Newborn bloodspot screening programs are some of the longest running population screening programs internationally. Debate continues regarding the need for parents to give consent to having their child screened. Little attention has been paid to how meanings of consent-related terminology vary among stakeholders and the implications of this for practice. We undertook semi-structured interviews with parents, healthcare professionals and policy decision makers in two Canadian provinces. Conceptions of consent-related terms revolved around seven factors within two broad domains, decision-making and information (...) attainment. Decision-making comprised: parent decision authority; voluntariness; parent engagement with decision-making; and the process of enacting choice. Information ascertainment comprised: professional responsibilities ; parent responsibilities; and the need for discussion and understanding prior to a decision. Our findings indicate that consent-related terms are variously understood, with substantive implications for practice. We suggest that consent procedures should be explained descriptively, regardless of approach, so there are clear indications of what is expected of parents and healthcare professionals. Support systems are required both to meet the educational needs of parents and families and to support healthcare professionals in delivering information in a manner in keeping with parent needs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Christian Ethics: A Very Short Introduction, and: Christian Ethics: A Brief History, and: Behaving in Public: How to Do Christian EthicsBeth K. HaileChristian Ethics: A Very Short Introduction D. Stephen Long Oxford: Oxford University Press, 2010. 144 pp. $11.95Christian Ethics: A Brief History Michael Banner West Sussex, UK: Wiley-Blackwell, 2009. 160 pp. $24.95Behaving in Public: How to Do Christian Ethics Nigel Biggar Grand Rapids, Mich.: Eerdmans, 2011. 142 (...) pp. $16.00In calling ethics “Christian,” the question of distinctiveness, or the normative force of theological claims, inevitably arises. Three new books explore what Christian ethics looks like if it is to take seriously its theological basis for engaging the world.Stephen D. Long, professor of systematic theology at Marquette University, attends to the difficulties in predicating “Christian” of “ethics,” yet he is concerned more with explaining how Christianity can be ethical rather than vice versa. His Christian Ethics: A Very Short Introduction opens with a quote from Christopher Hitchens and later dedicates almost an entire chapter to analyzing the failures of Christian ethics. From the Crusades to colonialism, the Galileo affair to slavery, Long provocatively asks whether modern ethics emerges as a result of the failure of Christian moral claims. While not sidestepping the difficulties in Christian history, Long is careful to note how this history is often distorted to serve the goals of contemporary secular politics, goals which he points out have resulted in the bloody failures of the twentieth century. Perhaps a renewed interest in Christian ethics, Long notes, is a result of the failures of secularism.Long manages to cover a surprising breadth of material in his brief book, from a sweeping historical overview of Christian theology to a final chapter on [End Page 195] the practical matters of sex, money, and political power. Long also summarizes some important theological differences among Christians that lead to practical disagreements about the nature of Christian ethics. His overview of the Catholic-Lutheran convergence on matters of faith and works is particularly helpful in establishing the theological basis for an ecumenical Christian ethics. This historical survey serves to illustrate that ethics is both an integral part of and a contradiction to Christianity. Still, argues Long, while Christianity may claim to be more than ethical, it may never claim to be less.While commendable in breadth, the genre of the “very short introduction” precludes depth and must necessarily omit important information. In his summary of Catholic ethics, for example, Long addresses nominalism and probabilism but omits the Catholic social tradition, a particularly glaring omission given his topic. In the end, the target audience is the educated and curious layperson, more suitable for a church group than a classroom, though this is reflective of the nature of “the very short introduction” series and does not indicate any limitation in Long’s skill as a scholar.In the spirit of brevity, Michael Banner, Fellow of Trinity College in Cambridge, offers Christian Ethics: A Brief History, which, like any brief history, paints with broad and admittedly selective strokes. The aim of this work is not to evaluate the normative value of Christian claims but rather to establish the ethical implications of Christian belief. Unlike Long, who directly addresses the ethical failures of the church, Banner is more apologetic. In clarifying the difficulties of writing a text such as this one, he observes that Christian history has not been guided by texts as much as by action. In this vein, Banner begins not chronologically but with the Rule of St. Benedict and its call to live in a relationship with God and neighbor characterized by love.Banner grounds the theoretical dimension of Christian ethics in this emphasis on practice. Given the way of life Christians are called to, what are its limitations and possibilities? Banner turns to Augustine’s notion of the weakness of the will and the human creature’s need for grace, which he then places in creative tension with Aquinas’s emphasis on the harmony between faith and reason. In somewhat breathtaking conciseness, Banner describes how the Scholastic emphasis on natural law, casuistry, and the categorizing of sins led to what he calls... (shrink)

The authors report and comment on student reactions to a clinical example of moral choice in the microallocation of scarce resources. Four patients require dialysis simultaneously, but only one kidney machine is available. What moral, as opposed to clinical, criteria are available to determine who should have priority?

**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)

To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration (VA) facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients (n = 32) and managers (n = 38); semi-structured interviews with managers (n = 31), clinicians (n = 55), and ethics committee chairpersons (n = 21). Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly (...) distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions. (shrink)

The use of digital presentation tools such as PowerPoint is ubiquitous; however we still do not know much about the persuasiveness of these programs. Examining the use of visual analogy and visual chronology, in particular, this paper explores the use of visual argumentation in a Keynote presentation by Al Gore. It illustrates how images function as an integrated part of Gores reasoning.

To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients and managers ; semi-structured interviews with managers, clinicians, and ethics committee chairpersons. Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on (...) patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions. (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)

BackgroundThe preferable position of Deep Brain Stimulation electrodes is proposed to be located in the dorsolateral subthalamic nucleus to improve general motor performance. The optimal DBS electrode localization for the post-operative improvement of balance and gait is unknown.MethodsIn this single-center, retrospective analyses, 66 Parkinson’s disease patients were assessed pre- and post-operatively by using MDS-UPDRS, freezing of gait score, Giladi’s gait and falls questionnaire and Berg balance scale. The clinical outcome was related to the DBS electrode coordinates in x, y, z (...) plane as revealed by image-based reconstruction. Binomial generalized linear mixed models with fixed-effect variables electrode asymmetry, parkinsonian subtype, medication, age class and clinical DBS induced changes were analyzed.ResultsSubthalamic nucleus-deep brain stimulation improved all motor, balance and FoG scores in MED OFF condition, however there were heterogeneous results in MED ON condition. DBS electrode reconstructed coordinates impacted the responsiveness of axial symptoms. FoG and balance responders showed slightly more medially located STN electrode coordinates and less medio-lateral asymmetry of the electrode reconstructed coordinates across hemispheres compared to non-responders.ConclusionDeep brain stimulation electrode reconstructed coordinates, particularly electrode asymmetry on the medio-lateral axis affected the post-operative responsiveness of balance and FoG symptoms in PD patients. (shrink)

BackgroundFreezing of gait is a disabling burden for Parkinson’s disease patients with poor response to conventional therapies. Combined deep brain stimulation of the subthalamic nucleus and substantia nigra moved into focus as a potential therapeutic option to treat the parkinsonian gait disorder and refractory FoG. The mechanisms of action of DBS within the cortical-subcortical-basal ganglia network on gait, particularly at the cortical level, remain unclear.MethodsTwelve patients with idiopathic PD and chronically-implanted DBS electrodes were assessed on their regular dopaminergic medication in (...) a standardized stepping in place paradigm. Patients executed the task with DBS switched off, conventional STN DBS and combined STN+SN DBS and were compared to healthy matched controls. Simultaneous high-density EEG and kinematic measurements were recorded during resting-state, effective stepping, and freezing episodes.ResultsClinically, STN+SN DBS was superior to conventional STN DBS in improving temporal stepping variability of the more affected leg. During resting-state and effective stepping, the cortical activity of PD patients in STIM OFF was characterized by excessive over-synchronization in the theta, alpha, and high-beta band compared to healthy controls. Both active DBS settings similarly decreased resting-state alpha power and reduced pathologically enhanced high-beta activity during resting-state and effective stepping compared to STIM OFF. Freezing episodes during STN DBS and STN+SN DBS showed spectrally and spatially distinct cortical activity patterns when compared to effective stepping. During STN DBS, FoG was associated with an increase in cortical alpha and low-beta activity over central cortical areas, while with STN+SN DBS, an increase in high-beta was prominent over more frontal areas.ConclusionsSTN+SN DBS improved temporal aspects of parkinsonian gait impairment compared to conventional STN DBS and differentially affected cortical oscillatory patterns during regular locomotion and freezing suggesting a potential modulatory effect on dysfunctional cortical-subcortical communication in PD. (shrink)

Background: The Parkinsonian [i.e., Parkinson's disease ] gait disorder represents a therapeutical challenge with residual symptoms despite the use of deep brain stimulation of the subthalamic nucleus and medical and rehabilitative strategies. The aim of this study was to assess the effect of different DBS modes as combined stimulation of the STN and substantia nigra and environmental rehabilitative factors as footwear on gait kinematics.Methods: This single-center, randomized, double-blind, crossover clinical trial assessed shod and unshod gait in patients with PD with (...) medication in different DBS conditions during different gait tasks and compared gait characteristics to healthy controls. Notably, 15 patients participated in the study, and 11 patients were analyzed after a dropout of four patients due to DBS-induced side effects.Results: Gait was modulated by both factors, namely, footwear and DBS mode, in patients with PD. Footwear impacted gait characteristics in patients with PD similarly to controls with longer step length, lower cadence, and shorter single-support time. Interestingly, DBS exerted specific effects depending on gait tasks with increased cognitive load. STN+SN DBS was the most efficient DBS mode compared to STIM OFF and STN DBS with intense effects as step length increment during dual task.Conclusion: The PD gait disorder is a multifactorial symptom, impacted by environmental factors as footwear and modulated by DBS. DBS effects on gait were specific depending on the gait task, with the most obvious effects with STN+SN DBS during gait with increased cognitive load. (shrink)

We present a one per cent measurement of the cosmic distance scale from the detections of the baryon acoustic oscillations in the clustering of galaxies from the Baryon Oscillation Spectroscopic Survey, which is part of the Sloan Digital Sky Survey III. Our results come from the Data Release 11 sample, containing nearly one million galaxies and covering approximately 8500 square degrees and the redshift range 0.2 < z < 0.7. We also compare these results with those from the publicly released (...) DR9 and DR10 samples. Assuming a concordance Λ cold dark matter cosmological model, the DR11 sample covers a volume of 13 Gpc3 and is the largest region of the Universe ever surveyed at this density. We measure the correlation function and power spectrum, including density-field reconstruction of the BAO feature. The acoustic features are detected at a significance of over 7σ in both the correlation function and power spectrum. Fitting for the position of the acoustic features measures the distance relative to the sound horizon at the drag epoch, rd, which has a value of rd,fid = 149.28 Mpc in our fiducial cosmology. We find DV = at z = 0.32 and DV = at z = 0.57. At 1.0 per cent, this latter measure is the most precise distance constraint ever obtained from a galaxy survey. Separating the clustering along and transverse to the line of sight yields measurements at z = 0.57 of DA = and H =. Our measurements of the distance scale are in good agreement with previous BAO measurements and with the predictions from cosmic microwave background data for a spatially flat CDM model with a cosmological constant. © 2014 The Author Published by Oxford University Press on behalf of the Royal Astronomical Society. (shrink)

This review assesses a rare and insightful philosophical examination of the ethics of the medical management of sex-atypical children. In Making Sense of Intersex, Ellen K. Feder crafts an ethics that would shift several common foci of the contemporary debate on her topic: from questions of gender to the ethics of normalization; from individual or parental autonomy to a general corporeal vulnerability; and from parental medical proxy rights to the interdependency of parent-child relations. The review identifies some seemingly unavoidable conundrums (...) that would remain unsolved after such shifts: the continuing role of gender in normalizing medical aims, the utility of an undifferentiated concept of vulnerability in medical decision making, and the place of cosmetic medicine in general. (shrink)

This collection of thirteen essays, when viewed together, offers a unique perspective on the history of American philosophy. It illuminates for the first time in book form, how thirteen major American philosophical thinkers viewed a problem of special interest in the American philosophical tradition: the relationship between experience and reflection. Written by well-known authorities on the figure about which he or she writes, the essays are arranged chronologically to highlight the changes and developments in thought from Puritanism to Pragmatism to (...) Process Philosophy. While Doctrine and Experience will be of particular interest to specialists in American Philosophy, there is also much to offer anyone interested in the intellectual and cultural history of the United States. In order of appearance, the essays are: "Jonathan Edwards and the Great Awakening" by John E. Smith "Heart and Head: The Mind of Thomas Jefferson" by Andrew J. Reck"Emerson and the American Future" by Robert C. Pollock"Chauncey Wright and the Pragmatists" by Edward Madden"Charles S. Peirce: Action Through Thought – The Ethics of Experience" by Vincent G. Potter"Life Is in the Transitions’: Radical Empiricism and Contemporary Concerns" by John J. McDermott"John Dewey and the Metaphysics of American Democracy" by Ralph W. Sleeper"Individualization and Unification in Sartre and Dewey" by Thelma Z. Levine"Josiah Royce: Anticipator of European Existentialism and Phenomenology" by Jacqueline Ann K. Kegley"The Transcendence of Materialism and Idealism in American Thought" by John Lachs"C. I. Lewis and the Pragmatic Tradition in American Philosophy" by Sandra Rosenthal"The Social Philosophy of George Herbert Mead" by David Miller"Existence as Transaction: A Whiteheadian Study of Causality" by Elizabeth Kraus. (shrink)