Background: Clinical research nurses experience unique challenges in the context of their role that can lead to conflict and moral distress. Although examined in many areas, moral distress has not been studied in clinical research nurses. Research aim: The aim of this study was to examine moral distress in clinical research nurses and the relationship between moral distress scores and demographic characteristics of clinical research nurses. Research design: This was a descriptive quantitative study to measure moral distress in clinical research (...) nurses using the Measure of Moral Distress – Healthcare Professionals (MMD-HP) administered electronically. Demographic data were also collected. Participants and research context: Registered nurses working in the clinical research nurse role ( N = 322) were recruited through use of social media, emails, digital flyers, and snowball recruitment. Data was analyzed using SPSS. Pearson’s correlation, independent t-test, and one-way ANOVA were performed to explore differences among the demographic variables. Ethical considerations: This study was approved by the Institutional Review Board at Texas Woman’s University. A consent statement was included, and completion of the questionnaire was construed as consent. Findings/results: Analysis revealed a mean overall moral distress score of 79.58 (SD = 64.27) and median of 67, with a range of 0–354. Moral distress scores were negatively correlated with clinical research nurse age ( r = 0-.156, p < 0.05). Reliability of the MMD-HP was demonstrated with a Cronbach’s alpha of 0.93. Conclusions: The findings demonstrate that clinical research nurses do experience moral distress and revealed a wide range of scores. Further research is necessary to determine potential patient impact due to moral distress and to develop processes to minimize moral distress in the clinical research setting. This study was conducted during the COVID-19 pandemic, and the digital recruitment methods proved effective in recruiting a wide range of clinical research nurses, both nationally and internationally. (shrink)

Consumer demand for health information and health services has rapidly evolved to capture and even propel the movement to online health information seeking. Seventeen percent of health information internet users will look for information about memory loss, dementia and Alzheimer’s disease. We examined the content of the 25 most frequently retrieved websites marketing AD dietary supplements. We found that the majority of websites and their products claimed AD-related benefits, including improvement and enhancement of function, treatment for AD, prevention of AD, (...) maintenance of function, delayed progression of AD, and decreased symptoms. Supplements were described as effective, natural, powerful or strong, dependable and pure or of high quality. Peer reviewed references to proper scientific studies were infrequent on websites. Statements highlighting the risks of dietary supplements were as common as statements mitigating or minimizing these risks. Different strategies were used to promote supplements such as popular appeals and testimonials. Further enforcement of relevant policy is needed and preparation of clinicians to deal with requests of patients and caregivers is indicated. (shrink)

Legal decision-support systems have the potential to improve access to justice, administrative efficiency, and judicial consistency, but broad adoption of such systems is contingent on development of technologies with low knowledge-engineering, validation, and maintenance costs. This paper describes two approaches to an important form of legal decision support—explainable outcome prediction—that obviate both annotation of an entire decision corpus and manual processing of new cases. The first approach, which uses an attention network for prediction and attention weights to highlight salient case (...) text, was shown to be capable of predicting decisions, but attention-weight-based text highlighting did not demonstrably improve human decision speed or accuracy in an evaluation with 61 human subjects. The second approach, termed semi-supervised case annotation for legal explanations, exploits structural and semantic regularities in case corpora to identify textual patterns that have both predictable relationships to case decisions and explanatory value. (shrink)

Melanie presented at twenty weeks of gestation to an obstetrics clinic in a critical access hospital in rural Vermont. She was excited to undergo routine fetal ultrasonography, but her obstetrician gave her grave news: the ultrasound revealed hypoplastic left heart syndrome, a devastating congenital heart defect. Initially, Melanie agreed in general to pursue surgical care for her fetus—a three‐stage process that has somewhat uncertain results and could only be done in tertiary care facilities far from her home in Vermont. A (...) week later, while the maternal fetal medicine and pediatric cardiology units made arrangements with colleagues in Boston, Melanie began having second thoughts. An ethics meeting was called to discuss conflicting clinician reactions to Melanie's dilemma. Most of the clinicians were stunned that the patient would change her mind. What advice should the ethics consultant offer the team about caring for Melanie? (shrink)

Review of Canhada, J. M. (2023). Le discours et l’histoire: la philosophie au Brésil au dix-neuvième siècle. (F. Brandi, Trans.). Paris: Harmattan.

Authentic objects are those that have a historical link to a person, event, time, or place of some significance. The current study examines everyday beliefs about authentic objects, with three primary goals: to determine the scope of adults' evaluation of authentic objects, to examine such evaluation in two distinct cultural settings, and to determine whether a person's attachment history predicts evaluation of authentic objects. We found that college students in the UK and the USA consistently evaluate a broad range of (...) authentic items as more valuable than matched control objects, more desirable to keep, and more desirable to touch, though only non-personal authentic items were judged to be more appropriate for display in a museum. These patterns were remarkably similar across the two cultural contexts. Additionally, those who had an attachment object as a child evaluated objects more favorably, and in particular judged authentic objects to be more valuable. Altogether, these results demonstrate broad endorsement of "positive contagion" among college-educated adults. (shrink)

La especulación filosófica suele observar que lo feo y el mal carecen de entidad y que sólo pueden ser considerados como una belleza y bondad menguadas. Sin embargo, esta disminución entitativa no constituye sólo una carencia, sino que además puede ofrecer en sí la posibilidad de una belleza y un bien mayores. En este sentido, pensar la belleza del mal no ha constituido para muchos autores antiguos y medievales una imposibilidad lógica, sino por el contrario una nueva manera de hablar (...) de la Belleza del Universo. Este ha sido el parecer agustino y dionisiano, y es también el que asume la conocida Summa Halensis, aunque desde una óptica cuya originalidad radica en la integración de esas tradiciones. Analizar cómo la Summa Halensis entiende que la belleza es capaz de integrar a lo malo, es la intención del presente trabajo. (shrink)

No hay duda que la cuestión de los trascendentales y su posible distinción atrajo la atención de los pensadores del siglo XIII. Sin embargo, este tema siguió caminos diversos. En tal sentido, la Summa Halensis propone un abordaje que no sólo delimita cada transcendental en sí, sino que además los incorpora al plano soteriológico humano. Así, el presente trabajo se ocupará de ambos aspectos.

This essay explores the relationship between nature and grace and the theological impact of this relationship on feminist anthropological debates. Engaging this debate through an examination and critique of Serene Jones’ ‘eschatological essentialism’, this essay suggests that Jones mistakenly characterizes constructivism, and thus turns too quickly to an essentialist paradigm without considering its risks. Using Judith Butler and Karl Barth, this essay proposes an account of identity that the author calls a ‘Christological constructivism’. Suggesting that the person and work of (...) Christ instantiates a grace that disrupts nature, Daniels argues for an account of identity as ‘more-than’, suggesting that this anthropology engenders healing for women, and men, within communities religious and otherwise. (shrink)

Ecclesial practices have long served as a resource in and for Christian ethical scholarship; drawing on both the postliberal tradition and critical identity studies, a number of contemporary theologians and ethicists have turned to ecclesial practices as a liberative resource for marginalized identities and oppressed communities. Through a close reading of two contemporary examples of this ethical approach, this essay outlines and critically examines how Christian identity, belonging, and practice function discursively, subsuming difference into religious sameness, in ways that perpetuate (...) the systemic and social injustices they aim to address and combat. Drawing on recent critiques of the theo-ethical turns to practice by Katie Grimes and Lauren Winner, and on feminist philosopher Lynne Huffer’s ethics of narrative performance, this essay proposes a more critical attention to difference for and within ethical turns to Christian practices, and begins to outline potential paths forward. (shrink)

Review of Joel Faflak. Romantic Psychoanalysis: The Burden of the Mystery. Albany: State University of New York Press, 2008. 333 pages; paper $29.95. ISBN 978-0-7914-7269-0.

When I was a 7 months pregnant medical student, an attending surgeon asked me to which specialty I would be applying. When I replied that I was hoping to match in general surgery, he touched my pregnant abdomen and said, “Not with that you’re not.” I am not alone. Gender bias and discrimination have been shown to negatively impact women surgeons throughout their careers and deter women from even applying in surgical fields.1 Bias against female surgical trainees leads to less (...) operative autonomy and higher dropout rates.2 3 Once faculty, women surgeons are less likely to reach leadership roles.4 Recent studies confirm the author’s assertion that implicit biases create substantial harm. The author has undertaken an important study, conducting in-depth interviews with 46 women surgeons in Australia that identifies four distinct types of bias causing cumulative harm. In all four types of biases: Workplace factors including leave policies and mentorship. Epistemic injustices, or unfair assessments of women surgeons’ credibility by patients and colleagues. Stereotyped expectations. Objectification, implicit biases were seen. While many of the broad factors impeding women in surgery are well known, the author argues that these subtler factors, including both implicit bias and epistemic injustice, have a large impact. The …. (shrink)

Until very recently, feminist criticism has not had a theoretical basis; it has been an empirical orphan in the theoretical storm. In 1975, I was persuaded that no theoretical manifesto could adequately account for the varied methodologies and ideologies which called themselves feminist reading or writing.1 By the next year, Annette Kolodny had added her observation that feminist literary criticism appeared "more like a set of interchangeable strategies than any coherent school or shared goal orientation."2 Since then, the expressed goals (...) have not been notably unified. Black critics protest the "massive silence" of feminist criticism about black and Third-World women writers and call for a black feminist aesthetic that would deal with both racial and sexual politics. Marxist feminists wish to focus on class along with gender as a crucial determinant of literary production. Literary historians want to uncover a lost tradition. Critics trained in deconstructionist methodologies with to "synthesize a literary criticism that is both textual and feminist." Freudian and Lacanian critics want to theorize about women's relationship to language and signification.· 1. See my "Literary Criticism," Signs 1 : 435-60.· 2. Annette Kolodny, "Literary Criticism," Signs 2 : 420.Elaine Showalter is professor of English at Rutgers University. The author of A Literature of Their Own: British Women Novelists from Bronte to Lessing, she is currently completing The English Malady, a study of madness, literature, and society in England. (shrink)

Overdose deaths involving prescription opioids killed more than 17,000 Americans in 2017, marking a five-fold increase since 1999. High prescribing rates of opioid analgesics have been a substantial contributor to prescription opioid misuse, dependence, overdose and heroin use. There was recognition approximately ten years ago that opioid prescribing patterns were contributing to this startling increase in negative opioid-related outcomes, and federal actions, including Medicare reimbursement reform and regulatory actions, were initiated to restrict opioid prescribing. The current manuscript is a description (...) of those actions, the effect of those actions on opioid prescribing and related patient outcomes. We also describe our proposal of methods of expanding these efforts as an important piece to further reduce opioid-related misuse, dependence, and overdose death. (shrink)

In the ontology of the artwork and its regimes of existence, Gérard Genette gives but little room to the theory and practice of restoration. However, restoration is seen in relation to the identity of the work itself and to its material and pragmatic temporality and anachronism. In the wake of Nelson Goodman, it is also understood as a form of actuation and implementaion of the aesthetic experience. Starting from these premises, the present essay intends to examine the relationship between Genette’s (...) and Daniel Arasse’s reflections on restoration and the history of art, highlighting their similarities and differences with Cesare Brandi’s theory of restoration and, therefore, pointing out their as yet undischarged debts to Sartre’s phenomenology of image. (shrink)

Within the deep philosophical reflection of the thirteenth century are commonly heard names such as Albertus Magnus, Thomas Aquinas and Bonaventure. However, little is said of those disciples of lesser brilliance who spread the thought of their teachers. Such is the case of Ulrich of Strasbourg. This Dominican friar, a fellow student of Thomas Aquinas in Cologne, studied under Albertus Magnus the De Divinis nominibus of Pseudo-Dionysius. Years later, Ulrich wrote a work called Summa de bono where, in dealing with (...) beauty, a unique Neoplatonic synthesis operates, but from the original perspective of his master. This paper analyses the concept of beauty present in Ulrich of Strasbourg to show how there is as much clear dependence on Albertian Neoplatonism as there is originality in the presentation of the topic. (shrink)

The global COVID-19 pandemic has created a crisis of suffering. We conceptualize suffering as a deeply existential issue that fundamentally changes people indelible ways and for which there are no easy solutions. To better understand its effects and how people can flourish in the midst of this crisis, we formally introduce and elaborate on an Existential Positive Psychology Model of Suffering (EPPMS) and apply that to the COVID-19 global pandemic. Our model has three core propositions: (a) suffering reveals existential concerns, (...) (b) existential anxiety impairs one's ability to find meaning, and (c) cultivating meaning is the primary way to address suffering and allay existential anxiety, eventually leading to flourishing (and potentially growth). We apply this model to the COVID-19 pandemic, including how to build meaning, and discuss clinical implications. (shrink)

Conley and colleagues (2023) conduct a fascinating analysis of how influential organizations in the global governance of human genome editing debate conceptualize and perform public engagement. Whi...

Emotion regulation (i.e. either up- or down-regulating affective responses to emotional stimuli) has been shown to modulate long-term emotional memory formation. Further, research has demonstrated that the emotional aspects of scenes are preferentially remembered relative to neutral aspects (known as the emotional memory trade-off effect). This trade-off is often enhanced when sleep follows learning, compared to an equivalent period of time spent awake. However, the interactive effects of sleep and emotion regulation on emotional memory are poorly understood. We presented 87 (...) participants with pictures of neutral or negative objects on neutral backgrounds paired with instructions to either increase or decrease their emotional response by altering personal relevance, or to passively view the stimuli. Following a 12 h period of sleep or wakefulness, participants were tested for their memory of objects and backgrounds separately. Although we replicated the emotional memory trade-off effect, no differences in the magnitude of the trade-off effect were observed between regulation conditions. Sleep improved all aspects of memory, but it did not preferentially benefit memory for emotional components of scenes. Irrespective of a period of sleep or wake following encoding, findings suggest emotion regulation during encoding did not influence memory for emotional items at a 12-hour delay. (shrink)

As they age, many people are afraid that they might become a burden to their families and friends. In fact, fear of being a burden is one of the most frequently cited reasons for individuals who request physician aid in dying. Why is this fear so prevalent, and what are the issues underlying this concern? I argue that perceptions of individual autonomy, dependency, and dignity all contribute to the fear of becoming a burden. However, this fear is misplaced; common conceptions (...) of these values should be re-framed and re-examined. Practices that support a more community-centered type of autonomy can be found in dependency and dignity. This paper offers some practical examples of how to address common end-of-life situations that may cause anxiety to patients who are worried about being a burden. These practices include discussing expectations, both for care and how the relationship among the participants might change, and modeling respectful caregiving behaviors. Most difficult of all, though, includes cultural and societal attitude changes so that people recognize the good in receiving care and get used to the idea that they do not need to do anything to be valuable. (shrink)

This article offers a critique and reconstruction of the concept of medicalization. Most researchers describe medicalization as the redefinition of social problems as medical concerns, and track its spread by the proliferation of disease language and diagnostic categories. Forensic psychiatry and disorders like psychopathy are often cited in these debates. I argue that focusing on discourse overlooks how medical language can justify or mask non-medical practices and outcomes, and lead researchers to identify medicalization where it has not occurred. Building on (...) other critiques of medicalization and recent studies of medical and legal expertise, I propose an alternative conception based on conditions for the performance of medical practice and other forms of expert labor. I distinguish the participation or intervention of medical practitioners from the medicalization of expert practice and identify several institutional factors that facilitate the latter. I illustrate this approach using a critical historical case: the first adult penal psychiatric clinic in the United States, founded by the eminent psychopathologist Bernard Glueck at New York’s Sing Sing Prison in 1916. Glueck’s extensive writings reveal little evidence of medicalization: psychopaths were largely defined and diagnosed according to penal rather than medical criteria, and they received additional punishment rather than treatment. A review of recent research confirms that psychopathy remains primarily a penal rather than medical condition. I conclude that focusing studies of medicalization on practice rather than discourse clarifies the concept and avoids reifying the notion of a medicalized society. (shrink)

Plasminogen activator inhibitor‐1 (PAI‐1) is a physiological inhibitor of urokinase (uPA), a serine protease known to promote cell migration and invasion. Intuitively, increased levels of PAI‐1 should be beneficial in downregulating uPA activity, particularly in cancer. By contrast, in vivo, increased levels of PAI‐1 are associated with a poor prognosis in breast cancer. This phenomenon is termed the “PAI‐1 paradox”. Many factors are responsible for the upregulation of PAI‐1 in the tumor microenvironment. We hypothesize that there is a breast cancer (...) predisposition to a more aggressive stage when PAI‐1 is upregulated as a consequence of Metabolic Syndrome (MetS). MetS exerts a detrimental effect on the breast tumor microenvironment that supports cancer invasion. People with MetS have an increased risk of coronary heart disease, stroke, peripheral vascular disease and hyperinsulinemia. Recently, MetS has also been identified as a risk factor for breast cancer. We hypothesize the existence of the “PAI‐1 cycle”. Sustained by MetS, adipocytokines alter PAI‐1 expression to promote angiogenesis, tumor‐cell migration and procoagulant microparticle formation from endothelial cells, which generates thrombin and further propagates PAI‐1 synthesis. All of these factors culminate in a chemotherapy‐resistant breast tumor microenvironment. The PAI‐1 cycle may partly explain the PAI‐1 paradox. In this hypothesis paper, we will discuss further how MetS upregulates PAI‐1 and how an increased level of PAI‐1 can be linked to a poor prognosis. BioEssays 29:1029–1038, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

The vast network of Drosophila geneticists spawned by Thomas Hunt Morgan's fly room in the early 20th century has justifiably received a significant amount of scholarly attention. However, most accounts of the history of Drosophila genetics focus heavily on the "boss and the boys," rather than the many other laboratory groups which also included large numbers of women. Using demographic information extracted from the Drosophila Information Service directories from 1934 to 1970, we offer a profile of the gendered division of (...) labor within Drosophila genetics in the United States during the middle decades of the 20th century. Our analysis of the gendered division of labor supports a reconsideration of laboratory practices as different forms of work. (shrink)

While the list of 17 Sustainable Development Goals proposed by the United Nations’ Open Working Group comprises a catalog of highly important post-2015 development priorities, one of the key issue that has not received the attention it deserves is the need to safeguard the Earth's life-support system. Over the course of the past decades, we have concentrated much more on socioeconomic development rather than on environmental sustainability while putting a number of the Earth's systems at risk, and with it poverty (...) eradication and sustainable development. There is thus a need to put the spotlight on global environmental change and to take account of the insights from the latest Earth system science and its implications for the future of global development and global ethics. The ongoing debate on the post-2015 SDGs offers an important occasion for this endeavor. Going beyond the current proposal of the Open Working Group and building on the planetary boundaries or guard rails framework, the SDGs.. (shrink)

This is a reproduction of a book published before 1923. This book may have occasional imperfections such as missing or blurred pages, poor pictures, errant marks, etc. that were either part of the original artifact, or were introduced by the scanning process. We believe this work is culturally important, and despite the imperfections, have elected to bring it back into print as part of our continuing commitment to the preservation of printed works worldwide. We appreciate your understanding of the imperfections (...) in the preservation process, and hope you enjoy this valuable book. (shrink)

This paper examines the nexus between climate change and trade governance from a normative perspective. Only little research attention has been paid to assessing the interactions between empirical and normative approaches to climate change in the context of potential trade measures. To this end, the paper focuses on currently discussed border carbon adjustment measures. The paper assesses these trade measures from a normative perspective: it explores whether they are compatible or in conflict with development ethics on the one hand and (...) with climate ethics on the other. The paper finds that border adjustment measures are both a potential threat to development, as well as to a workable climate agreement. It argues that they are therefore both in conflict with development as well as climate ethics concerns. From a development ethics perspective, border adjustment measures are objectionable for two reasons. First, they hurt developing countries and above all the ones that are vulnerable in terms of relying only on few export goods. Second, border adjustment measures restrict market access for developing countries and thereby undermine the potential of trade to foster development. From a climate ethics perspective, border adjustment measures are objectionable for three reasons. First, border adjustment measures amount to unilaterally changing whatever global burden-sharing deal has been agreed to—thereby undermining procedural justice. Second, border adjustment measures disregard the consumption-dimension: it might be questioned whether it is fair to focus exclusively on making producers pay for emissions rather than also holding those responsible that import and consume the goods that incorporate these emissions. Third, even if border adjustment measures and countries with low emissions are exempted from border adjustment measures, they still burden countries that bear no historic responsibility for current high levels of greenhouse gases in the atmosphere, thereby undermining distributive justice by being in conflict with the polluter pays principle. (shrink)

Przedmiotem rozważań artykułu jest próba określenia postaci występujących w twórczości dramatycznej znanego pisarza austriackiego, tworzącego w okresie międzywojennym, Ödöna von Horvátha. Przystępując do analizy poszczególnych postaci autorka artykułu przyjmuje za punkt wyjścia stwierdzenie samego pisarza na temat własnej twórczości, której posłannictwo widział w wypełnieniu dwóch zadań: w zwalczaniu wszelkiej głupoty i kłamstwa oraz w walce o zwycięstwo rozsądku i prawości. Walkę tę podjął przez „rejestrowanie“ różnych form zachowań ludzkich, na które składała się sytuacja polityczno-gospodarcza lat międzywojennych. W centrum zainteresowania pisarza (...) znajduje się zawsze drobnomieszczanin. Ho rv a th próbuje określić jego stanowisko wobec problemów społecznych, kulturalnych i politycznych, posługując się przy tym niepowtarzalną satyrą, humorem, symboliką i muzyką. Pisarz szczególnie ostro atakuje obojętność ludzi wobec losu innych oraz okrucieństwo zawarte w ich postępowaniu. Świadomie nawiązuje przy tym d o tradycji wiedeńskiej sztuki ludowej, w tym przede wszystkim do głównych jej przedstawicieli Ferdinanda Raimunda i Johanna Nepomuka Nestroya. (shrink)

This current wave of globalization is perpetuating the sex trade in the form of human trafficking by providing new, cheaper and easier methods for enabling the movement of humans across borders and markets. Examines the the causes and consequences of human trafficking as well as the specific movements that have taken action against this ever-growing and changing market.

By examining the methods of prevention and mediation employed by the UN during the Rwandan and Bosnian genocides, this essay will argue that the dispute resolution approaches taken by the UN are vague and ineffective, and instead rely much too heavily on the tribunals that follow genocide.