In 2018-2019, at the Keck School of Medicine of the University of Southern California, we developed and piloted a narrative-based health systems science intervention for patients living with HIV and medical students in which medical students co-wrote patients’ life narratives for inclusion in the electronic health record. The pilot study aimed to assess the acceptability of the “life narrative protocol” from multiple stakeholder positions and characterize participants’ experiences of the clinical and pedagogical implications of the LNP. Students were recruited from (...) KSOM. Patients and staff were recruited from the Maternal, Child, and Adolescent/Adult Center for Infectious Disease and Virology at Los Angeles County+USC Medical Center. Ten patients, seventeen students, and ten MCA staff participated in the pilot study. Qualitative methods were used to gather data from students’, patients’, and staff’s perspectives. Three themes emerged from the thematic analysis: patients’ life narratives conveyed their unique life experiences and voices; the protocol could result in wide-ranging effects on HIV care; the LNP enabled students to contribute value to patients’ healthcare. Across groups, participants considered the LNP an acceptable intervention. The LNP, its limitations, and implications for HIV care, narrative medicine, and health information technology are presented. (shrink)
Proofs of Prophecy and the Refutation of the Ismāʿīliyya: The Kitāb Ithbāt nubuwwat al-nabī by the Zaydī al-Muʾayyad bi-llāh al-Hārūnī. By Eva-Maria Lika. Worlds of Islam, vol. 9. Berlin: de Gruyter, 2018. Pp. vii + 177, 152. $149.99, €129.95, £106.99.
Raising a child with an autism spectrum disorder (ASD) is a stressful experience and has been associated with poor maternal mental health and increased maternal emotional distress. However, the experiences of fathers of children with ASD are largely unexplored and the coping strategies these men employ to cope with the challenges they face have received little research attention. This research aimed to explore the phenomenological experiences of fathers of preschool children with ASD by gaining a better understanding of the manner (...) in which these individuals attempted to cope with their situation. A multiple, single-case study design was employed and five participants were recruited via two local paediatric practices. Semi-structured interviews were conducted with the participants and data were analysed making use of Interpretative Phenomenological Analysis (IPA). This analysis yielded three superordinate themes, which were labelled as follows: (a) the experience of fathering a child with ASD, (b) challenges of fathering a child with ASD, and (c) coping with fathering a child with ASD. The results suggest that the fathers of children with ASD experience their parental role as stressful. The participants in the current study related the stress they experienced to a number of challenges associated directly with their children’s behaviour, as well as to the effects that parenting a child with ASD had on their own wellbeing and functioning. The participants reported making use of a number of coping strategies in order to deal with the challenges they faced. The participants used both problem-focussed and avoidant coping strategies. The results are discussed and recommendations made with regard to future research. (shrink)
Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective (...) ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called “moral spaces,” reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings. (shrink)
We consider Walker's thorough review in the context of thinking about future research on the relation between sleep and memory. We first address methodological issues including type of memory and sleep-stage dependency. We suggest a broader investigation of potential signaling molecules that may be critical to sleep-related consolidation. A brief review of the importance of the stress hormone cortisol illustrates this point.
Upon entering the White House in 1933, President Franklin D. Roosevelt faced an ailing economy in the throes of the Great Depression and rushed to transform the country through recovery programs and legislative reform. By 1934, he began to send professional photographers to the state of West Virginia to document living conditions and the effects of his New Deal programs. The photographs from the Farm Security Administration Project not only introduced “America to Americans,” exposing a continued need for government intervention, (...) but also captured powerful images of life in rural and small town America.New Deal Photographs of West Virginia, 1934-1943 presents images of the state's northern and southern coalfields, the subsistence homestead projects of Arthurdale, Eleanor, and Tygart Valley, and various communities from Charleston to Clarksburg and Parkersburg to Elkins. With over one hundred and fifty images by ten FSA photographers, including Walker Evans, Marion Post Wolcott, Arthur Rothstein, and Ben Shahn, this collection is a remarkable proclamation of hardship, hope, endurance, and, above all, community. These photographs provide a glimpse into the everyday lives of West Virginians during the Great Depression and beyond. (shrink)
The practice of teaching virtue for pay was typical of the Greek sophists but consistently eschewed by their contemporary Socrates. Plato and Xenophon offer various explanations for Socrates' refusal to take pay, explanations intended not only to reflect favourably upon their teacher but also to reflect negatively upon the sophists. Indeed, Plato and Xenophon have been so persuasive in this regard that the mere fact of accepting pay has become a common source of invective against the sophists. This paper examines (...) and evaluates these passages of Plato and Xenophon in light of the historical information we have concerning sophistic and Socratic pedagogy in general and it reaches two major conclusions: first, that most of the reasons ascribed to Socrates for refusing to accept pay are sufficiently problematic to raise serious doubts about their authenticity and, second, that none of these reasons functions successfully as a general critique of the sophists. (shrink)
An examination of the contemporary Italian movement associated with M. P. Sciacca, and the serious application of dialectical and phenomenological methods to unveil the structure of "intentionality" or "spirit." An appraisal of Sciacca together with a sample critique of Dante follows a competent summary of the prevailing positions.--D. B. B.
Psychopaths routinely disregard social norms by engaging in selfish, antisocial, often violent behavior. Commonly characterized as mentally disordered, recent evidence suggests that psychopaths are executing a well-functioning, if unscrupulous strategy that historically increased reproductive success at the expense of others. Natural selection ought to have favored strategies that spared close kin from harm, however, because actions affecting the fitness of genetic relatives contribute to an individual’s inclusive fitness. Conversely, there is evidence that mental disorders can disrupt psychological mechanisms designed to (...) protect relatives. Thus, mental disorder and adaptation accounts of psychopathy generate opposing hypotheses: psychopathy should be associated with an increase in the victimization of kin in the former account but not in the latter. Contrary to the mental disorder hypothesis, we show here in a sample of 289 violent offenders that variation in psychopathy predicts a decrease in the genetic relatedness of victims to offenders; that is, psychopathy predicts an increased likelihood of harming non-relatives. Because nepotistic inhibition in violence may be caused by dispersal or kin discrimination, we examined the effects of psychopathy on (1) the dispersal of offenders and their kin and (2) sexual assault frequency (as a window on kin discrimination). Although psychopathy was negatively associated with coresidence with kin and positively associated with the commission of sexual assault, it remained negatively associated with the genetic relatedness of victims to offenders after removing cases of offenders who had coresided with kin and cases of sexual assault from the analyses. These results stand in contrast to models positing psychopathy as a pathology, and provide support for the hypothesis that psychopathy reflects an evolutionary strategy largely favoring the exploitation of non-relatives. (shrink)
Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)
Another exceptionally fine text by Suppes. Designed for those who can follow a mathematical argument, but presupposes no special knowledge of mathematics or symbolic logic. The system developed is that of Zermelo-Fraenkel. Especially noteworthy is the discussion of the exact role played by the various axioms.--N. D. B., Jr.
This is a first attempt to formalize the language required for analysis of purposive organizations or systems into the subordinate systems of which they organically consist. The authors take a philosophic position midway between Atomism and the Absolute; like Aristotle, they take a finite, complex individual as the ultimate referent of explanation. The sole primitive is "s///tOx," interpreted as "upon analytic dissection, the system t organized by [the property] x." It is claimed without argument that the relationship is independent of (...) who, so to speak, is doing the dissecting. This paper is welcome as a first attack on a difficult problem, although it does not pay off in the production of non-trivial theorems or in clarification much beyond that afforded by technical English.--N. D. B. Jr. (shrink)
Can the totality of consciousness be found within the waking state? Can human consciousness be understood in its entirety by only considering the contents presented to us in the waking state? Why is the waking state so privileged? -/- This treatise from Indian author D.B. Gangolli presents the tri-basic method or the method of the three states of consciousness as the principle device or strategy employed in the science of Advaita Vedanta for arriving at knowledge and understanding of Ultimate Reality (...) as expounded in the Upanishadic tradition. This tri-basic method of wisdom inquiry into Pure Consciousness is contrasted with the pervasive mono-basic or waking-state-only method of inquiry common to science, western, and most other philosophical systems wherein explication of the Ultimate Reality is sought solely within waking consciousness. -/- The tri-basic method of the Advaita system takes waking consciousness as only one of three great states of conscious awareness within Intuition or Intuitive experience, the other two being dreaming and sleeping (deep sleep) states. Instead of privileging the waking state, the tri-basic method views all three states from the viewpoint of Intuition and sets about to inquire into the whole of conscious experience giving equal importance to all three states. It helps us to recognize how we are taught to see waking consciousness as predominant, as the sole perspective from within which we discover knowledge of truth and reality, and to see the limitations of the truncated view of consciousness that it is. -/- Advaita Vedanta is the only philosophical system that consciously inquires within all three great states of consciousness in order for the discrimination of Ultimate Reality. “To observe these states and discriminate about them means whatever is witnessed in the states – all that is to be taken en masse (rolled up into one mass) and is to be made an object to one’s Intuition, i.e., the essence of Being as the Witness or the Self, and then discriminate.” . (shrink)