Background Caring is a core function of nurses and it confers upon them ethical obligations as ethical agents. Failure to carry out such ethical obligations raises ethical concerns. This study was not intended to explore ethical concerns, but the reported findings reveal problems which have ethical implications. This paper aims to elucidate the ethical issues inherent in the findings and propose strategies to mitigate them. Research design and methods An exploratory-descriptive qualitative design was used within a larger Action Research Study. (...) Data were collected through focus group discussions with nurse/midwives, and through exit interviews which were conducted with the women who participated in the study on their day of discharge. Six focus group discussions and thirty exit interviews were conducted, and data were analysed through thematic analysis. Participants and research context The study took place at selected maternal and child healthcare settings in Lilongwe, Malawi. The participants were nurse/midwives and women who were admitted in maternal and child healthcare settings and were purposively sampled. Ethical considerations Ethical approval was obtained from the relevant ethics committee and all ethical guidelines were followed in the conduct of the study. Findings The findings are presented under three themes which emerged from the data. The findings reveal effects of staff shortages on patient outcomes, problems experienced in low resource clinical settings and disrespectful nurse/patient communication. Conclusion The findings reveal that institutional factors constrain moral agency and patient safety is severely compromised in some of the clinical settings in Malawi which raises serious ethical concerns. (shrink)

This paper responds to the commentaries from Stacy Carter and Alan Cribb. We pick up on two main themes in our response. First, we reflect on how the process of setting standards for empirical bioethics research entails drawing boundaries around what research counts as empirical bioethics research, and we discuss whether the standards agreed in the consensus process draw these boundaries correctly. Second, we expand on the discussion in the original paper of the role and significance of the concept of (...) ‘integrating’ empirical methods and ethical argument as a standard for research practice within empirical bioethics. (shrink)

The COVID-19 global pandemic has led to significant disruptions in the lives of high-performance athletes, including the postponement of the Tokyo Olympic and Paralympic Games, the cancellation of many international and national competitions, and drastic changes in athletes’ daily training environment. The purpose of this research was to examine the interplay between the mental health and mental performance of Canadian national team athletes and the impact of the COVID-19 pandemic on these variables from the perspective of mental performance consultants and (...) mental health practitioners. Twelve individuals working in these roles with national team athletes participated in focus groups and interviews during the second wave of the COVID-19 pandemic in Canada. Findings from the inductive reflexive thematic analysis revealed three main themes: factors impacting athlete mental health, consequences of COVID-19 for athletes, and impact of the pandemic on practitioners. Interestingly, athletes with prior good mental performance skills were perceived to be more equipped to cope with challenges related to the pandemic, which concurrently seemed to facilitate good mental health throughout the pandemic. Furthermore, even though the pandemic had several debilitative consequences on athletes’ mental health, it imposed a break from training and competition that allowed them to rest and enjoy their life outside of sport. Finally, participants discussed the need for more mental health resources and better access to practitioners supporting mental performance and mental health in the Canadian sport system. (shrink)

Increasingly, professionalism has been recognized as a core competency for health service professionals and is the domain in which vexing competence problems are observed in trainees. We begin by describing manifestations of problems of professionalism in accord with the values that fall within the rubric of this multifaceted construct. We provide an approach for evaluating problems of professionalism and discuss intervention for trainees with mild, moderate, or severe problems in this domain. We propose implications for training focused on enhancing the (...) culture of programs; bolstering the education, guidance, and mentoring provided related to professionalism; and encouraging best practices for addressing trainees with problems of professionalism. We conclude by sharing ideas about defining professionalism, identifying problems of professionalism, strengthening our approach to assessing professionalism and intervening when problems are evident, developing strategies for preventing professionalism problems, and ensuring that psychologists take seriously their responsibility to address professionalism concerns with colleagues. (shrink)

Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to identify key governance challenges and explore how public involvement can (...) meet these challenges. This brief report discusses four cross-cutting themes from the study: the need to move beyond individual consent; issues in benefit and data sharing; the challenge of delineating and understanding publics; and the goal of clarifying justifications for public involvement. The report aims to provide a starting point for making sense of the relationship between public involvement and the governance of population-level biomedical research, showing connections, potential solutions and issues arising at their intersection. We suggest that, in population-level biomedical research, there is a pressing need for a shift away from conventional governance frameworks focused on the individual and towards a focus on collectives, as well as to foreground ethical issues around social justice and develop ways to address cultural diversity, value pluralism and competing stakeholder interests. There are many unresolved questions around how this shift could be realised, but these unresolved questions should form the basis for developing justificatory accounts and frameworks for suitable collective models of public involvement in population-level biomedical research governance. (shrink)

COVID-19 continues to dominate 2020 and is likely to be a feature of our lives for some time to come. Given this, how should health systems respond ethically to the persistent challenges of responding to the ongoing impact of the pandemic? Relatedly, what ethical values should underpin the resetting of health services after the initial wave, knowing that local spikes and further waves now seem inevitable? In this editorial, we outline some of the ethical challenges confronting those running health services (...) as they try to resume non-COVID-related services, and the downstream ethical implications these have for healthcare professionals’ day-to-day decision making. This is a phase of recovery, resumption and renewal; a form of reset for health services.1 This reset phase will define the ‘new normal' for healthcare delivery, and it offers an opportunity to reimagine and change services for the better. There are difficulties, however, healthcare systems are already weakened by austerity and the first wave of COVID-19 and remain under stress as the pandemic continues. The reset period is operating alongside, rather than at the end, of the pandemic and this creates difficult ethical choices. ### Balancing the greater good with individual care Pandemics—and public health emergencies more generally—reinforce approaches to ethics that emphasise or derive from the interests of communities, rather than those grounded in the claims of the autonomous individual. The response has been to draw on more public health focused ethics, ‘if demand outstrips the ability to deliver to existing standards, more strictly utilitarian considerations will have to be applied, and decisions about how to meet the individual's need will give way to decisions about how to maximise overall benefit’.2 Alongside this, effective …. (shrink)

The COVID-19 pandemic will generate vexing ethical issues for the foreseeable future and many journals will be open to content that is relevant to our collective effort to meet this challenge. While the pandemic is clearly the critical issue of the moment, it’s important that other issues in medical ethics continue to be addressed as well. As can be seen in this issue, the Journal of Medical Ethics will uphold its commitment to publishing high quality papers on the full array (...) of medical ethics. At the same time, JME aims to be a premiere home for ground-breaking scholarship on the ethical issues raised by COVID-19. Toward this end, we have a number of papers that are freely available online and for which production has been fast-tracked.1–5 A challenge for authors who want to write about the pandemic is the rapidly evolving nature of the situation and the time it takes for journal content to be reviewed and published, even when fast-tracked. For that reason, all authors who would like to submit a paper on the pandemic can also submit a post to the JME blog prior to submitting a full paper to the journal. Those interested in writing for the JME blog should contact one of its editors, Hazem Zohny or Mike King. Over the last 3 weeks, 30 high-quality commentaries on the pandemic have been posted to the blog. These posts are circulated widely via the JME Twitter and Facebook feeds and have stimulated significant …. (shrink)

Community engagement (CE) contributes to successful research. There is, however, a lack of literature on the effectiveness of different models of CE and, specifically, on CE strategies for the conduct of genomic research in sub-Saharan Africa. There is also a need for models of CE that transcend the recruitment stage of engaging prospective individuals and communities and embed CE throughout the research process and after the research has concluded. The qualitative study reported here was designed to address these knowledge gaps (...) and comprised of 36 key informant semi-structured interviews and fifteen focus groups with 50 participants. We interviewed selected stakeholders in genomic research in Nigeria: biomedical researchers, community rulers, opinion leaders, community health workers, and prospective research participants. We explored these stakeholders’ views on their understanding of community engagement, their expectations, experiences, and their opinions on acceptable processes of community consultation in genomic research. The methodological design, adapted from grounded theory, used the constant comparative method of data analysis; while normative conclusions were made using the symbiotic empirical ethics approach. Data analysis revealed five main themes important for successfully engaging communities in genomic research: effective communication, diversity of community gatekeeping, trust, cultural integration of research, and conservation of the research setting. From these themes, we have developed a four-stage model of community engagement that covers all stages of the research process; namely, the Community Approach, Intermediate phase, Collaboration and Post-research Cordiality model (CICP). This model could be used to improve the integration of CE in genomic research among local communities. (shrink)

Lectures, scientific papers, top secret wartime material, correspondence, and broadcasts are introduced and set in context by Jack Copeland, Director of the Turing Archive for the History of Computing."--Jacket.

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

Processing information in the context of personal survival scenarios elicits a memory advantage, relative to other rich encoding conditions such as self-referencing. However, previous research is unable to distinguish between the influence of survival and self-reference because personal survival is a self-referent encoding context. To resolve this issue, participants in the current study processed items in the context of their own survival and a familiar other person’s survival, as well as in a semantic context. Recognition memory for the items revealed (...) that personal survival elicited a memory advantage relative to semantic encoding, whereas other-survival did not. These findings reinforce suggestions that the survival effect is closely tied with self-referential encoding, ensuring that fitness information of potential importance to self is successfully retained in memory. (shrink)

Community engagement (CE) contributes to successful research. There is, however, a lack of literature on the effectiveness of different models of CE and, specifically, on CE strategies for the conduct of genomic research in sub-Saharan Africa. There is also a need for models of CE that transcend the recruitment stage of engaging prospective individuals and communities and embed CE throughout the research process and after the research has concluded. The qualitative study reported here was designed to address these knowledge gaps (...) and comprised of 36 key informant semi-structured interviews and fifteen focus groups with 50 participants. We interviewed selected stakeholders in genomic research in Nigeria: biomedical researchers, community rulers, opinion leaders, community health workers, and prospective research participants. We explored these stakeholders’ views on their understanding of community engagement, their expectations, experiences, and their opinions on acceptable processes of community consultation in genomic research. The methodological design, adapted from grounded theory, used the constant comparative method of data analysis; while normative conclusions were made using the symbiotic empirical ethics approach. Data analysis revealed five main themes important for successfully engaging communities in genomic research: effective communication, diversity of community gatekeeping, trust, cultural integration of research, and conservation of the research setting. From these themes, we have developed a four-stage model of community engagement that covers all stages of the research process; namely, the Community Approach, Intermediate phase, Collaboration and Post-research Cordiality model (CICP). This model could be used to improve the integration of CE in genomic research among local communities. (shrink)

We have been researching the distinctive ethical issues raised by what we have called “the reset period,” when non-Covid services resumed alongside the continuing pandemic in the UK. In this commen...

This introduction to the special issue of the same title sets out the context for a critical examination of contemporary developments in sociotechnical systems deployed in the name of security. Our focus is on technologies of tracking, with their claims to enable the identification of those who comprise legitimate targets for the use of violent force. Taking these claims as deeply problematic, we join a growing body of scholarship on the technopolitical logics that underpin an increasingly violent landscape of institutions, (...) infrastructures, and actions, promising protection to some but arguably contributing to our collective insecurity. We examine the asymmetric distributions of sociotechnologies of security; their deadly and injurious effects; and the legal, ethical, and moral questions that haunt their operations. (shrink)

How is it that we think and refer in the first-person way? For most philosophers in the analytic tradition, the problem is essentially this: how two apparently conflicting kinds of properties can be reconciled and united as properties of the same entity. What is special about the first person has to be reconciled with what is ordinary about it. The range of responses reduces to four basic options. The orthodox view is optimistic: there really is a way of reconciling these (...) apparently contradictory properties as contained within the same thing. The heretical views are pessimistic and content to be so: there is no such way, and that is because there is simply nothing to reconcile – because there is really nothing special about what is in question; or there is really nothing ordinary about it; or there is really nothing …. (shrink)

Artificial Intelligence is making rapid and remarkable progress in the development of more sophisticated and powerful systems. However, the acknowledgement of several problems with modern machine learning approaches has prompted a shift in AI benchmarking away from task-oriented testing towards ability-oriented testing, in which AI systems are tested on their capacity to solve certain kinds of novel problems. The Animal-AI Environment is one such benchmark which aims to apply the ability-oriented testing used in comparative psychology to AI systems. Here, we (...) present the first direct human-AI comparison in the Animal-AI Environment, using children aged 6–10. We found that children of all ages were significantly better than a sample of 30 AIs across most of the tests we examined, as well as performing significantly better than the two top-scoring AIs, “ironbar” and “Trrrrr,” from the Animal-AI Olympics Competition 2019. While children and AIs performed similarly on basic navigational tasks, AIs performed significantly worse in more complex cognitive tests, including detour tasks, spatial elimination tasks, and object permanence tasks, indicating that AIs lack several cognitive abilities that children aged 6–10 possess. Both children and AIs performed poorly on tool-use tasks, suggesting that these tests are challenging for both biological and non-biological machines. (shrink)

To study how religiosity affects family business goals, we merge literatures on goal setting, temporal orientation, and family business to argue that family business goals can be distinguished into short-term and long-term orientations and propose that religiosity affects both orientations, but to varying degrees. Drawing on a sample of private U.S. family businesses and applying partial least squares structural equations modeling, we find tentative support that religiosity has a stronger positive effect on long-term goal orientation than on short-term goal orientation. (...) We discuss implications for theory development and future research involving religiosity and family business goals. (shrink)

The elaborated intrusion (EI) theory of desire (Kavanagh, Andrade, & May, 2005) attributes the motivational force of cravings to cognitive elaboration, including imagery, of apparently spontaneous thoughts that intrude into awareness. We report a questionnaire study in which respondents rated a craving for food or drink. Questionnaire items derived from EI theory formed a single factor alongside factors for anticipated reward/relief, resistance, and opportunity. In a multiple regression predicting strength of craving, the first three factors accounted for 36% of the (...) variance. Opportunity did not enter the model. In a second study, the difference between individuals' strong and weak cravings to take part in a sporting activity was shown to be related to visual, auditory, and general imagery, and to anticipated reward or relief from engaging in the activity. Implications for treatment of craving-related disorders are discussed in the light of these results and of other research indicating that interference with imagery can reduce the strength of craving. (shrink)

A working party of academics from both professional safeguarding backgrounds and research backgrounds developed and wrote ethical guidelines on safeguarding children in research on behalf of their faculty research ethics committee. The working party encountered a lack of useful precedents while developing the guidelines leading to a lengthy process of debate and consideration of the issues. This paper explores the various issues and dilemmas arising during this process, particularly the tension between safeguarding children from abuse and maintaining research confidentiality. One (...) of the main areas of discussion was how to establish the limits of confidentiality without compromising the research in hand. The role and responsibilities of researchers in supporting children's welfare, and the development of procedures for ensuring that safeguarding is effective are discussed as key elements. In addition, the issues researchers may face when determining thresholds for intervention are considered alongside the uncertainties created by considerations of the extent to which children can give informed consent in research contexts. The paper reflects the process of considering these issues and the conclusions the working party drew as to how best to support children's welfare during research. It also outlines the key elements of the guidelines and the structures developed to ensure researchers could get advice if suspected child abuse became an issue in their research. The paper includes a short version of the guidelines which were eventually approved across the Higher Education Institute. (shrink)

This is a paper based on research with the LGBTIQ+ community in South Australia, the likes of which has not been conducted previously in the state. The paper, which utilized both quantitative and qualitative research methods identifies the key issues that the LGBTIQ+ community face with respect to sporting involvement. There were a range of themes that emerged in relation to a variety of topics including homophobia, sexism and gender discrimination, gender roles and gender stereotypes. This paper provides data and (...) discussion around this important part of the research, which has implications pertaining to sporting organizations and the LGBTIQ+ community. (shrink)

Introduction:Athletes are at increased risk of disordered eating compared to non-athletes. Inspired by previous investigation into quantitative work on an etiological model of disordered eating in athletes, the current study aimed to explore a problematic aspect of the model: athletes' lived experiences of social and sport pressures in relation to the onset of disordered eating and differing eating behaviors.Methods:Nine (N= 9) male and female athletes representing a range of endurance sports took part in semi-structured interviews. Thematic analysis was utilized.Analysis:Analysis revealed (...) two main themes each with two corresponding subthemes (1) Conflating physical appearance and sporting ability with the subthemes of (1a) social comparison in a sporting world and (1b) societal notions of “the athlete body” and (2) Living as an athlete with the corresponding subthemes of (2a) discipline and sacrifice and (2b) the balancing act.Discussion:It is the complex interaction between societal expectations as lived out in social messages and comparisons, and sport pressures that contributes to the development of disordered eating behaviors. These findings suggest that prevention and treatment of disordered eating in athletes can be applied from those already established in non-sporting realm. (shrink)

In a number of membrane-bound viruses, ion channels are formed by integral membrane proteins. These channel proteins include M2 from influenza A, NB from influenza B, and, possibly, Vpu from HIV-1. M2 is important in facilitating uncoating of the influenza A viral genome and is the target of amantadine, an anti-influenza drug. The biological roles of NB and Vpu are less certain. In all cases, the protein contains a single transmembrane α-helix close to its N-terminus. Channels can be formed by (...) homo-oligomerization of these proteins, yielding bundles of transmembrane helices that span the membrane and surround a central ion-permeable pore. Molecular modeling may be used to integrate and interpret available experimental data concerning the structure of such transmembrane pores. This has proved successful for the M2 channel domain, where two independently derived models are in agreement with one another, and with solid-state nuclear magnetic resonance (NMR) data. Simulations based on channel models may yield insights into possible ion conduction and selectivity mechanisms. BioEssays 20:992–1000, 1998. © 1998 John Wiley & Sons, Inc. (shrink)

Strong evidence shows that exposure and engagement with the natural world not only improve human wellbeing but can also help promote environmentally friendly behaviors. Human-nature relationships are at the heart of global agendas promoted by international organizations including the World Health Organization’s “One Health” and the United Nations “Ocean Decade.” These agendas demand collaborative multisector interdisciplinary efforts at local, national, and global levels. However, while global agendas highlight global goals for a sustainable world, developing science that directly addresses these agendas (...) from design through to delivery and outputs does not come without its challenges. In this article, we present the outcomes of international meetings between researchers, stakeholders, and policymakers from the United Kingdom and Brazil. We propose a model for interdisciplinary work under such global agendas, particularly the interface between One Health and the UN Ocean Decade and identify three priority research areas closely linked to each other: human-nature connection, conservation-human behavior, and implementation strategies. We also discuss a number of recommendations for moving forward. (shrink)

The importance of working memory in reading and mathematics performance has been widely studied, with recent research examining the components of WM and their roles in these educational outcomes. However, the differing relationships between these abilities and the foundational skills involved in the development of reading and mathematics have received less attention. Additionally, the separation of verbal, visual and spatial storage and processing and subsequent links with foundational skills and downstream reading and mathematics has not been widely examined. The current (...) study investigated the separate contributions of processing and storage from verbal, visual and spatial tasks to reading and mathematics, whilst considering influences on the underlying skills of verbal comprehension and counting, respectively. Ninety-two children aged 7- to 8-years were assessed. It was found that verbal comprehension was predicted by verbal storage and reading was predicted by verbal and spatial storage. Counting was predicted by visual processing and storage, whilst mathematics was related to verbal and spatial storage. We argue that resources for tasks relying on external representations of stimuli related mainly to storage, and were largely verbal and spatial in nature. When a task required internal representation, there was a draw on visual processing and storage abilities. Findings suggest a possible meaningful separability of types of processing. Further investigation of this could lead to the development of an enhanced WM model, which might better inform interventions and reasonable adjustments for children who struggle with reading and mathematics due to WM deficits. (shrink)

Individualism: The Cultural Logic of Modernity is an edited collection of sixteen essays on the idea of the modern sovereign individual in the western cultural tradition. Reconsidering the eighteenth-century realist novel, twentieth-century modernism, and underappreciated topics on individualism and literature, this volume provocatively revises and enriches our understanding of individualism as the generative premise of modernity itself.

Previous research has shown that short-term fasting in healthy individuals is associated with changes in risky decision-making. The current experiment was designed to examine the influence of short-term fasting in healthy individuals on four types of impulsivity: reflection impulsivity, risky decision-making, delay aversion, and action inhibition. Participants were tested twice, once when fasted for 20 hours, and once when satiated. Participants demonstrated impaired action inhibition when fasted; committing significantly more errors of commission during a food-related Affective Shifting Task. Participants also (...) displayed decreased reflection impulsivity when fasted, opening significantly more boxes during the Information Sampling Task (IST). There were no significant differences in performance between fasted and satiated sessions for risky decision-making or delay aversion. These findings may have implications for understanding eating disorders such as Bulimia Nervosa (BN). Although BN has been characterised as a disorder of poor impulse control, inconsistent findings when comparing individuals with BN and healthy individuals on behavioural measures of impulsivity question this characterisation. Since individuals with BN undergo periods of short-term fasting, the inconsistent findings could be due to differences in the levels of satiation of participants. The current results indicate that fasting can affect performance on the IST, a measure of impulsivity previously studied in BN, whilst performance on other impulsivity measures were unaffected. However, the results from the IST were contrary to the original hypothesis and should be replicated before specific conclusions can be made. (shrink)

The use of psychometric tools to investigate the impact of school-based wellbeing programs raises a number of ethical issues around students’ rights, confidentiality and protection. Researchers have explicit ethical obligations to protect participants from potential psychological harms, but guidance is needed for effectively navigating disclosure of identifiable confidential information that indicates signs of psychological distress. Drawing on a large-scale study examining student, school, and system-based factors that impact the implementation of a school-based social and emotional learning program, we describe patterns (...) of distress attained from quantitative and qualitative questions and describe the process that we evolved to monitor and disclose sensitive mental health information, providing one example of how researchers might effectively address the responsibilities that emerge when collecting sensitive information from students within an education system. The patterns and processes that emerged illustrate that the inclusion of mental distress information can elicit important insights, but also brings responsibilities for minimising risks and maximising benefits. (shrink)