Theories of Early Childhood Education continues to provide a comprehensive overview of the various theoretical perspectives in early childhood education from developmental psychology to critical studies, Piaget to Freire. This revised and updated edition includes additional chapters on Michael Alexander Halliday's view of language learning and the attachment theory work of John Bowlby and Mary Ainsworth. Each author questions assumptions underpinning the use of theory in early childhood education and explores the implications of these questions for policy and practice. Theories (...) reported in this book are a timely reminder of the importance of the relationship between theory and practice necessary for teacher candidates, teacher educators, and early childhood teachers. Students will learn the fundamentals while in-service teachers and professionals will learn the theory behind field observations for their certification exams. (shrink)

Bidirectional deep brain stimulation (DBS) platforms have enabled a surge in hours of recordings in naturalistic environments, allowing further insight into neurological and psychiatric disease states. However, high amplitude, high frequency stimulation generates artifacts that contaminate neural signals and hinder our ability to interpret the data. This is especially true in psychiatric disorders, for which high amplitude stimulation is commonly applied to deep brain structures where the native neural activity is miniscule in comparison. Here, we characterized artifact sources in recordings (...) from a bidirectional DBS platform, the Medtronic Summit RC + S, with the goal of optimizing recording configurations to improve signal to noise ratio (SNR). Data were collected from three subjects in a clinical trial of DBS for obsessive-compulsive disorder. Stimulation was provided bilaterally to the ventral capsule/ventral striatum (VC/VS) using two independent implantable neurostimulators. We first manipulated DBS amplitude within safe limits (2–5.3 mA) to characterize the impact of stimulation artifacts on neural recordings. We found that high amplitude stimulation produces slew overflow, defined as exceeding the rate of change that the analog to digital converter can accurately measure. Overflow led to expanded spectral distortion of the stimulation artifact, with a six fold increase in the bandwidth of the 150.6 Hz stimulation artifact from 147–153 to 140–180 Hz. By increasing sense blank values during high amplitude stimulation, we reduced overflow by as much as 30% and improved artifact distortion, reducing the bandwidth from 140–180 Hz artifact to 147–153 Hz. We also identified artifacts that shifted in frequency through modulation of telemetry parameters. We found that telemetry ratio changes led to predictable shifts in the center-frequencies of the associated artifacts, allowing us to proactively shift the artifacts outside of our frequency range of interest. Overall, the artifact characterization methods and results described here enable increased data interpretability and unconstrained biomarker exploration using data collected from bidirectional DBS devices. (shrink)

This book presents a collection of contemporary discourses that reconsider the relationship of democracy as a political ideology and American ideal and education as the foundation of preparing democratic citizens in America.

Appearing between two historical touchstones—the alleged end of communism and the 100th anniversary of Nietzsche’s death—this book offers a provocative hypothesis about the philosopher’s afterlife and the fate of leftist thought and culture. At issue is the relation of the dead Nietzsche and his written work to subsequent living Nietzscheanism across the political spectrum, but primarily among a leftist _corps_ that has been programmed and manipulated by concealed dimensions of the philosopher’s thought. If anyone is responsible for what Geoff Waite (...) maintains is the illusory death of communism, it is Nietzsche, the man and concept. Waite advances his argument by bringing Marxist—especially Gramscian and Althusserian—theories to bear on the concept of Nietzsche/anism. But he also goes beyond ideological convictions to explore the vast Nietzschean influence that proliferates throughout the marketplace of contemporary philosophy, political and literary theory, and cultural and technocultural criticism. In light of a philological reconstruction of Nietzsche’s published and unpublished texts, _Nietzsche’s Corps/e_ shuttles between philosophy and everyday popular culture and shows them to be equally significant in their having been influenced by Nietzsche—in however distorted a form and in a way that compromises all of our best interests. Controversial in its “decelebration” of Nietzsche, this remarkable study asks whether the postcontemporary age already upon us will continue to be dominated and oriented by the haunting spectre of Nietzsche’s corps/e. Philosophers, intellectual historians, literary theorists, and those interested in western Marxism, popular culture, Friedrich Nietzsche, and the intersection of French and German thought will find this book both appealing and challenging. (shrink)

Speech unfolds over time, and the cues for even a single phoneme are rarely available simultaneously. Consequently, to recognize a single phoneme, listeners must integrate material over several hundred milliseconds. Prior work contrasts two accounts: (a) a memory buffer account in which listeners accumulate auditory information in memory and only access higher level representations (i.e., lexical representations) when sufficient information has arrived; and (b) an immediate integration scheme in which lexical representations can be partially activated on the basis of early (...) cues and then updated when more information arises. These studies have uniformly shown evidence for immediate integration for a variety of phonetic distinctions. We attempted to extend this to fricatives, a class of speech sounds which requires not only temporal integration of asynchronous cues (the frication, followed by the formant transitions 150–350 ms later), but also integration across different frequency bands and compensation for contextual factors like coarticulation. Eye movements in the visual world paradigm showed clear evidence for a memory buffer. Results were replicated in five experiments, ruling out methodological factors and tying the release of the buffer to the onset of the vowel. These findings support a general auditory account for speech by suggesting that the acoustic nature of particular speech sounds may have large effects on how they are processed. It also has major implications for theories of auditory and speech perception by raising the possibility of an encapsulated memory buffer in early auditory processing. (shrink)

In Born to Wonder, Alister McGrath, a prolific Oxford scholar, scientist, and theologian, explores the deepest mystery at the heart of life itself. Life is a gift. We never asked to be born. Yet here we are, living in this strange world of space and time, trying to work out what it's all about before the darkness closes in and extinguishes us. We are adrift on a misty, grey sea of ignorance, seeking a sun-kissed island of certainty, on which we (...) might hope to find clear answers to our deepest and most poignant questions. What is the point of life? Why are we here? And what is it about us that makes us want to ask these questions? As far as we know, we're the only species on earth that asks these questions, and dares to hope that we might find an answer. It seems that we are born to wonder, not merely to exist. From time to time, all of us find ourselves overwhelmed by a sense of awe or mystery, often when confronted with the beauty of nature, whether it is a mountain stream or the vast expanse of ocean waters. That is when we see a flicker of a grander vision of reality, perhaps lying beyond the horizons of our experience. It is as if, for only a moment, a veil is removed, and we catch a half-glimpsed sight of a promised land, waiting to be mapped and explored. This sense of wonder fuels much of humanity's creativity and its search for understanding. (shrink)

Speech unfolds over time, and the cues for even a single phoneme are rarely available simultaneously. Consequently, to recognize a single phoneme, listeners must integrate material over several hundred milliseconds. Prior work contrasts two accounts: (a) a memory buffer account in which listeners accumulate auditory information in memory and only access higher level representations (i.e., lexical representations) when sufficient information has arrived; and (b) an immediate integration scheme in which lexical representations can be partially activated on the basis of early (...) cues and then updated when more information arises. These studies have uniformly shown evidence for immediate integration for a variety of phonetic distinctions. We attempted to extend this to fricatives, a class of speech sounds which requires not only temporal integration of asynchronous cues (the frication, followed by the formant transitions 150–350 ms later), but also integration across different frequency bands and compensation for contextual factors like coarticulation. Eye movements in the visual world paradigm showed clear evidence for a memory buffer. Results were replicated in five experiments, ruling out methodological factors and tying the release of the buffer to the onset of the vowel. These findings support a general auditory account for speech by suggesting that the acoustic nature of particular speech sounds may have large effects on how they are processed. It also has major implications for theories of auditory and speech perception by raising the possibility of an encapsulated memory buffer in early auditory processing. (shrink)

Few years pass without an attempt to interpret Theocritus, Idyll 7. The poem's narrative and descriptive skill, dramatic subtlety and felicity of language are mercifully more than adequate to survive these scholarly onslaughts, so I have less hesitation in offering my own interpretation. The poem's chief problems seem to me to arise from uncertainty as to: Who is the narrator, and why are we kept waiting until line 21 before we are told that he is called Simichidas? Who, or what (...) sort of man, is the goatherd Lycidas, whom he encounters on his way from town to the harvest festival? Answers to these questions fundamentally affect our interpretation of their exchange of songs, which occupies almost half the idyll, and of Lycidas' gift of his stick to Simichidas; and these interpretations will go far towards interpreting the poem as a whole. (shrink)

The evolving Ebola epidemic in West Africa is unprecedented in its size and scope, requiring the rapid mobilization of resources. It is too early to determine all of the ethical challenges associated with the outbreak, but these should be monitored closely. Two issues that can be discussed are the decision to implement and evaluate unregistered agents to determine therapeutic or prophylactic safety and efficacy and the justification behind this decision. In this paper, I argue that it is not compassionate use (...) that justifies this decision and suggest three lines of reasoning to support the decision. (shrink)

RATIONALE, AIMS AND OBJECTIVES: This paper deals with the problem of surgical waiting lists and is aimed, in particular, at comparing two different prioritization approaches: (1) the clinical assessment of treatment urgency aimed at categorizing patients into urgency-related groups (URGs) with a given recommended maximum waiting time for treatment; and (2) the implementation of an original prioritization scoring algorithm aimed at determining the relative priority of each patient in the waiting list and the corresponding order of admission. METHODS: A modelling (...) exercise based on a cohort of 236 patients enrolled on the waiting list of a surgical department in an Italian public university hospital, from 1 January to 30 June 2004, is presented. The comparison is based on a measure called need-adjusted-waiting-days, which allows to take into proper account both urgency and priority. RESULTS: The results show that both methods should be implemented simultaneously for increasing the department's performance in terms of both efficiency--outcome gained from a given amount of resources--and equity--how patients are admitted according to their need. CONCLUSIONS: Waiting list prioritization should not be limited to classifying patients into URGs, but to using a scoring system as well, in order to schedule patient admissions in an explicit and transparent way. (shrink)

In a recent article Professor W. Beare casts doubt on the authenticity of XOPOY at certain places in the Plutus. Of 626–7, he observes: ‘…the editors assume an interlude and insert in Aristophanes’ text. But what the scholiast says is . The poet “ought to have” inserted a choral interlude and “waited a little” until someone could return from the temple with news of the cure.

Whether we're in the boardroom or the classroom, we spend far too much time and energy looking for the right answer. But the truth is that questions are just as important as answers, often more so. If you ask the wrong question, for instance, you're guaranteed to get the wrong answer. A good question, on the other hand, inspires a good answer and, in the process, invites deeper understanding and more meaningful connections between people. Asking a good question requires us (...) to move beyond what we think we know about an issue or a person to explore the difficult and the unknown, the awkward, and even the unpleasant. Expanding on his 2016 commencement address, Jim Ryan, dean of Harvard University's Graduate School of Education, celebrates the art of asking -- and answering -- good questions. Five questions in particular: Wait, what?; I wonder...? Couldn't we at least...?; How can I help?; and What truly matters? Using examples from politics, history, popular culture, and social movements, as well as his own personal life, Ryan demonstrates how these essential inquiries generate understanding, spark curiosity, initiate progress, fortify relationships, and draw our attention to the important things in life -- from the Supreme Court to Fenway Park. By regularly asking these five essential questions, Ryan promises, we will be better able to answer life's most important question: "And did you get what you wanted out of life, even so? (shrink)

Online platforms like Instagram cover potentially distressing imagery with a sensitive-content screen (blurred imagery plus a content warning). Previous research suggests people typically choose to “uncover” and view screened content. In three studies, we investigated whether the presence of screens mitigates the negative emotional impact of viewing content. In Study 1, participants viewed positive and neutral images, and screens (with an option to view the negative images beneath) for a 5-minute period. In Study 2, half the participants saw a grey (...) mask in place of the typical sensitive-content screen. In addition, each image appeared for a fixed period (5 s) and participants had no option to uncover it. Study 3 was like Study 2 except half the participants saw negative images preceded by a sensitive-content screen and half saw negative images without screens. Overall, participants reported a significant increase in state anxiety and negative affect from pre-to post task when they were exposed to sensitive-content screens, whether or not they were also exposed to the negative imagery beneath. Our data suggest sensitive-content screens cause negative responses – state anxiety and negative affect – that do not translate to an emotional benefit when people view negative content. (shrink)

Most of the literature on phase one trials has focused on ethical and safety issues in research on patients with advanced cancer, but this article focuses on healthy, adult subjects. The article makes six specific recommendations for protecting the rights and welfare of healthy subjects in phase one trials: 1) because phase one trials are short in duaration (usually 1 to 3 months), researchers should gather more data on the short-term and long-term risks of participation in phase one studies by (...) healthy subjects; 2) researchers should develop strict inclusion/exclusion criteria that exclude unhealthy or vulnerable subjects, such as decisionally impaired people, in phase one studies; 3) subjects should not participate in more than one phase one study at the same time and should wait at least 30 days between participating in different studies; 4) researchers should develop a database to keep track of phase one participants; 5) subjects should be guaranteed a minimum wage equivalent to the equivalent type of unskilled labor, but there should be no upper limits on wages; and 6) subjects should be allowed to engage in collective bargaining with research sponsors. *Disclaimer: The ideas and opinions expressed in this article are the authors' personal views and do not represent the views of the National Institute of Environmental Health Sciences, the National Institutes of Health, or the United States government. (shrink)

One of the tasks of Jean‐Paul Sartre's later work was to consider how an individual could live freely within a free community. This paper examines how Sartre describes the process of group formation and the implications of this discussion for education. The paper begins with his metaphor of a bus queue in order to describe a series. Then, by means of Sartre's analysis of the storming of the Bastille, the discussion expands to show how a series becomes a genuine group. (...) Finally, suggestions are offered, extrapolated from Sartre's theorizing about groups, as to how teachers might create and maintain genuine groups in and across schools rather than having them remain merely collections of individuals organized from outside. Throughout the paper, the implications of Sartre's insights into groups and educational settings are examined. (shrink)

Suppose you are on a commercial airplane that is flying at 35,000 feet. Next to you sits a man who appears to be sleeping. In fact, this man has been drugged and put upon the plane without his knowledge or consent. He has never flown on a plane before and, indeed, has no idea what an airplane is. Suddenly the man awakes and looks around him. Terrified by the alien environment in which he finds himself, he searches for a door (...) or window from which to make an escape. As luck would have it, he is seated right next to a window exit and he begins to pull the handle that will open the window. You are aware that opening the window exit at this altitude will cause the cabin to quickly depressurize and that this man, you, and probably several other passengers will be sucked out the window to your deaths. You desperately want to stop him from opening the window. Now assume that for some reason it is impossible to prevent him physically from performing the deadly act. Your only option is to rationally persuade him to leave the window exit alone. You cry out to him and, with both hands on the handles, he turns to face you and waits to hear what you have to say. What sort of argument would you make? (shrink)

IntroductionAt present, in the UK, live lobe donation of the lung is generally considered in the context of patients with cystic fibrosis which is a life-threatening, inherited disease.1 However, if this technique is successfully developed it may be applicable to other patients with end stage lung disease. Cystic fibrosis is a disease where the major morbidity and mortality is due to pulmonary infection and respiratory failure.2 In l938 70% of patients born with CF died within one year of birth, but (...) now the average survival has improved to 32 years.1 The improved survival has been due to improved medical care, but also, and in very large measure, to the devotion of the families who have carried out time-consuming daily treatments such as chest physiotherapy, nebuliser treatment, high calorie diets etc. To these patients and their families lung transplantation brought new hope.3 The first successful transplant for CF was performed in the UK in 1985 and we now have patients alive and well more than ten years after transplantation. However, sadly, nearly 50% of patients with CF die on the transplant waiting list because of a shortage of donor organs from brain stem dead donors. This is a tragedy for the individual patient, the families and those who care for them. Is there a way forward?Can the number of organs available for transplantation be increased?Education of the public so that a relative of a brain dead individual will give permission for the organs to be used has been carried out for many years but only with a small increase in the number of available organs. “Required request” where doctors would be required, by law, to ask relatives of brain dead patients to consider transplantation and “assume consent” where consent to donation is assumed unless there is evidence to the contrary, do not have the …. (shrink)

There is limited knowledge about cancer patients' experiences of uncertainty while waiting for genome sequencing results, and whether prolonged uncertainty contributes to psychological factors in this context. To investigate uncertainty in patients with a cancer of likely hereditary origin while waiting for genome sequencing results, we collected questionnaire and interview data at baseline, and at three and 12 months follow up. Participants had negative attitudes towards uncertainty at baseline, and low levels of uncertainty at three and 12 months. Uncertainty about (...) genome sequencing did not change significantly over time [t = 0.660, p = 0.510]. Greater perceived susceptibility for cancer [r = 0.14, p < 0.01], fear of cancer recurrence [r = 0.19, p < 0.01], perceived importance of genome sequencing [r = 0.24, p < 0.01], intention to change behavior if a gene variant indicating risk is found [r = 0.29, p < 0.01], perceived ability to cope with results [r = 0.36, p < 0.01], and satisfaction with decision to have genome sequencing [r = 0.52, p < 0.01] were significantly correlated with negative attitudes towards uncertainty at baseline. Multiple primary cancer diagnoses [B = −2.364 [−4.238, −0.491], p = 0.014], lower perceived ability to cope with results [B = −0.1.881 [−3.403, −0.359], p = 0.016] at baseline, greater anxiety about genome sequencing [B = 0.347 [0.148, 0.546], p = 0.0012] at 3 months, and greater perceived uncertainty about genome sequencing [B = 0.494 [0.267, 0.721] p = 0.000] at 3 months significantly predicted greater perceived uncertainty about genome sequencing at 12 months. Greater perceived uncertainty about genome sequencing at 3 months significantly predicted greater anxiety about genome sequencing at 12 months [B = 0.291 [0.072, 0.509], p = 0.009]. Semi-structured interviews revealed that while participants were motivated to pursue genome sequencing as a strategy to reduce their illness and risk uncertainty, genome sequencing generated additional practical, scientific and personal uncertainties. Some uncertainties were consistently discussed over the 12 months, while others emerged over time. Similarly, some uncertainty coping strategies were consistent over time, while others emerged while patients waited for their genome sequencing results. This study demonstrates the complexity of uncertainty generated by genome sequencing for cancer patients and provides further support for the inter-relationship between uncertainty and anxiety. Helping patients manage their uncertainty may ameliorate psychological morbidity. (shrink)

Most of the literature on phase one trials has focused on ethical and safety issues in research on patients with advanced cancer, but this article focuses on healthy, adult subjects. The article makes six specific recommendations for protecting the rights and welfare of healthy subjects in phase one trials: 1) because phase one trials are short in duaration (usually 1 to 3 months), researchers should gather more data on the short-term and long-term risks of participation in phase one studies by (...) healthy subjects; 2) researchers should develop strict inclusion/exclusion criteria that exclude unhealthy or vulnerable subjects, such as decisionally impaired people, in phase one studies; 3) subjects should not participate in more than one phase one study at the same time and should wait at least 30 days between participating in different studies; 4) researchers should develop a database to keep track of phase one participants; 5) subjects should be guaranteed a minimum wage equivalent to the equivalent type of unskilled labor, but there should be no upper limits on wages; and 6) subjects should be allowed to engage in collective bargaining with research sponsors. *Disclaimer: The ideas and opinions expressed in this article are the authors' personal views and do not represent the views of the National Institute of Environmental Health Sciences, the National Institutes of Health, or the United States government. (shrink)

Frankfurt sets out to refute the principle according to which ‘a person is morally responsible for what he has done only if he could have done otherwise’ . Frankfurt devises a counterexample in which an agent is intuitively responsible even though she could not have done otherwise: Suppose someone – Black, let us say – wants Jones to perform a certain action. Black is prepared to go to considerable lengths to get his way, but he prefers to avoid showing his (...) hand unnecessarily. So he waits until Jones is about to make up his mind what to do, and he does nothing unless it is clear to him that Jones is going to decide to do something other than what he wants him to do. If it does become clear that Jones is going to decide to do something else, Black takes effective steps to ensure that Jones decides to do, and that he does do, what he wants him to do. Whatever Jones's initial preferences and inclinations, then, Black will have his way … Now suppose that Black never has to show his hand because Jones, for reasons of his own, decides to perform and does perform the very action Black wants him to perform. In that case, it seems clear, Jones will bear precisely …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Storytelling and Narrative Knowing:An Examination of the Epistemic Benefits of Well-Told StoriesSarah E. Worth (bio)IntroductionPeople love to tell stories. When something scary, or funny, or out of the ordinary happens, we cannot wait to tell others about it. If it was really funny, etc., we tell the story repeatedly, embellishing as we see fit, shortening or lengthening it as the circumstances prescribe. When people are bad storytellers we (...) tend not to pay as close attention to their stories; our minds drift, and we hope for a swift conclusion. We tend not to remember those stories as well as the ones that were carefully constructed and skillfully delivered. Storytelling is one of our primary forms of communication with other people. Narrativity is the principle way that human beings order their experience in time. It is also one of the primary ways that humans make coherent sense out of seemingly unrelated sequences of events. Thus, an account of how this ordering works is essential to understanding one of the many ways of knowing used by humans, one that has been widely unaccounted for, I believe. What I will argue in this article is that reading, telling, and hearing well-constructed narratives are not just idle pastimes that we have created for entertainment purposes or even as a mere means of communication. Rather, there are epistemological benefits to reading, hearing, and telling well-constructed narratives. In particular, by practicing what I call narrative reasoning, we develop this skill, just as by practicing discursive reasoning we develop discursive reasoning skills. In turn, we develop an enhanced reasoning ability that arises from narrative reasoning and narrative meaning construction. Ultimately, I will argue that those who are able to develop the capacity to reason narratively will be able to have a more comprehensive understanding of the human experience. [End Page 42]Defining NarrativeTo begin, I will go into some detail about what I mean when I talk about narratives since the reasoning skills that will ultimately come from engaging with narratives will be related to the way that we come to understand and make sense of them. Since I do not intend to posit a theory of narrative, I will talk about what constitutes narrativity and what sort of features contribute to increasing the narrativity of a story. To begin, narrative is generally the representation of an event or sequence of events. It is closely tied to description, but it goes beyond description. "My cat has fleas" is a description of a state of affairs. "My cat was bitten by a flea" is a narrative about my cat, which includes a description. Some theorists (such as Barthes and Rimmon-Kenan) argue that a narrative must consist of more than one event or state of affairs in order to be minimally considered a narrative. For my purposes, the change in states of affairs from one to another will be essential for understanding the cognitive aspects that can be gained from engaging with narrative. Although I do not advocate a minimal requirement for something to be considered a narrative, at least two, if not multiple, states of affairs increase narrativity significantly. Narratives also have a unified subject and some relatively easily understood temporal structure. Although many narratives do not order all of their events sequentially, good narratives will have a temporal order that can be gleaned by its reader.1An annal might be something that is temporally ordered and likely have more than two events or states of affairs, and for this reason it might be put into a category of "story form." The primary principle of organization of an annal, however, is merely a temporal list of events. It cannot count as a full-fledged narrative since it may be a temporal list of events that has no unified subject. For example,A: "The Space shuttle Challenger explodes in 1988, the Berlin wall comes down in 1989, there is a massacre at Srebenica, Bosnia in 1995."B: "The Space Shuttle Columbia blows up upon reentry to Earth; the Space Shuttle Challenger explodes upon take off."A is a temporally ordered list of events and is an annal; B, however, is... (shrink)

Prior to European influence, predation by Native Americans was the major factor limiting the numbers and distribution of ungulates in the Intermountain West. This hypothesis is based on analyses of (1) the efficiency of Native American predation, including cooperative hunting, use of dogs, food storage, use of nonungulate foods, and hunting methods; (2) optimal-foraging studies; (3) tribal territory boundary zones as prey reservoirs; (4) species ratios, and sex and age of aboriginal ungulate kills; (5) impact of European diseases on aboriginal (...) populations; and (6) synergism between aboriginal and carnivore predation. Native Americans had no effective conservation practices, and the manner in which they harvested ungulates was the exact opposite of any predicted conservation strategy. Native Americans acted in ways that maximized their individual fitness regardless of the impact on the environment. For humans, conservation is seldom an evolutionarily stable strategy. By limiting ungulate numbers and purposefully modifying the vegetation with fire, Native Americans structured entire plant and animal communities. Because ecosystems with native peoples are entirely different than those lacking aboriginal populations, a “hands-off” or “natural regulation” approach by today’s land managers will not duplicate the ecological conditions under which those ecosystems developed. The modern concept of wilderness as areas without human influence is a myth. North America was not a “wilderness” waiting to be discovered, instead it was home to tens of millions of aboriginal peoples before European-introduced diseases decimated their numbers. (shrink)

Risk management of nanotechnology is challenged by the enormous uncertainties about the risks, benefits, properties, and future direction of nanotechnology applications. Because of these uncertainties, traditional risk management principles such as acceptable risk, cost–benefit analysis, and feasibility are unworkable, as is the newest risk management principle, the precautionary principle. Yet, simply waiting for these uncertainties to be resolved before undertaking risk management efforts would not be prudent, in part because of the growing public concerns about nanotechnology driven by risk perception (...) heuristics such as affect and availability. A more reflexive, incremental, and cooperative risk management approach is required, which not only will help manage emerging risks from nanotechnology applications, but will also create a new risk management model for managing future emerging technologies. (shrink)

Objectives To describe the distress experienced by Spanish podiatrists related to ethical dilemmas, organisational matters, and lack of resources. Design A 2008 email survey of a representative sample of 485 Spanish podiatrists presenting statements about different ethical dilemmas, values and goals at the workplace. Results The response rate was 44.8%. Of all the respondents, 57% described sometimes having to act against their own conscience as distressing. Time constraints is the main cause of moral distress (67%) and 58% of respondents said (...) that they found it distressing that patients have long waits for treatment. Distress related to inadequate treatment due to economical constraints or ineffectiveness was described by 60% of the podiatrists. Another 51% reported that time spent on administration and documentation is distressing. Female doctors experienced more distress than their male colleagues. Last, 36% of respondents reported that their workplace lacked strategies for dealing with ethical dilemmas. Conclusion These study results identify moral distress among Spanish podiatrists mainly related to time constraints, patient demands and lack of resources. Moral distress varies with sex and age. Organisational strategies such as moral deliberation and responsive evaluation offer the potential to address moral distress. (shrink)

Public surveys conducted in many countries report widespread willingness of individuals to donate a kidney while alive to a family member or close friend, yet thousands suffer and many die each year while waiting for a kidney transplant. Advocates of financial incentive programs or “regulated markets” in kidneys present the problem of the kidney shortage as one of insufficient public motivation to donate, arguing that incentives will increase the number of donors. Others believe the solutions lie—at least in part—in facilitating (...) so-called “altruistic donation;” harnessing the willingness of relatives and friends to donate by addressing the many barriers which serve as disincentives to living donation. Strategies designed to minimize financial barriers to donation and the use of paired kidney exchange programs are increasingly enabling donation, and now, an innovative program designed to address what has been termed “chronologically incompatible donation” is being piloted at the University of California, Los Angeles, and elsewhere in the United States. In this program, a person whose kidney is not currently required for transplantation in a specific recipient may instead donate to the paired exchange program; in return, a commitment is made to the specified recipient that priority access for a living-donor transplant in a paired exchange program will be offered when or if the need arises in the future. We address here potential ethical concerns related to this form of organ “banking” from living donors, and argue that it offers significant benefits without undermining the well-established ethical principles and values currently underpinning living donation programs. (shrink)

Approximately 62,000 people in this country await organ transplants. Ten years ago the waiting list numbered 16,000. The line gets longer every day. Up to 30% of those waiting in line will die waiting. We face a chronic shortage of organs. While demand for organs steadily increases, the number of cadaveric organ donors remains relatively constant: approximately 4,000 in 1988, and approximately 5,500 in 1997. In response to this environment of scarcity, policymakers have considered initiatives in a number of domains.

Prior to European influence, predation by Native Americans was the major factor limiting the numbers and distribution of ungulates in the Intermountain West. This hypothesis is based on analyses of (1) the efficiency of Native American predation, including cooperative hunting, use of dogs, food storage, use of nonungulate foods, and hunting methods; (2) optimal-foraging studies; (3) tribal territory boundary zones as prey reservoirs; (4) species ratios, and sex and age of aboriginal ungulate kills; (5) impact of European diseases on aboriginal (...) populations; and (6) synergism between aboriginal and carnivore predation. Native Americans had no effective conservation practices, and the manner in which they harvested ungulates was the exact opposite of any predicted conservation strategy. Native Americans acted in ways that maximized their individual fitness regardless of the impact on the environment. For humans, conservation is seldom an evolutionarily stable strategy. By limiting ungulate numbers and purposefully modifying the vegetation with fire, Native Americans structured entire plant and animal communities. Because ecosystems with native peoples are entirely different than those lacking aboriginal populations, a “hands-off” or “natural regulation” approach by today’s land managers will not duplicate the ecological conditions under which those ecosystems developed. The modern concept of wilderness as areas without human influence is a myth. North America was not a “wilderness” waiting to be discovered, instead it was home to tens of millions of aboriginal peoples before European-introduced diseases decimated their numbers. (shrink)

Background: There is a growing interest in using cognitive behavioural therapy with people who have Asperger Syndrome and comorbid mental health problems. Aims: To examine whether modified group CBT for clinically significant anxiety in an AS population is feasible and likely to be efficacious. Method: Using a randomised assessor-blind trial, 52 individuals with AS were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised to (...) treatment were followed-up for 24 weeks. Results: The conversion rate for this trial was high, while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared to those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety. Conclusions: Trials of psychological therapies with this population are feasible. Larger definitive trials are now needed. Declaration of Interest: None Trial Registration: ISRCTN 30265294, UKCRN 8370. (shrink)

‘Creative Involution’ posits something of a philosophical genealogy, a line of flight that has neither need for nor interest in the periodisation of Modernism, a line of which Beckett (even reluctantly) is part. Murphy, among others, is deterritorialised as much as Beckett's landscapes are, and so he/they become a ‘complexification’ of being that manifests itself in Beckett not as represented, representative or a representation, since so much of Beckett deals with that which cannot be uttered, known or represented, but whose (...) image the works (and its figures) have become, a thinking through of negativity, becoming, and multiplicity through non-Newtonian motion, of being as becoming, where every movement brings something new into the world, but in something of a reverse Darwinism that moves from complex to simple organism, from Murphy to Worm, or Watt to Pim, or among the nameless figures in the short prose, a ‘becoming-animal’, in something not so much of a creative devolution but rather a ‘neoevolution’, or to adopt another term from Deleuze and Guattari, an ‘involution’, which ‘is in no way confused with regression’ (1987: 238), becomings creating nothing less than new worlds. Writing casually to his post-war confidant Georges Duthuit on 26 July 1951, Beckett noted in the midst of gardening chores, ‘Never seen so many butterflies in such worm-state, this little central cylinder, the only flesh, is the worm’ (2011: 271). The observation comes after the writing but before the premiere performance of Waiting for Godot in which Gogo tells Didi, ‘You and your landscapes! Tell me about the worms!’ (1954: 67). Such ‘becoming-animal always involves a pack, a band, a population, a peopling, in short a multiplicity’ (1987: 239), Deleuze and Guattari tell us. For Beckett it defines creativity as well, only possible through such un-tethered selves or beings, amid the generation of varieties and differences, accessible through moments of deterritorialisation, characterised by, ‘A fearsome involution calling us toward unheard-of becomings’ (240). (shrink)

Recently, debate about the distribution of scarce organs for transplantation has focused on whether patients should have the right to place themselves on waiting lists at several transplant centers, thereby gaining an advantage over other potential recipients. This article explores the social and ethical issues raised by multiple listing, contrasting policies adopted at the national level with those implemented in New York State. It concludes by examining the implications of the debate for broader questions about entitlement and access to health (...) care. (shrink)

THE WOFFORD SYMPOSIUM: ITs PURPOSE, GENESIS, AND THEME The purpose of The Wofford Symposium was to stimulate original scholarship on the theme of the meeting, to provide a forum in philosophy of high quality in the area which Wofford College principally serves, and to make available for publication this collection of papers, which it was felt would meet a peculiar need in the contemporary literature of philosophy. In April, 1967, I attended the annual meeting of the Metaphysical Society of America (...) at Purdue University. Noting the frequency with which Hegel was brought into the discussions at that meeting, I was led on two occasions to inject the question into informal group discussions in the halls, "Isn't it time some sort of symposium on Hegel was held?" On the last occasion Professor Frederick Weiss replied, "Why don't you start it?" I'm not yet certain how serious the remark was intended to be, but after waiting two months, half expecting to hear of a plan under way, it occurred to me that perhaps what was wanting was a concrete proposal. (shrink)

In September 1998 the Dutch Ministry of Health together with the Dutch Society of General Practitioners , the Royal Dutch Society of Pharmacists , and the Dutch Patient and Consumer Federation published a pamphlet entitled: The same medicine in a different coat. Drugs without a trademark, equally effective, but cheaper. Patients could obtain a copy at the local pharmacy or in the waiting room of their general practitioner. It deals with the question whether the name of the patent drug should (...) be written on the prescription or only the active component. This is important because, according to the authors, the costs of health care can be reduced without reducing the quality of the care if the doctor prescribes the generic form. It is also mentioned that another advantage of prescribing the generic form is that, contrary to the …. (shrink)

Life history theory predicts that exposure to high mortality in early childhood leads to faster and riskier reproductive strategies. Individuals who grew up in a high mortality regime will not overly wait until they find a suitable partner and form a stable union because premature death would prevent them from reproducing. Cox proportional hazard models were used to determine whether women who experienced sibling death during early childhood (0–5 years) reproduced earlier and were at an increased risk of giving (...) birth to an illegitimate child, with illegitimacy serving as a proxy for risky sexual behavior. Furthermore, we investigate whether giving birth out of wedlock is influenced by individual mortality experience or by more promiscuous sexual behavior that is clustered in certain families. Models are fitted on pedigree data from the eighteenth- and nineteenth-century Krummhörn population in Germany. The results show a relationship between sibling death in early childhood and the risk of reproducing out of wedlock, and reproductive timing. The risk of giving birth out of wedlock is linked to individual mortality experience rather than to family-level effects. In contrast, adjustments in connubial reproductive timing are influenced more by family-level effects than by individual mortality experience. (shrink)

The noted Cambridge philosopher, who has twice served as President of the British Society for Psychical Research, discusses a representative summary of the most impressive cases of experience which seem to refute some of the generally conceived limits of possible personal existence and experience. The subject matter is divided into experiments in card-guessing, cases of veridical but paranormal quasi-perception, and mediumship. Painstaking distinctions in the interpretations and estimates of credibility occasionally make for tedious reading, though they amply prove their advisability (...) as a corrective the tempting imaginative leaps and careless inferences with which some people react to the trans-commonsensical. Occasional flashes of Broad's ironic humor, delightfully testy, lighten the reading considerably. The focus of interest is on the relevance of this material to the question of human survival after death. For someone interested in knowing the current state of psychic science on this question, the book is invaluable. Mr. Broad is not concerned with building a case for any one position. Though he believes that paranormal phenomena strongly suggest some sort of persistence of personality in some cases, he concludes that "one can only wait and see, or alternately wait and not see."--E. W. (shrink)

Terminal kidney patients are faced with lower quality of life, restricted diets and higher morbidity and mortality rates while waiting for deceased donor kidney transplantation. Fortunately, living kidney donation has proven to be a better treatment alternative (e.g. in terms of waiting time and graft survival rates). We observed an inequality in the number of living kidney transplantations performed between the non-European and the European patients in our center. Such inequality has been also observed elsewhere in this field and it (...) has been suggested that this inequality relates to, among other things, attitude differences towards donation based on religious beliefs. In this qualitative research we investigated whether religion might indeed (partly) be the explanation of the inequalities in living donor kidney transplants (LDKT) among non-European patients. Fifty patients participated in focus group discussions and in-depth interviews. The interviews were conducted following the focus group method and analyzed in line with Grounded Theory. The qualitative data analyses were performed in Atlas.ti. We found that religion is not perceived as an obstacle to living donation and that religion actually promotes helping and saving the life of a person. Issues such as integrity of the body were not seen as barriers to LDKT. We observed also that there are still uncertainties and a lack of awareness about the position of religion regarding living organ donation within communities, confusion due to varying interpretations of Holy Scriptures and misconceptions regarding the process of donation. Faith leaders play an important educational role and their opinion is influential. This study has identified modifiable factors which may contribute to the ethnic disparity in our living donation program. We argue that we need to strive for more clarity and awareness regarding the stance of religion on the issue of living donation in the local community. Faith leaders could be key figures in increasing awareness and alleviating uncertainty regarding living donation and transplantation. (shrink)

Temporal discounting is the tendency to devalue temporally distant rewards. Past studies have examined the k-value, the indifference point, and the area under the curve as dependent measures on this task. The current study included these three measures and a fourth measure, called the interest rate total score. The interest rate total score was based on scoring only those items in which the delayed choice should be preferred given the expected return based on simple interest rates. In addition, associations with (...) several individual difference measures were examined including intelligence, executive functions (inhibition, working memory, and set-shifting), thinking dispositions (Need for Cognition and Consideration of Future Consequences) and engagement in substance use and gambling behavior. A staircase temporal discounting task was examined in a sample of 99 university students. Replicating previous studies, temporal discounting increased with longer delays to reward and decreased with higher reward magnitudes. A hyperbolic function accounted for variance in temporal discounting better than an exponential function. Reaction time at the indifference point was significantly longer than at the other choice points. The four dependent measures of temporal discounting were all significantly correlated and were also significantly associated with our individual difference measures. That is, the tendency to wait for a larger delayed reward on all of the temporal discounting measures was associated with higher intelligence, higher executive functions and more consideration of future consequences. Associations between our measures of temporal discounting and outcomes related to substance use and gambling behavior were modest in our university sample. (shrink)

Objectives Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. Methods A vignette study was undertaken in participants in a colorectal cancer screening pilot programme in the Netherlands. Screenees with a negative test result received a questionnaire in which nine hypothetical situations were described: three different healthcare settings (screening, lung cancer, chronic (...) obstructive pulmonary disease) combined with three forms of differentiation each: a difference in premium, waiting list ordering or copayment according to lifestyle. We evaluated the responses using a general hierarchical linear model. Results The percentage of participants in agreement with differentiation varied from 20% to 58% (overall mean of 40%). Significantly more participants were in favour of giving a premium discount to those who do not engage in unhealthy behaviour compared with supporters for higher payments for those who do. More differentiation was supported for non-smoking versus smoking cessation than for participation versus non-participation in screening. We observed in-group favouritism in smokers, but no significant effects of age or disease. There was no support for waiting list ordering based on lifestyle. Conclusions Results of this study show that Dutch citizens eligible for colorectal cancer screening are in favour of some form of financial differentiation in the distribution of healthcare, but that significant differences exist between type of setting and the type of behaviour. Our study can be used in the ongoing discussion about solidarity and behaviour in healthcare. (shrink)

In recent years it has been demonstrated that the use of the traditional property registry models involves the risk of corruption along with long waiting times. This paper points out the main problems associated with conventional models and makes a survey of the new ones that are based on blockchain technology. This type of model is already being developed as a proof of concept by different countries. With the use of this technology in land registry systems, it is possible to (...) improve the transparency of the processes as well as optimize costs and execution time. To show the theoretical results of this study, the Spanish land registry has been taken as an example of a use case scenario. (shrink)

ObjectivesMany older adults with visual impairment also have significant hearing loss. The aim was to investigate the effectiveness of a newly developed Dual Sensory Loss protocol on communication and wellbeing of older persons with DSL and their communication partners in the Netherlands and Belgium.MethodsParticipants and their communication partners were randomized in the “DSL-protocol” intervention group or a waiting-list control group. The intervention took 3 to 5 weeks. Occupational therapists focused on optimal use of hearing aids, home-environment modifications and effective communication (...) strategies. The primary outcome was the Communication Strategies domain of the Communication Profile for the Hearing Impaired. Secondary outcomes measured in participants were the Low Vision Quality Of Life Adjustment subscale, the Center for Epidemiological Studies - Depression Scale, De Jong Gierveld Loneliness Scale and the Fatigue Assessment Scale. The Hearing Handicap and Disability Inventory - Reaction of Others subscale and the Care-related Quality of Life - 7 Dimensions was measured in communication partners. Measurements were taken at baseline and 3-month follow-up. Linear mixed models were used to analyze effects between groups over time for every outcome measure.ResultsIntention-to-treat analyses showed a significant effect of the DSL-protocol on the use of verbal strategies in favor of the control group, however, this effect was non-significant after adjustment for confounding. Effect sizes of other outcomes varied between −0.23 [−0.57, 0.12] and 0.30 [−0.05, 0.64]. The LMM showed a significant effect on the HHDI-Reaction of others scale in favor of communication partners in the treatment group, however, the effect did not remain significant at a 0.01 significance level and the effect size was very small and non-significant 0.12, 95% CI [−0.27 to 0.51]. Adjusted analyses did not reveal treatment effects.ConclusionThe DSL-protocol did not clearly contribute to the enhancement of communication and wellbeing in DSL-patients. Possible reasons for the lack of effects are OTs not being comfortable giving advice on communication and psychosocial issues or the short-term treatment and follow-up period. Further study is warranted to find out how the protocol may be adapted or whether it is necessary to involve mental healthcare professionals.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NTR2843. (shrink)

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments (n=98; proportion of participation was (...) 99%) conducted in 2015 across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)