Social contracts are the mechanisms by which society legitimizes professions and grants them authority and autonomy to carry out their functions. The nursing profession is currently renegotiating its contract with society in a manner which clearly reflects a change from physician dominance, and emphasis on illness care to increased independent and autonomous functioning within a newly developing framework of nursing science which emphasizes health care. In return for their services, nurses are also negotiating for those benefits which historically they have (...) not received. These include legitimization of their newly acquired autonomous role functions, and adequate reimbursement mechanisms and structures. When the contemporary role of the nurse is fully legitimzed, the impact on contemporary society and health care is likely to be enormous. (shrink)

Number concepts must support arithmetic inference. Using this principle, it can be argued that the integer concept of exactly ONE is a necessary part of the psychological foundations of number, as is the notion of the exact equality - that is, perfect substitutability. The inability to support reasoning involving exact equality is a shortcoming in current theories about the development of numerical reasoning. A simple innate basis for the natural number concepts can be proposed that embodies the arithmetic principle, supports (...) exact equality and also enables computational compatibility with real- or rational-valued mental magnitudes. (shrink)

The theories or programs of research described in the chapters of this book move beyond the traditional evaluation model of prejudice, drawing on a broad range of theoretical ancestry to develop models of why, when, and how differentiated reactions to groups arise, and what their consequences might be. The chapters have in common a re-focusing of interest on emotion as a theoretical base for understanding differentiated reactions to, and differentiated behaviors toward, social groups. The contributions also share a focus on (...) specific interactional and structural relations among groups as a source of these differentiated emotional reactions. The chapters in the volume thus reflect a theoretical shift from an earlier emphasis on knowledge about ingroups and outgroups to a new perspective on prejudice in which socially-grounded emotional differentiation becomes a basis for social regulation. (shrink)

The theories or programs of research described in the chapters of this book move beyond the traditional evaluation model of prejudice, drawing on a broad range of theoretical ancestry to develop models of why, when, and how differentiated reactions to groups arise, and what their consequences might be. The chapters have in common a re-focusing of interest on emotion as a theoretical base for understanding differentiated reactions to, and differentiated behaviors toward, social groups. The contributions also share a focus on (...) specific interactional and structural relations among groups as a source of these differentiated emotional reactions. The chapters in the volume thus reflect a theoretical shift from an earlier emphasis on knowledge about ingroups and outgroups to a new perspective on prejudice in which socially-grounded emotional differentiation becomes a basis for social regulation. (shrink)

Although ethics is an essential component of undergraduate medical education, research suggests current medical ethics curricula face considerable challenges in improving students’ ethical reasoning. This paper discusses these challenges and introduces a promising new mode of graduate and professional ethics instruction for overcoming them. We begin by describing common ethics curricula, focusing in particular on established problems with current approaches. Next, we describe a novel method of ethics education and assessment for medical students that we have devised, the Medical Ethics (...) Bowl. Finally, we suggest pedagogical advantages to MEBs when compared to other ethics curricula. (shrink)

Bioethical decision‐making in pediatrics diverges from similar decisions in other medical domains because the young child is not an autonomous decision‐maker, while the teen is developing—and should be encouraged to develop—autonomy and decisional capacity. Thus the balance between autonomy and beneficence is fundamentally different in pediatrics than in adult medicine. While ethical dilemmas that reflect these fundamental issues are common, many pediatric physician and nursing training programs do not delve into the issues or offer specific training about how to deal (...) with borderline cases.To meet this need, the Children's Mercy Bioethics Center in Kansas City, Missouri, created a program specifically dedicated to serving practicing, experienced pediatric health professionals. Our students come from various professional disciplines: they are doctors, nurses, social workers, chaplains, lawyers, psychologists, counselors, and hospital administrators practicing in pediatrics. (shrink)

This case recounts the story of Rajat Gupta, a Goldman Sachs board member and seniorpartner emeritus of McKinsey & Co., who was accused by the government of giving critical nonpublicfinancial information to Raj Rajaratnam, Galleon Group founder, during the financial crisisof 2008. The information passed along to Rajaratnam was about a pending $5 billion investment byWarren Buffett’s Berkshire Hathaway in Goldman Sachs at a time when its stock had been faltering.The government alleged that based on this information, Rajaratnam purchased a (...) large number ofshares in the company and then sold them when the deal became public and Goldman’s stock rose.Rajaratnam purportedly made $18 million on these trades. (shrink)

Over-time variability characterizes not only individual-level emotions, but also group-level emotions, those that occur when people identify with social groups and appraise events in terms of their implications for those groups. We discuss theory and research regarding the role of emotions in intergroup contexts, focusing on their dynamic nature. We then describe new insights into the causes and consequences of emotional dynamics that flow from conceptualizing emotions as based in group membership, and conclude with research recommendations.

This case recounts the story of Rajat Gupta, a Goldman Sachs board member and seniorpartner emeritus of McKinsey & Co., who was accused by the government of giving critical nonpublicfinancial information to Raj Rajaratnam, Galleon Group founder, during the financial crisisof 2008. The information passed along to Rajaratnam was about a pending $5 billion investment byWarren Buffett’s Berkshire Hathaway in Goldman Sachs at a time when its stock had been faltering.The government alleged that based on this information, Rajaratnam purchased a (...) large number ofshares in the company and then sold them when the deal became public and Goldman’s stock rose.Rajaratnam purportedly made $18 million on these trades. (shrink)

Illness narratives invite practitioners to understand how biomedical and traditional health information is incorporated, integrated, or otherwise internalized into a patient’s own sense of self and social identity. Such narratives also reveal cultural values, underlying patterns in society, and the overall life context of the narrator. Most illness narratives have been examined from the perspective of European-derived genres and literary theory, even though theorists from other parts of the globe have developed locally relevant literary theories. Further, illness narratives typically examine (...) only the experience of illness through acute or chronic suffering (and potential recovery). The advent of biomedical disease prevention methods like post- and pre-exposure prophylaxis (PEP and PrEP) for HIV, which require daily pill consumption or regular injections, complicates the notion of an illness narrative by including illness prevention in narrative accounts. This paper has two aims. First, we aim to rectify the Eurocentrism of existing illness narrative theory by incorporating insights from African literary theorists; second, we complicate the category by examining prevention narratives as a subset of illness narratives. We do this by investigating several narratives of HIV prevention from informants enrolled in an HIV prevention trial in Kenya and Uganda in 2022. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

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

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

Traditional accounts hold that reference consists in a relation between the mind and an object; the relation is effected by a mental act and mediated by internal mental contents (internal representations). Contemporary theories as diverse as Fodor’s [Fodor, J.A., 1987. Psychosemantics: The Problem of Meaning in the Philosophy of Mind. MIT Press, Cambridge, MA] language of thought hypothesis, Dretske’s [Dretske, F., 1988. Explaining Behaviour: Reasons in a World of Causes. MIT Press, Cambridge, MA] informational semantics and Millikan’s [Millikan, R.G., 1984. (...) Language, Thought and Other Biological Categories: New Foundations for Realism. MIT Press, Cambridge, MA] teleosemantics share this act– content–object picture (which was also held by several early modern philosophers, in particular Locke). The core of the traditional view is the thesis that reference and intentionality are relational (‘thesis RR’). Although deeply problematic, RR is entrenched also in psychology, linguistics, cognitive science and Artificial Intelligence. Using for the most part arguments employed by Wittgenstein, we mount a case against RR and advance a deflationary account of reference and intentionality according to which neither is relational. (shrink)

Based on seventeenth- and eighteenth-century accounts written by and for slavers, this article investigates the provisioning of the French Middle Passage. As the transatlantic trade in African captives developed, foodstuffs for the feeding of both Europeans and Africans figured prominently in a specifically Atlantic system of commodity exchanges. The trade in foodstuffs depended most heavily on African subsistence systems encountered along the coasts of West Africa, but a surprising quantity of French and other European foodstuffs were embarked specifically for the (...) Middle Passage, revealing, I argue, the precariousness of conditions of trade and of European slaving factories. As a key element of Atlantic political economy, the study of food and its transatlantic provisioning networks sheds light not only on the governance and regulation of the networks themselves, but also on the ability of early modern states to establish and maintain metropolitan control, on the growth of local, colonial forms of autonomy and authority, and on the complex systems of ‘national’ and colonial interdependence that lay behind the expansion of every Atlantic colony. I conclude that this study of provisioning demonstrates that however fractured and differentiated, imperial power was an irrefutable aspect of colonial continuity. (shrink)

Childbearing is an increasingly complicated matter, which has evolved significantly over the past several decades. Treatment options for infertility have expanded. Prenatal testing and treatment have led to an evolution in obstetrical decision-making, wherein the risks and benefits to the fetus and future child are better understood and more strongly considered in medical management of the pregnant woman. Obstetrics appears to be increasingly interventional; one in three babies in the United States is now born by cesarean section. Neonatal intensive care (...) has markedly improved outcomes for premature babies. A pregnant woman may now be presented with many options— obstetrician or midwife, home or hospital delivery, choices among prenatal testing and monitoring, early induction of labor, cesarean delivery. Health care professionals face similar decisions with regard to what they recommend and the boundaries of safe and responsible care they should make available. Preterm Babies, Fetal Patients, and Childbearing Choices, by John D. Lantos and Diane S. Lauderdale, provides an excellent overview of the available information relevant to these questions. (shrink)

_This paper discusses the concept of compassion fatigue in light of the importance that political decisions, especially the application of the concept of public spirit, have had on care and nursing in a Danish hospital context during the COVID-19 pandemic. The paper is based on recent research literature in the field as well as the author’s own participatory observation study. The paper suggests that nurses already show a sense of public spirit due to their authorization and professional ethics, but at (...) the same time they must balance the ambiguity of nursing care. A linguistic-philosophical study of public spirit shows that the concept can have a discursive, double-binding and interpellative effect on nurses, who may therefore have an experience of inadequacy and compassion fatigue. In this context, compassion fatigue must be understood as the fact that nurses cannot provide the care they want or that is expected of them. Public spirit can be said to have had a renaissance and linguistic and moral supremacy during the COVID-19 pandemic. The paper views the concept of __waywardness 1 as a possible response for how to prevent or completely avoid compassion fatigue, so that nurses instead have an experience of compassion / self-compassion. This could in the end be important for encouraging more nursing students and nurses who have the desire and opportunity to stay in the profession._ _Keywords_: Nursing care, compassion fatigue, public spirit, compassion, COVID-19 pandemic. (shrink)

In this article, the authors explore the impact of a potential future regulatory decision by FDA whether or not to continue its enforcement discretion policy allowing physicians to perform, and stool banks to sell, stool product for fecal microbiota transplantation as a treatment for recurrent Clostridium Difficile infection without an Investigative New Drug application. The paper looks at the Agency's regulatory options in light of the current gut microbiota based products that are in the FDA pipeline for drug approval and (...) the potential impact and repercussions of their approval on FDA action. In laying out FDA's options we consider the implications of market exclusivity and off-label use of newly approved drugs. Ultimately, we explore the potential impact of FDA's decision on patients, research, and innovation. (shrink)

Daniel Kahneman's book Thinking, Fast and Slow (2011) has had a worldwide impact. The book's insights are profound and have changed the thinking of both decision scientists and general audiences about how choices are made. Kahneman, however, claims that standard utility theory cannot explain these insights because it 1) lacks “reference points” from which gains and losses can be measured, 2) does not predict loss aversion, and 3) assumes preferences are stable (amid supposed counter evidence). These alleged failures of utility (...) theory are what led Kahneman and Tversky (1979, 1991) to develop prospect theory. This brief article shows that a close reading of Thinking, Fast and Slow reveals fundamental oversights in these criticisms. Not only does loss aversion arise naturally within utility theory for rational economic agents with stable preferences, but the very measurements of gains and losses rely directly upon reference points. Rather than overturning the insights of prospect theory, proper use of utility theory and its indifference curve representations reveals these behavioral insights and places them within the sturdier, longer- established framework of neoclassical microeconomic theory. (shrink)

It is not widely realised that Turing was probably the first person to consider building computing machines out of simple, neuron-like elements connected together into networks in a largely random manner. Turing called his networks 'unorganised machines'. By the application of what he described as 'appropriate interference, mimicking education' an unorganised machine can be trained to perform any task that a Turing machine can carry out, provided the number of 'neurons' is sufficient. Turing proposed simulating both the behaviour of the (...) network and the training process by means of a computer program. We outline Turing's connectionist project of 1948. (shrink)