to do with a distinction between theory—that is, the world of ideas and reflection—and practice, by which Blondel means the concrete world of human action, a world that for Blondel is an expansive range or "body" of action. It is true, after all, that an idea is not a deed. And yet no deed is without its idea, without the mediatory power of the act of consciousness, nor without the mediation of this consciousness's rationality—a further synthesizing act within consciousness—even when the deed contradicts reason. "Hence," says Blondel, "it is because we find in our acts a kind of creative sovereignty that we have a consciousness of ourselves and reason; it is because we are reasonable and conscious of ourselves that we judge ourselves capable of voluntary initiative."2 The paradox, at one angle, is this leap or gap, this difference nevertheless sustained by a mediation, where ideas and deeds are non-identical yet inseparable. At another angle, it is a paradox that a "science of practice" has to straddle, since it studies (as science) what it is not: concrete action (practice). Blondel, whether young or of his latter days, is after the possibility of such a science. He is also after the bond between reasoning and acting. In this section, I also seek that bond, and I make use of Blondel's early and later works together to give a sense not of Blondel's development, but of the Gestalt of his life's work with respect to the bond between thought and action.3The bond first requires the rejection of monism. Though Blondel's stance toward theologies of his day tends to be more well-known among theologians, and therefore filtered through questions of nature and grace and carried through to a rejection of a two-tiered conception of the universe, still, his nearer interlocutors are often monists: modern philosophers and the modern sciences, and their strange compatriots in history, the spiritual movements of the fin de siècle, involving spiritualisms of various kinds, recollected in our popular imagination today in visions of crystal balls and séance tables. The positivism of the modern sciences and of modern (French) philosophy poses a totally self-contained "nature" that can be explained [End Page 1306] without religion, in a form of what English speakers might call "secularism," but which is more accurately filtered through French Republican desires for laïcité.4 While Blondel was writing, there were not only these political and scientific and philosophical trends, but also the semi-pantheistic, variously agnostic religious movements that dominated privileged circles in Europe at the time. These are a kind of... (shrink)

The demand for science trainees to have appropriate responsible conduct of research instruction continues to increase the attention shown by federal agencies and graduate school programs to the development of effective ethics curriculums. However, it is important to consider that the main learning environment for science graduate students and post-doctoral research fellows is within a laboratory setting. Here we discuss an internal laboratory program of weekly 15-minute ethics discussions implemented and used over the last 3 years in addition to the (...) graduate school’s program of scientific integrity training. During this time, the environment and culture within our laboratory has changed to place greater emphasis on the ethical implications of our own research and the research we evaluate. We still struggle with how to accurately assess this behavioral change; although, we present preliminary survey results on the evaluation and impact of this style of curriculum for ethics instruction in our laboratory. (shrink)

This paper explores the notion of practical wisdom asan alternative to current formulations of criticalthinking. The practical realm is that ofill-structured problems that emerge from life aslived; it is a realm of legitimate uncertainty andambiguity that requires an ethical responsiveness orpractical wisdom. The death of a child is a case inpoint. The author identifies and examines threeaspects of practical wisdom – the ethical claims ofpartiality, a yielding responsiveness and the play ofthought – and juxtaposes them with aspects of criticalthinking. The (...) work of Martha Nussbaum and RichardPaul are interwoven throughout the discussion. Theauthor concludes that the discourse of criticalthinking is in danger of lapsing into a form of moralescapism wherein all we are rationally responsible foris thinking correctly. Practical wisdom, on theother hand, recognizes that thinking is not simply anintellectual cognitive act of an individual but adance between the life of a child and the love of anelder, a conversation between what is and what couldbe, an openness to passionate sorrow and surprise, aplay between understanding and perception. As such,practical wisdom provides a more likely account ofliving in good faith with oneself and others. (shrink)

Agricultural intensification and extensification are standard responses to ecological and economic vulnerability among smallholder communities. Climate change has exacerbated this vulnerability and thrown the complexity of and critical need for managing a healthy natural resource base while increasing on-farm productivity into sharp light. Sustainable intensification is one of many mechanisms for accomplishing this balancing act. This study examines the adoption of sustainable intensification practices, namely input packages focused on tef row planting—designed to boost yield and promote more efficient use of (...) inputs. This study utilized a mix methods approach to survey 115 smallholder farmers in the South Wollo zone of the Amhara region in Ethiopia. This study found that cash and capital, more so than contact with the AIS, influenced farmers’ decisions to adopt row planting input packages. Khat production was an important source of cash for inputs and was more likely to be available to farmers with irrigation schemes. Long-term, farmers who cultivate khat may not successfully engage in SI, as khat replaces traditional food crop production in the region. Yet, for farmers who do not grow khat, long-term investment in SI practices is unlikely unless access to affordable credit options is improved. (shrink)