Background Stroke is a worldwide problem with a limited number of approved treatments. Obtaining informed consent for acute stroke therapy is complicated by the breadth of information that must be communicated in a short period of time, the hectic nature of the emergency environment, the possible lack of understanding by the patient and/or family, and the critically time-sensitive nature of treatment for stroke. Complicating matters even further, patients are often unable to consent for themselves, placing the burden on surrogates to (...) infer patients’ wishes regarding treatment, and potentially limiting acute treatment by practitioners. Innovation An advance directive for acute stroke therapy was created, entitled COAST (Coordinating Options for Acute Stroke Therapy). This clinical initiative is being piloted at a large comprehensive stroke center, including the development of the advance directive form, integration of the form with electronic medical records, training healthcare providers, and outreach to patients. Conclusions COAST is an advance directive for stroke designed to make stroke care more efficient, optimize patients’ autonomy, improve the quality of healthcare, and streamline the ethical management of complex care decisions in acute stroke. The inherent benefit of COAST is in providing patients and their families with more information regarding stroke and its treatment options, allowing them to take a more active role in their care. (shrink)

New Approaches to Religion and the Enlightenment examines religious belief and practice during the age of Enlightenment from a range of disciplinary perspectives, including theology, the natural sciences, politics, the law, art, philosophy, and literature.

This paper presents an integrative, descriptive model of ethical decision making, with special attention given to issues of measurement. After building the model, hypotheses are developed from a portion of it. These hypotheses are tested in an exploratory analysis to determine if further research and testing of this model and the measurement instruments it employs are warranted.

While outcomes for children with T-cell acute lymphoblastic leukemia have improved dramatically, survival rates for patients with relapsed/refractory disease remain dismal. Prior studies indicate that glucocorticoid resistance is more common than resistance to other chemotherapies at relapse. In addition, failure to clear peripheral blasts during a prednisone prophase correlates with an elevated risk of relapse in newly diagnosed patients. Here we show that intrinsic GC resistance is present at diagnosis in early thymic precursor T-ALLs as well as in a subset (...) of non-ETP T-ALLs. GC-resistant non-ETP T-ALLs are characterized by strong induction of JAK/STAT signaling in response to interleukin-7 stimulation. Removing IL7 or inhibiting JAK/STAT signaling sensitizes these T-ALLs, and a subset of ETP T-ALLs, to GCs. The combination of the GC dexamethasone and the JAK1/2 inhibitor ruxolitinib altered the balance between pro- and anti-apoptotic factors in samples with IL7-dependent GC resistance, but not in samples with IL7-independent GC resistance. Together, these data suggest that the addition of ruxolitinib or other inhibitors of IL7 receptor/JAK/STAT signaling may enhance the efficacy of GCs in a biologically defined subset of T-ALL.Leukemia advance online publication, 30 May 2017; doi:10.1038/leu.2017.136. (shrink)

Higher education has expanded at astonishing rates around the world. We seek to understand the oppositions that periodically arise, which may produce enrollment declines and/or imposition of political controls. The post-1945 growth of higher education was – to a greater extent than is often recognized – propelled by the liberal, and later neoliberal, international order. Oppositions arise from illiberal alternatives, which also may organize globally. The recent weakening of the global liberal order, associated with growing populism and nationalism, creates conditions (...) for a new wave of oppositions. We hypothesize that attacks on higher education emerge in countries less integrated into world society and in countries linked to international structures that support illiberal alternatives. We examine cross-national data on higher education over the period 1960–2017. Enrollments and funding are higher in societies more tightly linked to world society and lower in countries tied to illiberal international organizations. Analyses of enrollments in various fields, constraints on academic freedom, and terrorist attacks on education institutions show similar pattern. Finally, we observe heterogeneity in the forms of illiberal opposition: countries that suppress academic freedom generally are less likely to restrict enrollments. (shrink)

Humans’ indigenous microbes strongly influence organ functions in an age‐ and diet‐dependent manner, adding an important dimension to aging biology that remains poorly understood. Although age‐related differences in the gut microbiota composition correlate with age‐related loss of organ function and diseases, including inflammation and frailty, variation exists among the elderly, especially centenarians and people living in areas of extreme longevity. Studies using short‐lived as well as nonsenescent model organisms provide surprising functional insights into factors affecting aging and implicate attenuating effects (...) of microbes as well as a crucial role for certain transcription factors like forkhead box O. The unexpected beneficial effects of microbes on aged animals imply an even more complex interplay between the gut microbiome and the host. The microbiome constitutes the major interface between humans and the environment, is influenced by biosocial stressors and behaviors, and mediates effects on health and aging processes, while being moderated by sex and developmental stages. (shrink)

Acquiring perceptual expertise is slow and effortful. However, untrained novices can accurately make difficult classification decisions by reformulating the task as similarity judgment. Given a query image and a set of reference images, individuals are asked to select the best matching reference. When references are suitably chosen, the procedure yields an implicit classification of the query image. To optimize reference selection, we develop and evaluate a predictive model of similarity-based choice. The model builds on existing psychological literature and accommodates stochastic, (...) dynamic shifts of attention among visual feature dimensions. We perform a series of human experiments with two stimulus types and nine classification tasks to validate the model and to demonstrate the model's potential to boost performance. Our system achieves high accuracy for participants who are naive as to the classification task, even when the classification task switches from trial to trial. (shrink)

De Neys offers a welcome departure from the dual-process accounts that have dominated theorizing about reasoning. However, we see little justification for retaining the distinction between intuition and deliberation. Instead, reasoning can be treated as a case of multiple-cue decision making. Reasoning phenomena can then be explained by decision-making models that supply the processing details missing from De Neys's framework.

Does exploration of the gut microbiota–brain axis expand our understanding of what it means to be human? Recognition and conceptualization of a gut microbiota–brain axis challenges our study of the nervous system. Here, integrating gut microbiota–brain research into the metaorganism model is proposed. The metaorganism—an expanded, dynamic unit comprising the host and commensal organisms—asserts a radical blurring between man and microbe. The metaorganism nervous system interacts with the exterior world through microbial‐colored lenses. Ongoing studies have reported that gut microbes contribute (...) to brain function and pathologies, even shaping higher neurological functions. How will continued collaborative efforts (e.g., between neurobiology and microbiology), including partnerships with the arts (e.g., philosophy), contribute to the knowledge of microbe‐to‐mind interactions? While this is not a systemic review, this nascent field is briefly described, highlighting ongoing challenges and recommendations for emerging gut microbiota–brain research. Also see the video abstract here https://youtu.be/lP9gOW8StXg. (shrink)

Research Ethics, Volume 18, Issue 1, Page 64-83, January 2022. Automated, wearable cameras can benefit health-related research by capturing accurate and objective information about individuals’ daily experiences. However, wearable cameras present unique privacy- and confidentiality-related risks due to the possibility of the images capturing identifying or sensitive information from participants and third parties. Although best practice guidelines for ethical research with wearable cameras have been published, limited information exists on the risks of studies using wearable cameras. The aim of this (...) literature review was to survey risks related to using wearable cameras, and precautions taken to reduce those risks, as reported in empirical research. Forty-five publications, comprising 36 independent studies, were reviewed, and findings revealed that participants’ primary concerns with using wearable cameras included physical inconvenience and discomfort in certain situations. None of the studies reviewed reported any serious adverse events. Although it is possible that reported findings do not include all risks experienced by participants in research with wearable cameras, our findings suggest a low level of risk to participants. However, it is important that investigators adopt recommended precautions, which can promote autonomy and reduce risks, including participant discomfort. (shrink)

For all of the emphasis on quality improvement—as well as the acknowledged overlap between assessment of the quality of healthcare services and clinical ethics—the quality of clinical ethics consultation has received scant attention, especially in terms of empirical measurement. Recognizing this need, the second edition of Core Competencies for Health Care Ethics Consultation identified four domains of ethics quality: (1) ethicality, (2) stakeholders’ satisfaction, (3) resolution of the presenting conflict/dilemma, and (4) education that translates into knowledge. This study is the (...) first, to our knowledge, to directly measure all of these domains. Here we describe the quality improvement process undertaken at a tertiary care academic medical center, as well as the tools developed to measure the quality of ethics consultation, which include post-consultation satisfaction surveys and weekly case conferences. The information gained through these tools helps to improve not only the process of ethics consultation, but also the measurement and assurance of quality. (shrink)

Access to abortion services in the United States continues to decline. It does so not because of significant changes in legislation or court rulings but because fewer and fewer physicians wish to perform abortions and because most states now have "conscientious objection" legislation that makes it easy for physicians to refuse to do so. We argue in this paper that physicians have an obligation to perform all socially sanctioned medical services, including abortions, and thus that the burden of justification lies (...) upon those who wish to be excused from that obligation. That is, such persons should have to show how requiring them to perform abortions would represent a serious threat to their fundamental moral or religious beliefs. We use current California law as an example of legislation that does not take physicians' obligations into account and thus allows them too easily to declare conscientious objection. (shrink)

In this consensus report by a diverse group of academics who conduct and/or are concerned about social and behavioral genomics (SBG) research, the authors recount the often‐ugly history of scientific attempts to understand the genetic contributions to human behaviors and social outcomes. They then describe what the current science—including genomewide association studies and polygenic indexes—can and cannot tell us, as well as its risks and potential benefits. They conclude with a discussion of responsible behavior in the context of SBG research. (...) SBG research that compares individuals within a group according to a “sensitive” phenotype requires extra attention to responsible conduct and to responsible communication about the research and its findings. SBG research (1) on sensitive phenotypes that (2) compares two or more groups defined by (a) race, (b) ethnicity, or (c) genetic ancestry (where genetic ancestry could easily be misunderstood as race or ethnicity) requires a compelling justification to be conducted, funded, or published. All authors agree that this justification at least requires a convincing argument that a study's design could yield scientifically valid results; some authors would additionally require the study to have a socially favorable risk‐benefit profile. (shrink)

The demand that epistemic support be explicated as rational compulsion has consistently undermined the dialogue between theology and science. Rational compulsion entails too restrictive a form of epistemic support for most scientific theorizing, let alone interdisciplinary dialogue. This essay presents a less restrictive form of epistemic support, explicated not as rational compulsion but as explanatory power. Once this notion of epistemic support is developed, a genuinely productive interdisciplinary dialogue between theology and science becomes possible. This essay closes by sketching how (...) the Big Bang model from cosmology and the Christian doctrine of Creation can be viewed as supporting each other. (shrink)

Due to natural selection pressure, certain aspects of memory may have been selected to give humans a survival advantage. Research has demonstrated that processing information for survival relevance leads to better item memory (i.e., the content of information) compared to control conditions. The current study investigates the effects of survival processing on context memory (i.e., memory for peripheral episodic details) and item memory to better understand when the survival processing memory advantage emerges. In this study, participants viewed objects in either (...) a plausible color, for example a red apple, or in an implausible color, such as a green pie. We chose this color plausibility manipulation because color is a detail that conveys information about the fitness of an item. After studying items in either a survival or moving (control) condition, participants made item memory judgments (did you see this item before?), and two context memory judgments: color context (in which color did you see this item?), and source context (in which condition did you see this item?). Results indicated better item memory for materials processed in the survival relative to moving condition. Critically, for color context there was a condition by plausibility interaction, where memory was best for plausibly colored items in the survival processing condition. There was no difference, however, in source context memory between the survival and moving conditions. These results suggest the survival processing memory advantage extends to some contextual details, but only those details that tap into the survival utility of items, such as color. (shrink)

In this article, we describe the social and economic changes that have contributed to contemporary problems of work—family conflict, gender inequality, and risks to children's healthy development. We draw on feminist welfare state scholarship to outline an institutional arrangement that would support an earner—carer society—a social arrangement in which women and men engage symmetrically in paid work and unpaid caregiving and where young children have ample time with their parents. We present a blueprint for work—family reconciliation policies in three areas—paid (...) family-leave provisions, working-time regulations, and early childhood education and care—and we identify key policy design principles. We describe and assess these work—family reconciliation policies as they operate in six European countries widely considered to be policy exemplars: Denmark, Finland, Norway, Sweden, Belgium, and France. We close with an analysis of potential objections to these policies. (shrink)

Whereas boson coherent states with complex parametrization provide an elegant, and intuitive representation, there is no counterpart for fermions using complex parametrization. However, a complex parametrization provides a valuable way to describe amplitude and phase of a coherent beam. Thus we pose the question of whether a fermionic beam can be described, even approximately, by a complex-parametrized coherent state and define, in a natural way, approximate complex-parametrized fermion coherent states. Then we identify four appealing properties of boson coherent states (eigenstate (...) of annihilation operator, displaced vacuum state, preservation of product states under linear coupling, and factorization of correlators) and show that these approximate complex fermion coherent states fail all four criteria. The inapplicability of complex parametrization supports the use of Grassman algebras as an appropriate alternative. (shrink)

Whereas boson coherent states with complex parametrization provide an elegant, and intuitive representation, there is no counterpart for fermions using complex parametrization. However, a complex parametrization provides a valuable way to describe amplitude and phase of a coherent beam. Thus we pose the question of whether a fermionic beam can be described, even approximately, by a complex-parametrized coherent state and define, in a natural way, approximate complex-parametrized fermion coherent states. Then we identify four appealing properties of boson coherent states and (...) show that these approximate complex fermion coherent states fail all four criteria. The inapplicability of complex parametrization supports the use of Grassman algebras as an appropriate alternative. (shrink)

Joshua Greene and Peter Singer argue, on the basis of empirical evidence, that deontological moral judgments result from emotional reactions while dispassionate reasoning leads to consequentialist judgments. Given that there are good reasons to doubt these emotionally driven intuitions, they argue that we should reject Kantian ethics. I argue that the evidence does not support the claim that consequentialism is inherently more reason-based or less emotion-based than Kantian ethics. This is partly because the experiments employ a functional definition of ‘deontological’ (...) that is so broad as to include any non-consequentialist theory, including virtue ethics, divine command theory, and even rule-utilitarianism. Thus the experiments failed to capture the reasons behind the judgments. Also, the results of the experiments are partly due to the extensive use of moral dilemmas like the footbridge version of the trolley scenario. The options in these dilemmas involve different levels of moral thinking. The consequ.. (shrink)

Recently, empirically minded philosophers have employed evidence of widespread, fundamental moral disagreement to argue against moral realism. I argue that the empirical evidence does not refute realism because the disagreement is consistent with certain pluralistic versions of moral realism that posit a set of pro tanto normative principles. Others have appealed to pluralism in defense of moral realism but have used pluralism to attack the empirically based approach to ethical theory. Although I argue that the empirical argument against moral realism (...) fails, I defend the approach and suggest better ways that (pluralist) moral realism could be tested empirically. (shrink)

This collection of 21 essays explores the creative interaction among the cognitive neurosciences, philosophy, and theology. It is the result of an international research conference co-sponsored by the Vatican Observatory, Rome, and the Center for Theology and the Natural Sciences, Berkeley.

Cognitive neuroenhancement involves the use of medical interventions to improve normal cognitive functioning such as memory, focus, concentration, or willpower. In this paper I give a Kantian argument defending the use of CNE in science, scholarly research, and creative fields. Kant’s universal law formulation of the categorical imperative shows why enhancement is morally wrong in the familiar contexts of sports or competitive games. This argument, however, does not apply to the use of CNE in higher education, scholarly or scientific research, (...) or creative endeavors such as visual art, fiction or poetry, or musical composition. This is because performance in these areas is embedded within practices that differ in morally significant ways from competitive practices. This important difference provides good reason to think that there is nothing morally wrong with the use of CNE in these areas. My approach is not simply to assume a full-fledged Kantian ethical theory and apply it straight away to the enhancement issue but to establish a reflective equilibrium between our moral intuitions, moral principles that support those intuitions, and the nature of the practices involved. (shrink)

Physicalism ? or roughly the view that the stuff that physics talks about is all the stuff there is ? has had a popular press in philosophical circles during the twentieth century. And yet, at the same time, it has become quite fashionable lately to believe that the mind matters in this world after all and that psychology is an autonomous science irreducible to physics. However, if (true, downward) mental causation implies non-reducibility and Physicalism implies the converse, it is hard (...) to see how these two views could be compatible. This paper reviews some classical arguments purportedly showing how the autonomy of the special sciences can be upheld without violating the laws of physics or the principle that physics constitutes a complete and closed system. These arguments are presented in order of increasing strength, indicating how the more popular arguments in fact fall short of establishing anti-reductionism of the intended kind. New arguments are added which claim to demonstrate quite effectively how downward causation is possible compatibly with the reign of physics. The paper begins with a section which distinguishes various kinds of reductionism. (shrink)

I defend a strong version of the Kantian claim that actions done solely from duty have moral worth by (1) considering pure cases of acting from duty, (2) showing that love and sympathy, unlike a sense of duty, can often lead us to do the wrong thing, (3) carefully distinguishing moral from non-moral virtues, and (4) by distinguishing pathological sympathy from practical sympathy. Not only is acting purely from a sense of duty superior to acting from love and sympathetic feelings, (...) but the cold-heartedness found in Kant’s examples should be thought of as a virtue rather than a vice. (shrink)