PurposeAdolescents develop their decision-making ability as they transition from childhood to adulthood. Participation in their medical care should be encouraged through obtaining assent, as recommended by the American Academy of Pediatrics (AAP). In this research, we aim to define the current knowledge of AAP recommendations and surgeon practices regarding assent for elective reconstructive procedures.MethodsAn anonymous electronic survey was distributed to North American paediatric surgeons and fellows through the American Pediatric Surgical Association (n=1353).ResultsIn total, 220 surgeons and trainees responded (16.3%). Fifty (...) per cent of the surgeons who are familiar with the concept of assent had received formal training; 12% of the respondents had not heard of assent before the survey. Forty-seven per cent were aware of the 2016 AAP policy statement regarding assent in paediatric patients. Eighty-nine per cent always include adolescents as part of the consent discussion. Seventy-seven per cent solicit an expression of willingness to accept the proposed care from the patient. The majority (74%) of the surgeons perceived patient cooperation/understanding as the biggest barrier to obtaining assent. Over half of the respondents would consider proceeding with elective surgery despite the adolescent patient’s refusal. Reasons cited for proceeding with elective surgery include surgeons’ perception of medical necessity, perceptions of disease urgency, and lack of patient maturity.ConclusionPaediatric surgeons largely acknowledge the importance of assent, but variably practice the principles of obtaining assent from adolescent patients undergoing elective reconstructive procedures. Fewer surgeons are explicitly aware of formal policy statements or received formal training. Additional surgeon education and institutional policies are warranted to maximise inclusion of adolescents in their medical care. (shrink)

PurposeThis study investigated whether the ability to utilize statistical regularities from fluent speech and map potential words to meaning at 18-months predicts vocabulary at 18- and again at 24-months.MethodEighteen-month-olds were exposed to an artificial language with statistical regularities within the speech stream, then participated in an object-label learning task. Learning was measured using a modified looking-while-listening eye-tracking design. Parents completed vocabulary questionnaires when their child was 18-and 24-months old.ResultsAbility to learn the object-label pairing for words after exposure to the artificial (...) language predicted productive vocabulary at 24-months and amount of vocabulary change from 18- to 24 months, independent of non-verbal cognitive ability, socio-economic status and/or object-label association performance.ConclusionEighteen-month-olds’ ability to use statistical information derived from fluent speech to identify words within the stream of speech and then to map the “words” to meaning directly predicts vocabulary size at 24-months and vocabulary change from 18 to 24 months. The findings support the hypothesis that statistical word segmentation is one of the important aspects of word learning and vocabulary acquisition in toddlers. (shrink)

We provide an overview of a transdisciplinary project about sustainable forest management under climate change. Our project is a partnership with members of the Menominee Nation, a Tribal Nation located in northern Wisconsin, United States. We use immersive virtual experiences, translated from ecosystem model outcomes, to elicit human values about future forest conditions under alternative scenarios. Our project combines expertise across the sciences and humanities as well as across cultures and knowledge systems. Our management structure, governance, and leadership behaviors have (...) both fostered and constrained our work and must be continuously responsive to changing group dynamics. Our project presents opportunities for substantial contributions to society, including insights and knowledge about complementary ways of knowing, skills training, and professional development, and opportunities for reflexive learning about effective transdisciplinary, translational, and transformative scientific processes. (shrink)

We begin, in section 2, with a brief sketch of a cluster of assumptions about human desires, beliefs, actions, and motivation that are widely shared by historical and contemporary authors on both sides in the debate. With this as background, we’ll be able to offer a more sharply focused account of the debate. In section 3, our focus will be on links between evolutionary theory and the egoism/altruism debate. There is a substantial literature employing evolutionary theory on each side of (...) the issue. However, it is our contention that neither camp has offered a convincing case. We are much more sanguine about recent research on altruism in social psychology, which will be our topic in section 4. Though we don’t think this work has resolved the debate, we will argue that it has made illuminating progress – progress that philosophers interested in the question cannot afford to ignore. (shrink)

BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...) objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)

In describing the foundations of our pedagogical approaches to service-learning, we seek to go beyond the navel-gazing—at times, paralyzing—paradoxes of neoliberal forces, which can do “good” for students and their communities, yet which also call students into further calculative frameworks for understanding the “value” of pre-health humanities education and social engagement. We discuss methods to create quiet forms of subversion that call for a moral imagination in extending an ethics of care to students as well as to the communities with (...) which they engage. While we recognize the partiality and limitations of our attempts, framing mentored service-learning in unexpected ways can help students and practitioners to understand their role within broader social, historical, cultural, and emotional contexts and encourage them to act intentionally toward the communities they seek to serve in response to this new self-knowledge. To that end, we outline an academically rigorous service-learning intervention at one of our universities. (shrink)

'When I play with my cat, who knows if I am not a pastime to her more than she is to me?' - Michel de Montaigne. Why do we live with pets? Is there something more to our relationship with them than simply companionship? What is it we look for in our pets and what does this say about us as human beings? In this fascinating book, Erica Fudge explores the nature of this most complex of relationships and the (...) difficulties of knowing what it is that one is living with when one chooses to share a home with an animal. Fudge argues that our capacity for compassion and ability to live alongside others is evident in our relationships with our pets, those paradoxical creatures who give us a sense of comfort and security while simultaneously troubling the categories human and animal. For what is a pet if it isn't a fully-fledged member of the human family? This book proposes that by crossing over these boundaries pets help construct who it is we think we are. Drawing on the works of modern writers, such as J. M. Coetzee, Elizabeth Marshall Thomas and Jacques Derrida, Fudge shows how pets have been used to think with and to undermine our easy conceptions of human, animal and home. Indeed, "Pets" shows our obsession with domestic animals that reveals many of the paradoxes, contra - dictions and ambiguities of life. Living with pets provides thought-provoking perspectives on our notions of possession and mastery, mutuality and cohabitation, love and dominance. We might think of pets as simply happy, loved additions to human homes but as this captivating book reveals perhaps it is the pets that make the home and without pets perhaps we might not be the humans we think we are. For anyone who has ever wondered, like Montaigne, what their cat is thinking, it will be illuminating reading. (shrink)

'When I play with my cat, who knows if I am not a pastime to her more than she is to me?' - Michel de Montaigne. Why do we live with pets? Is there something more to our relationship with them than simply companionship? What is it we look for in our pets and what does this say about us as human beings? In this fascinating book, Erica Fudge explores the nature of this most complex of relationships and the (...) difficulties of knowing what it is that one is living with when one chooses to share a home with an animal. Fudge argues that our capacity for compassion and ability to live alongside others is evident in our relationships with our pets, those paradoxical creatures who give us a sense of comfort and security while simultaneously troubling the categories human and animal. For what is a pet if it isn't a fully-fledged member of the human family? This book proposes that by crossing over these boundaries pets help construct who it is we think we are. Drawing on the works of modern writers, such as J. M. Coetzee, Elizabeth Marshall Thomas and Jacques Derrida, Fudge shows how pets have been used to think with and to undermine our easy conceptions of human, animal and home. Indeed, "Pets" shows our obsession with domestic animals that reveals many of the paradoxes, contra - dictions and ambiguities of life. Living with pets provides thought-provoking perspectives on our notions of possession and mastery, mutuality and cohabitation, love and dominance. We might think of pets as simply happy, loved additions to human homes but as this captivating book reveals perhaps it is the pets that make the home and without pets perhaps we might not be the humans we think we are. For anyone who has ever wondered, like Montaigne, what their cat is thinking, it will be illuminating reading. (shrink)

Dans son nouveau livre, Marie-Paule Ha bouleverse les idées reçues sur le rôle des Françaises dans les colonies. Se concentrant sur l’Indochine, Ha affirme que les femmes françaises n’ont pas tracé une ligne de démarcation stricte entre les colonisateurs et les colonisés. Elles ont bien plutôt inventé des façons diverses de vivre aux colonies, en fonction de leur position sociale, de leur privilèges de « race » et de leur accès à l’administration coloniale. Dans l’introduction, M.-P. Ha situe...

The COVID-19 pandemic has impacted data collection for longitudinal studies in developmental sciences to an immeasurable extent. Restrictions on conducting in-person standardized assessments have led to disruptive innovation, in which novel methods are applied to increase participant engagement. Here, we focus on remote administration of behavioral assessment. We argue that these innovations in remote assessment should become part of the new standard protocol in developmental sciences to facilitate data collection in populations that may be hard to reach or engage due (...) to burdensome requirements. We present a series of adaptations to developmental assessments and a detailed discussion of data analytic approaches to be applied in the less-than-ideal circumstances encountered during the pandemic-related shutdown. Ultimately, these remote approaches actually strengthen the ability to gain insight into developmental populations and foster pragmatic innovation that should result in enduring change. (shrink)

The paper aims at providing the multi-modal propositional logic LTK with a sound and complete axiomatisation. This logic combines temporal and epistemic operators and focuses on m odeling the behaviour of a set of agents operating in a system on the background of a temporal framework. Time is represented as linear and discrete, whereas knowledge is modeled as an S5-like modality. A further modal operator intended to represent environment knowledge is added to the system in order to achieve the expressive (...) power sufficient to describe the piece of information available to the agents at each moment in the flow of time. (shrink)

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems on students' mental health and academic outcomes.Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial conducted across five (...) school districts. School clinicians are randomized to either MATCH or usual care treatment conditions. The target sample includes 168 youths referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health.Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board. We plan to publish the findings in peer-reviewed journals and present them at academic conferences.Clinical Trial Registration:ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016. (shrink)

Indirect speech acts—responding “I forgot to wear my watch today” to someone who asked for the time—are ubiquitous in daily conversation, but are understudied in current neurobiological models of language. To comprehend an indirect speech act like this one, listeners must not only decode the lexical-semantic content of the utterance, but also make a pragmatic, bridging inference. This inference allows listeners to derive the speaker’s true, intended meaning—in the above dialog, for example, that the speaker cannot provide the time. In (...) the present work, we address this major gap by asking non-aphasic patients with behavioral variant frontotemporal dementia and brain-damaged controls with amnestic mild cognitive impairment to judge simple question-answer dialogs of the form: “Do you want some cake for dessert?” “I’m on a very strict diet right now,” and relate the results to structural and diffusion MRI. Accuracy and reaction time results demonstrate that subjects with bvFTD, but not MCI, are selectively impaired in indirect relative to direct speech act comprehension, due in part to their social and executive limitations, and performance is related to caregivers’ judgment of communication efficacy. MRI imaging associates the observed impairment in bvFTD to cortical thinning not only in traditional language-associated regions, but also in fronto-parietal regions implicated in social and executive cerebral networks. Finally, diffusion tensor imaging analyses implicate white matter tracts in both dorsal and ventral projection streams, including superior longitudinal fasciculus, frontal aslant, and uncinate fasciculus. These results have strong implications for updated neurobiological models of language, and emphasize a core, language-mediated social disorder in patients with bvFTD. (shrink)

Over the last generation, the womanist idea--and the tradition blooming around it--has emerged as an important response to separatism, domination, and oppression. Gary L. Lemons gathers a diverse group of writers to discuss their scholarly and personal experiences with the womanist spirit of women of color feminisms. Feminist and womanist-identified educators, students, performers, and poets model the powerful ways that crossing borders of race, gender, class, sexuality, and nation-state affiliation(s) expands one's existence. At the same time, they bear witness to (...) how the self-liberating theory and practice of women of color feminism changes one's life. Throughout, the essayists come together to promote an unwavering vein of activist comradeship capable of building political alliances dedicated to liberty and social justice. Contributors: M. Jacqui Alexander, Dora Arreola, Andrea Assaf, Kendra N. Bryant, Rudolph P. Byrd, Atika Chaudhary, Paul T. Corrigan, Fanni V. Green, Beverly Guy-Sheftall, Susan Hoeller, Ylce Irizarry, M. Thandabantu Iverson, Gary L. Lemons, Layli Maparyan, and Erica C. Sutherlin. (shrink)

One central strand in Quine's criticism of common-sense notions of linguistic meaning is an argument from the holism of empirical content. This paper explores (with many digressions) the several versions of the argument, and discovers them to be uniformly bad. There is a kernel of truth in the idea that ?holism?, in some sense, ?undermines the analytic?synthetic distinction?, in some sense; but it has little to do with Quine's radical empiricism, or his radical scepticism about meaning.

Twentieth century philosophers introduced the distinction between “objective rightness” and “subjective rightness” to achieve two primary goals. The first goal is to reduce the paradoxical tension between our judgments of what is best for an agent to do in light of the actual circumstances in which she acts and what is wisest for her to do in light of her mistaken or uncertain beliefs about her circumstances. The second goal is to provide moral guidance to an agent who may be (...) uncertain about the circumstances in which she acts, and hence is unable to use her standard moral principle directly in deciding what to do. This paper distinguishes two important senses of “moral guidance”; proposes criteria of adequacy for accounts of subjective rightness; canvasses existing definitions for “subjective rightness”; finds them all deficient; and proposes a new and more successful account. It argues that each comprehensive moral theory must include multiple principles of subjective rightness to address the epistemic situations of the full range of moral decision-makers, and shows that accounts of subjective rightness formulated in terms of what it would reasonable for the agent to believe cannot provide that guidance. (shrink)

In the first Critique Kant introduced the analytic/synthetic distinction and illustrated it with theoretical propositions. As his main aim in that work was to justify synthetic a priori propositions, Kant was able to bring his central questions into relief and discuss the methodology of their solution by contrasting synthetic propositions, such as: “Every event has a cause” with analytic propositions, such as: “Every effect has a cause.” Consequently, few commentators have any difficulty in stating as propositions the propositions Kant is (...) justifying in the first Critique or in pointing out the difficulty of justifying such propositions. (shrink)

(1972). Properties and causes: An approach to the problem of hypothesis in the scientific methodology of Sir Isaac Newton. Annals of Science: Vol. 28, No. 3, pp. 217-233.