BackgroundThe phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice.Research aimTo explore the concept of moral (...) distress in nursing both empirically and conceptually.MethodologyFeminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen’s six steps for data analysis.Ethical considerationsThe study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom.FindingsThe empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants’ narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas.DiscussionWe suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, ‘moral-uncertainty distress’. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress.ConclusionThe empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’. (shrink)

There has been increasing debate in recent years about the conceptualization of moral distress. Broadly speaking, two groups of scholars have emerged: those who agree with Jameton’s ‘narrow definition’ that focuses on constraint and those who argue that Jameton’s definition is insufficient and needs to be broadened. Using feminist empirical bioethics, we interviewed critical care nurses in the United Kingdom about their experiences and conceptualizations of moral distress. We provide our broader definition of moral distress and examples of data that (...) both challenge and support our conceptualization. We pre‐empt and overcome three key challenges that could be levelled at our account and argue that there are good reasons to adopt our broader definition of moral distress when exploring prevalence of, and management strategies for, moral distress. (shrink)

The research aims to investigate the characteristics and risks associated with the handling of sensitive data in the implementation of public policies within the digital government model. To achieve this, a hypothetical-deductive method and bibliographic and documentary procedures are employed, proposing an interdisciplinary discussion on technological advancement, data protection, transparency, and public policies. The justification revolves around the importance of a comprehensive, cohesive system that genuinely protects sensitive personal data, considering the need to keep pace with technological developments and maintain (...) a minimum level of security in the digital age at both national and international levels. There is no doubt that the judicious and strategic use of data has the potential to drive substantial improvements in policy evaluation, decision-making, and the relationship between government and citizens. However, dealing with personal data also means addressing risks with responsibility, transparency, and respect for individual rights. (shrink)

The aim of this paper is to explain why, while Charles Darwin was well recognized as a scientific leader of his time, Claude Bernard never really regarded Darwinism as a scientific theory. The lukewarm reception of Darwin at the Académie des Sciences of Paris and his nomination to a chair only after 8 years contrasts with his prominence, and Bernard’s attitude towards Darwin’s theory of species evolution belongs to this French context. Yet we argue that Bernard rejects the scientific value (...) of Darwinian principles mainly for epistemological reasons. Like Darwin, Bernard was interested in hereditary processes, and planned to conduct experiments on these processes that could lead to species transformation. But the potential creation of new forms of life would not vindicate Darwinism since biologists can only explain the origin of morphotypes and morphological laws by the means of untestable analogies. Because it can be the object neither of experiments nor of any empirical observation, phylogeny remains out of science’s scope. Around 1878 Bernard foresaw a new general physiology based on the study of protoplasm, which he saw as the agent of all basic living phenomena. We will analyze why Bernard regarded Darwinism as part of metaphysics, yet still referred to Darwinians in his latter works in 1878. Basically, the absence of a scientific reception of Darwinism in Bernard's work should not obscure its philosophical reception, which highlights the main principles of Bernard’s epistemology. (shrink)

In this study, we evaluate how individual virtues and inter-organizational management control systems influence buyer–supplier performance through relationship quality. Results from a sample of 232 firms confirm that virtues and IOMCS relate positively to relationship quality and performance, respectively. However, IOMCS lose their positive influence on relationship quality when considered along with virtues. That is, when both variables enter the regression model simultaneously, virtues win. This interesting finding has particular resonance at a time when research on ethics still needs to (...) reinforce its positive effects on the practice of management. (shrink)

In recent years, several countries have enacted guidelines and/or mandatory laws to increase the presence of women on the boards of companies. Through these regulatory interventions, the aim is to eradicate the social and labor grievances that women have traditionally experienced and which has relegated them to smaller-scale jobs. Nevertheless, and despite the advances achieved, the female representation in the boardroom remains far from the desired levels. In this context, it is now necessary to enhance the advantages of board gender (...) diversity from both ethical and economic points of view. This article examines the relation between board gender diversity and economic results in Spain: the second country in the world to legally require gender quotas in boardrooms and historically characterized by a minimal female participation in the workforce. Based on a sample of 125 non-financial firms listed on the Madrid Stock Exchange from 2005 to 2009, our findings show that in the period analyzed the increase of the number of women on boards was over 98 %. This suggests that compulsory legislation offers an efficient framework to execute the recommendation of Spanish codes of good governance by means of the increase in the number of women in the boards of firms. Furthermore, we find that the increase in the number of women on the boards is positively related to higher economic results. Therefore, both results suggest that gender diversity in boardrooms should be incremented, mandatory laws being a key factor to do so. (shrink)

We address how listeners perceive temporal regularity in music performances, which are rich in temporal irregularities. A computational model is described in which a small system of internal self‐sustained oscillations, operating at different periods with specific phase and period relations, entrains to the rhythms of music performances. Based on temporal expectancies embodied by the oscillations, the model predicts the categorization of temporally changing event intervals into discrete metrical categories, as well as the perceptual salience of deviations from these categories. The (...) model's predictions are tested in two experiments using piano performances of the same music with different phrase structure interpretations (Experiment 1) or different melodic interpretations (Experiment 2). The model successfully tracked temporal regularity amidst the temporal fluctuations found in the performances. The model's sensitivity to performed deviations from its temporal expectations compared favorably with the performers' structural (phrasal and melodic) intentions. Furthermore, the model tracked normal performances (with increased temporal variability) better than performances in which temporal fluctuations associated with individual voices were removed (with decreased variability). The small, systematic temporal irregularities characteristic of human performances (chord asynchronies) improved tracking, but randomly generated temporal irregularities did not. These findings suggest that perception of temporal regularity in complex musical sequences is based on temporal expectancies that adapt in response to temporally fluctuating input. (shrink)

With the COVID-19 pandemic, governments implemented successive lockdowns that forced employees to work from home to contain the spread of the coronavirus. This crisis raises the question of the effects of mandatory work from home on employees’ well-being and performance, and whether these effects are the same for all employees. In the present study, we examined whether working at home may be related to intensity, familiarity with WFH, employees’ well-being and creativity. We also examined whether the psychological profile of employees, (...) combining preference for solitude and associated personality variables from the Big Five, may influence the effects of WFH. The data were collected via an online survey from November 13th to December 15th 2020 among 946 employees from various organizations during the second lockdown in France. In addition to identifying two distinctive psychological profiles for employees having to WFH, results revealed that those with a “Solitary” profile reported higher loneliness at work, higher levels of stress, and lower levels of job satisfaction and work engagement than those with an “Affiliative” profile. It was also found that employees with a “Solitary” profile perceived themselves as less creative and produced objectively fewer ideas than individuals with an “Affiliative” profile. The present study suggests the necessity to distinguish the profiles of teleworkers and to offer a stronger support for the less affiliative employees when working from home. (shrink)

Research using the intermodal preferential looking paradigm (IPLP) has consistently shown that English‐learning children aged 2 can associate transitive argument structure with causal events. However, studies using the same methodology investigating 2‐year‐old children’s knowledge of the conjoined agent intransitive and semantic role assignment have reported inconsistent findings. The aim of the present study was to establish at what age English‐learning children have verb‐general knowledge of both transitive and intransitive argument structure using a new method: the forced‐choice pointing paradigm. The results (...) suggest that young 2‐year‐olds can associate transitive structures with causal (or externally caused) events and can use transitive structure to assign agent and patient roles correctly. However, the children were unable to associate the conjoined agent intransitive with noncausal events until aged 3;4. The results confirm the pattern from previous IPLP studies and indicate that children may develop the ability to comprehend different aspects of argument structure at different ages. The implications for theories of language acquisition and the nature of the language acquisition mechanism are discussed. (shrink)

Mitochondrial donation poses the latest regulatory challenge for policy-makers in the context of assisted conception. Since 2010 the Human Genetics Commission, the Human Fertilisation and Embryology Authority and the Nuffield Council on Bioethics have all considered the policy implications of permitting use of these techniques in treatment. The Nuffield Council on Bioethics reported its recommendations in June 2012 following a consultation on the ethical issues raised by these techniques; and a separate consultation by the Human Fertilisation and Embryology Authority in (...) conjunction with Sciencewise-ERC followed in September 2012. Matters for consideration included the potential relationships created by the use of three parties’ genetic material and the associated ramifications, eg whether or not there is a need to establish records of such donations and, if so, to whom should information later be provided? Thus, mitochondrial donation poses both novel and familiar questions about the ‘genetic family’, ‘parentage’ and ‘identity’. This article explores some of the ways in which mitochondrial DNA is constructed as relatively significant in recent Parliamentary debates, policy and consultation documents. It reflects on the ways in which the role of some genetic connections, or lack thereof, are mediated in law and policy. (shrink)

A growing body of research reveals that abusive supervision may have negative impacts in organizations. The purpose of the present study is to expand the knowledge regarding the impacts of this dysfunctional leadership behavior by examining its relationship with innovation in work teams. Specifically, we investigate the process through which abusive supervision may undermine team innovation by taking into account the mediating role of team proactive behavior. Moreover, we propose a boundary condition of the negative effect of abusive supervision by (...) considering leader–members interdependence as a moderator. Using a multisource approach, data were gathered from 394 members and 82 immediate supervisors in a public safety organization. Results of path analyses reveal that the relationship between abusive supervision and team innovation is mediated by team proactive behavior. Furthermore, we found that the relationship between abusive supervision and team proactive behavior is moderated by leader–members interdependence, such that this relationship is stronger when the level of interdependence is high. Taken together, the findings of this study improve the understanding of why and under what circumstances abusive supervision may impair team innovation. (shrink)

As donor trust legitimises research, trust is vital for research in the fields of biomedicine, genetics, translational medicine and personalised medicine. For parts of the donor community, the consent signature is a sign of trust in research. Many consent processes in biomedical research ask donors to provide their data for an unspecified future use, which introduces uncertainty of the unknown. This uncertainty can jeopardise donor trust or demand blind trust. But which donor wants to trust blindly? To reduce this uncertainty, (...) we explore first, which future-proof actors donors could trust when signing a consent form. Second, we discuss the question Can we know if donor trust expires? and what prevents donor trust from expiring. Finally, we present possible measures that can help to nurture trust in the far future. In this article, we draw on our previous research on trust in biomedical research, on trust in the broader healthcare system and Niklas Luhmann’s and Anthony Giddens’ trust theories. Our findings suggest that, in the far future, researchers will need to consider donor autonomy, as well as societal norms and values of the time period in which the data were donated. They will need to find mechanisms where possible to publicly announce the use of old data sets. However, foremost researchers will need to treat the data respectfully. It remains vital that professionals and the society continue to elaborate on the norms and values that shape the common understanding of what is morally right and wrong when researching data. (shrink)

While 23andMe aspires to be “the world's trusted source of personal genetic information,” the U.S. Food and Drug Administration (FDA) believes that the company's advertising practices have been anything but trustworthy. Last November, a harshly worded FDA “warning letter” demanded that the direct‐to‐consumer genetic testing company immediately discontinue marketing its unapproved “medical device.” The tussle between 23andMe and the FDA has attracted more attention than a typical disagreement between a company and a government agency. Larry Downes and Paul Nunes identify (...) 23andMe as a “Big Bang Disruption”: an invention that revolutionizes the existing market, foiling both industry incumbents and unprepared regulators. The outcome of the FDA's current review to hold the answer to the million‐dollar question: how will DTC genetic testing be regulated in the future? Ideally, the FDA's regulations should not pose undue burdens on consumers seeking personal genetic information but, rather, help consumers make a transition out of the consumer setting and into the medical setting. (shrink)

Mounting ambitions and capabilities for public and private, non-government sector crewed space exploration bring with them an increasingly diverse set of space travelers, raising new and nontrivial ethical, legal, and medical policy and practice concerns which are still relatively underexplored. In this piece, we lay out several pressing issues related to ethical considerations for selecting space travelers and conducting human subject research on them, especially in the context of non-governmental and commercial/private space operations.

Circadian rhythm abnormalities in bipolar disorder have led to a search for genetic abnormalities in circadian "clock genes" associated with BD. However, no significant clock gene findings have emerged from genome-wide association studies. At least three factors could account for this discrepancy: complex traits are polygenic, the organization of the clock is more complex than previously recognized, and/or genetic risk for BD may be shared across multiple illnesses. To investigate these issues, we considered the clock gene network at three levels: (...) essential "core" clock genes, upstream circadian clock modulators, and downstream clock controlled genes. Using relaxed thresholds for GWAS statistical significance, we determined the rates of clock vs. control genetic associations with BD, and four additional illnesses that share clinical features and/or genetic risk with BD. Then we compared the results to a set of lithium-responsive genes. Associations with BD-spectrum illnesses and lithium-responsiveness were both enriched among core clock genes but not among upstream clock modulators. Associations with BD-spectrum illnesses and lithium-responsiveness were also enriched among pervasively rhythmic clock-controlled genes but not among genes that were less pervasively rhythmic or non-rhythmic. Our analysis reveals previously unrecognized associations between clock genes and BD-spectrum illnesses, partly reconciling previously discordant results from past GWAS and candidate gene studies. (shrink)

Liberals agree that free speech should be protected, where speech is understood broadly to include all forms of intentional communication, including actions and pictures, not merely the spoken or written word. A surprising view about free speech in some liberal and legal circles is that communications should be protected on free-speech grounds only if the communications are mentally mediated. By “mentally mediated communication” we mean speech which communicates its message in such a way that the message can be rationally evaluated (...) by hearers, and causes the hearers to believe it, when it does, through the mechanism of those hearers employing their rational capacity to judge that it is correct. The mental-mediation or persuasion principle, as it is sometimes called, has some important legal and public policy implications. It has been applied to argue that certain forms of expression, despite being forms of speech or expression, lack even a prima facie claim to protection on free speech grounds. -/- Our central aim is to show why the mental mediation principle is mistaken. Liberals should think that some speech which is not mentally mediated deserves protection for the very same reasons that speech which is mentally mediated is often thought to deserve protection. (shrink)

At one time, specialized health privacy laws represented the bulk of the rules regulating genetic privacy, Today, however, as both the field of genomics and the content of privacy law change rapidly, a new generation of general-purpose privacy laws may impose new restrictions on collection, storage, and disclosure of genetic data. This article surveys these laws and considers implications.

People with neurodevelopmental disorders are often considered unsuitable or incapable of working in open employment. When employment is available, tasks are often limited, and opportunities for career development are restricted. Policy and funding constraints leave people with disabilities without an opportunity to develop skills due to the additional time and costs for employers. To overcome these barriers, virtual environments have been proposed as a safe and reliable solution for training. An important prerequisite for a wider uptake of training in virtual (...) environments are demonstrations that the training leads to improved performance in the real world. This is particularly true for people with neurodevelopmental disorders, as transferring learnings from one context to another can be challenging. A systematic review was conducted to assess whether training in virtual environments can be used to improve real-world vocational skills in people with neurodevelopmental disorders. After a systematic search in six databases, eight out of the initially identified 1,806 articles met the inclusion criteria. The findings from these eight studies demonstrate that people with neurodevelopmental disorders can transfer vocational skills from virtual environments to real-world settings. With substantial technological improvements, a surge in accessibility, and improved affordability, there is a need to build upon the promising results identified in this review. (shrink)

Fix an integer $r \ge 3$. We consider metric spaces on n points such that the distance between any two points lies in $\left\{ {1, \ldots,r} \right\}$. Our main result describes their approximate structure for large n. As a consequence, we show that the number of these metric spaces is $\left\lceil {{{r + 1} \over 2}} \right\rceil ^{\left + o\left}.$Related results in the continuous setting have recently been proved by Kozma, Meyerovitch, Peled, and Samotij [34]. When r is even, our (...) structural characterization is more precise and implies that almost all such metric spaces have all distances at least $r/2$. As an easy consequence, when r is even, we improve the error term above from $o\left$ to $o\left$, and also show a labeled first-order 0-1 law in the language ${\cal L}_r $, consisting of r binary relations, one for each element of $[r]$. In particular, we show the almost sure theory T is the theory of the Fraïssé limit of the class of all finite simple complete edge-colored graphs with edge colors in $\left\{ {r/2, \ldots,r} \right\}$.Our work can be viewed as an extension of a long line of research in extremal combinatorics to the colored setting, as well as an addition to the collection of known structures that admit logical 0-1 laws. (shrink)

Only when students feel engaged both socially and academically can schools and teachers lay the groundwork to motivate achievement. This volume, the fifth in the _Harvard Education Letter _Spotlight series, brings together fifteen seminal articles that examine research and practice on these complex and interrelated issues. Foreword by Sam M. Intrator, associate professor of education and of the Program in Urban Studies at Smith College and codirector of Smith’s Urban Education Initiative. Contributors include: Michael Bitz, James Paul Gee, Pedro A. (...) Noguera, Laura Pappano, George Sugai, and Richard Weissbourd. (shrink)

This volume maps the areas of ethical concern in the debate regarding the governance of genetic information, and suggests alternative ethical frameworks and models of regulation in order to inform its restructuring. Genetic governance is at the heart of medical and scientific developments, and is connected to global exploitation, issues of commodification, commercialisation and ownership, the concepts of property and intellectual property and concerns about individual and communal identity. Thus the decisions that are made in the next few years about (...) appropriate models of genetic governance will have knock-on effects for other areas of governance. In short the final answer to 'Who Decides?' in the context of genetic governance will fundamentally shape the ethical constructs of individuals and their networks and relationships in the public sphere. (shrink)

The production of complex sequences like music or speech requires the rapid and temporally precise production of events (e.g., notes and chords), often at fast rates. Memory retrieval in these circumstances may rely on the simultaneous activation of both the current event and the surrounding context (Lashley, 1951). We describe an extension to a model of incremental retrieval in sequence production (Palmer & Pfordresher, 2003) that incorporates this logic to predict overall error rates and speed—accuracy trade-offs, as well as types (...) of serial ordering errors. The model—assumes that retrieval of the current event is influenced by activations of surrounding events. Activations of surrounding events increase over time, such that both the accessibility of distant events and overall accuracy increases at slower production rates. The model's predictions were tested in an experiment in which pianists performed unfamiliar music at 8 different tempi. Model fits to speed—accuracy data and to serial ordering errors support model predictions. Parameter fits to individual data further suggest that working memory contributes to the retrieval of serial order and overall accuracy is influenced in addition by motor dexterity and domain-specific skill. (shrink)

Epigenetics reveals the biological mechanisms underlying the reproduction and even the transmission of social inequalities in health. It also emphasizes the complexity of factors involved in the development of some diseases. This complexity raises new difficulties for theories of justice. Is the equal opportunities theory the most appropriate to solve these difficulties? I demonstrate that epigenetics requires a multifactor model of justice—one that is grounded on principles of fairness, impartiality, and environmental and intergenerational justice. Depending on the point of view (...) assumed (i.e., individual, population-based, or intergenerational), the relevant principle of justice is different. (shrink)

We address the problem of musical variation (identification of different musical sequences as variations) and its implications for mental representations of music. According to reductionist theories, listeners judge the structural importance of musical events while forming mental representations. These judgments may result from the production of reduced memory representations that retain only the musical gist. In a study of improvised music performance, pianists produced variations on melodies. Analyses of the musical events retained across variations provided support for the reductionist account (...) of structural importance. A neural network trained to produce reduced memory representations for the same melodies represented structurally important events more efficiently than others. Agreement among the musicians' improvisations, the network model, and music‐theoretic predictions suggest that perceived constancy across musical variation is a natural result of a reductionist mechanism for producing memory representations. (shrink)

There seems to be a proliferation of prizes and rankings for ethical business over the past decade. Our principal aims in this article are twofold: to initiate an academic discussion of the epistemic and normative stakes in business-ethics competitions; and to help organizers of such competitions to think through some of these issues and the design options for dealing with them. We have been able to find no substantive literature — academic or otherwise — that addresses either of these two (...) broad topics and audiences. Our modest aim, therefore, is to suggest an agenda of issues, and to begin to explore and analyse some of the possible arguments for and against various philosophical or practical solutions. Part I explores the challenges facing a prize-organizing committee, including problems derived from what Rawls calls the "fact of pluralism" in democratic societies (reasonable people will always disagree over some basic values, including those relevant to evaluating business practices), and epistemic issues about how we can justify qualitative judgments on the basis of incomplete quantitative data. We also try to identify risks and opportunity costs for ethics-prize granters. In Part II we spell out (a) a range of design options and (b) some advice about how any particular prize-awarding committee might select among these options to best achieve its goals (which typically involve highlighting and publicizing best practices for ethical business). (shrink)

Despite general agreement within philosophy that peer review is indispensable, its fairness and reliability is often questioned. This article suggests that such worries can to a large extent be met by adopting the practice that reviews as well as earlier versions of papers are made publicly available when the final version of a paper is published. This suggestion combines the advantages of transparency with the merits of anonymity of reviewers. While there are obstacles to this suggestion, the article argues that (...) it would be worthwhile to implement it because it can help map patterns of conduct and secure confidence in the fairness and reliability of review procedures and journal editing within philosophy. (shrink)

We consider here how cultural and socioeconomic dimensions of justice beyond the state are related. First we examine cosmopolitan theories that have drawn on John Rawls's egalitarian liberal framework to argue that a just global order requires substantive, transnational redistribution of material resources. We then assess the view, ironically put forward by Rawls himself, that this perspective is ethnocentric and insufficiently tolerant of non-liberal cultures. We argue that Rawls is right to be concerned about the danger of ethnocentrism, but wrong (...) to assume that this requires us to reject the case for substantive redistribution across state boundaries. A more compelling account of justice beyond the state will integrate effectively socioeconomic and cultural aspects of justice. We suggest that this approach is best grounded in a critical theory of recognition that responds to the damage caused to human relations by legacies of historical injustice. (shrink)

Arabidopsis thaliana (Thale cress, Arabidopsis) is an ideal model organism for the molecular genetic analysis of many plant processes. The availability of a complete physical map would greatly facilitate the gene cloning steps in these studies. The small genome size of Arabidopsis makes the construction of such a map a feasible goal. One of the approaches to construct an overlapping library of the Arabidopsis genome takes advantage of the many mapped markers and the availability of Arabidopsis yeast artificial chromosome (YAC) (...) libraries. Mapped molecular markers are used to identify corresponding YAC clones and thereby place them on the genetic map. Subsequently, these YAC clones provide the framework for directed walking experiments aimed at closing the gaps between the YAC contigs. Adopting this strategy, YAC clones comprising about 10% of the genome have been assigned to the top halves of Arabidopsis chromosomes 4 and 5. Extensive walking experiments in a 10 cM interval of chromosome 4 have resulted in two contiguous regions in the megabase size range. (shrink)

"Dealing with the Visual will be of great use to advanced students because it offers an overview of current debates, and to graduate students and professionals in the field because the essays offer in-depth investigations of the methodological issues involved and various historical ways of defining visuality. The topics included range from early modern ways of viewing pictures and sixteenth-century views of Palladio's villas in their landscape settings to contemporary debate about whether there is life yet in painting."--BOOK JACKET.

In this paper anorexia nervosa is examined through three lenses to determine its possible causes. This paper contains a clinical analysis of the anorexic personality, a psychoanalytic/religious interpretation of the demands of society, and· a feminist reinterpretationof the effects of those demands on the female body. The societal demands to renounce instincts, when examined through a feminist lens, reveals that these demands, in concert with the detrimental effects of feminine socialization and characteristics of the anorexic personality, may lead some women (...) to view their needs as not important, and cause a detachment from and turning against the body in the form of anorexia nervosa. It is concluded that anorexia is not just women taking a diet “too far.” There are other psychological, philosophical, and social factors leading to a prevalence of anorexia nervosa in Western culture. (shrink)

Some patients awaken from their coma but only show reflex motor activity. This condition of wakeful (eyes open) unawareness is called the vegetative state. In 2002, a new clinical entity coined ‘‘minimally conscious state’’ defined patients who show more than reflex responsiveness but remain unable to communicate their thoughts and feelings. Emergence from the minimally conscious state is defined by functional recovery of verbal or nonverbal communication.1 Our empirical medical definitions aim to propose clearcut borders separating disorders of consciousness such (...) as coma, vegetative state and minimally conscious state but clinical reality shows that these boundaries can often be fuzzy (fig 1). Recent clinical, electrophysiological and neuroimaging studies are shedding light on these challenging limits of consciousness encountered following severe acute brain damage. At the patient’s bedside, it is very challenging to differentiate reflex or automatic motor behaviour from movements indicating signs of consciousness, and hence some minimally conscious patients might be misdiagnosed as being vegetative. For some motor responses (eg, blinking to visual threat, brief fixation, normal flexion response to pain, etc) it remains unclear whether they truly are voluntary or willed because we lack convincing scientific evidence. We also lack consensus on how to practically assess some of these behavioural responses. For example, there is no agreement on what stimulus to employ in the assessment of visual pursuit movements— often one of the first clinical signs heralding the transition from the vegetative to the minimally conscious state. Vanhaudenhuyse and colleagues2 recently studied visual pursuit in 51 post-comatose patients comparing eye tracking of a moving object, person or mirror. It was shown that more.. (shrink)

As more young people feel safe to outwardly identify as transgender or gender expansive (TGE), meaning that their gender identity does not align with the sex they were assigned at birth, an increasing number of youth who identify as TGE seek gender-affirming medical care (GAMC). GAMC raises a number of ethical questions, such as the capacity of a minor to assent or consent, the role of parents or legal guardians in decisions about treatment, and implications for equitable access to care (...) when differing parental or custodial viewpoints are present. These questions are further complicated by the difficulties in explaining the limits of long-term research in GAMC, with regard to the preservation of fertility, for example. We present two de-identified composite case studies to highlight dilemmas that may arise and offer recommendations to better support patient- and family-centered decision making for GAMC. These include employing a multidisciplinUniverary shared decision-making approach, disentangling informed consent and assent from chronological age, developing a consistent approach to the assessment of decisional capacity, and developing age-appropriate informational materials. (shrink)

Numismatique François de Callatay et Caroline Mattheeuws, À propos d'une série exceptionnelle de grands bronzes thasiens (fin ive- début me siècle) p. 481-490 L'acquisition par le Cabinet des Médailles de Bruxelles d'un lot de trente-cinq grands bronzes thasiens aux types «Tête de Déméter/Bustes des Dioscures» permet d'affiner la connaissance de cette émission exceptionnelle. Tous les exemplaires sont contremarques et beaucoup présentent des traces de surfrappe. L'étude du style combinée à celle des poids permet de déceler une manipulation monétaire qui (...) avait échappé jusqu'à présent. Avant de réaliser cette émission en surfrappant une émission existante au type de l'Héraclès imberbe, on s'était d'abord servi de nouveaux flans d'un poids lourd (ca 13 g). L'étude du contexte archéologique confirme d'autre part pour ces bronzes, sans toutefois qu'il soit permis de les situer à l'année près, une datation à l'extrême fin du ive s. av. J.-C. (shrink)

Lorsque la philosophie a voulu penser la propriété et son origine, elle a fait de la nature le cadre approprié pour l’appréhender, y compris à des époques où la propriété, aussi bien privée que commune, était déjà régulée par un système de juridictions préexistant. La propriété et la question de sa légitimité ont alors été interrogées aux confins de l’articulation entre l’ordre du fait (s’incarnant notamment dans l’appropriation) et celui du droit. Néanmoins la mise au premier plan d’une nécessité naturelle (...) ainsi que l’inscription de l’appropriation dans un registre naturaliste ont pour vocation de soustraire la propriété à la problématique de la justice distributive. L’approche naturaliste de l’appropriation privative implique en outre un usage pragmatique de la norme juridique, renversant par là la « loi de Hume », alors même que cette norme pourrait être tout aussi légitimement mobilisée pour instaurer un devoir-être plutôt que pour instituer juridiquement un état de fait. Classification JEL : B12, P14. (shrink)

Lorsque la philosophie a voulu penser la propriété et son origine, elle a fait de la nature le cadre approprié pour l’appréhender, y compris à des époques où la propriété, aussi bien privée que commune, était déjà régulée par un système de juridictions préexistant. La propriété et la question de sa légitimité ont alors été interrogées aux confins de l’articulation entre l’ordre du fait (s’incarnant notamment dans l’appropriation) et celui du droit. Néanmoins la mise au premier plan d’une nécessité naturelle (...) ainsi que l’inscription de l’appropriation dans un registre naturaliste ont pour vocation de soustraire la propriété à la problématique de la justice distributive. L’approche naturaliste de l’appropriation privative implique en outre un usage pragmatique de la norme juridique, renversant par là la « loi de Hume », alors même que cette norme pourrait être tout aussi légitimement mobilisée pour instaurer un devoir-être plutôt que pour instituer juridiquement un état de fait. Classification JEL : B12, P14. (shrink)