An evaluation of mental capacity is critical to a clinician's judgment about whether or not persons can make medical treatment decisions on their own behalf, and uncertainty about their ability to meaningfully participate in that process is one of the more common reasons an ethics consult is requested. The care of decisionally incapable patients—particularly those who lack advance care documents and no living relative who can speak for them—presents a quandary to healthcare personnel attempting to plan care in their best (...) interest, especially when options are multiple but none are ideal. These situations can be further complicated if involving a patient with a dual diagnosis of mental retardation and mental illness living in a community group home. (shrink)
Nearly $2 trillion is spent annually in the U.S. treating chronic illness — yet accessibility to quality health care services in rural communities for the chronically ill and dying remains problematic. Unique barriers present special challenges to a meaningful discussion of and subsequent strategies for addressing these issues in the context of increasingly scarce resources.
The Institute of Medicine reporting on the quality of health care in America recommends six aims for achieving the health care system we could have. Together with the Institute for Healthcare Improvement Triple Aim initiative, a framework has emerged to challenge providers, educators, and policymakers to remake the health care system according to specific objectives: to provide care that is safe, effective, patient-centered, timely, efficient, and equitable to more people at a price we can afford. Complicating this mission of better (...) prevention and better care at a lower cost is a daunting demographic: January of 2011 marked the month and year that the first of the baby boomers turned 65. The U.S. Census Bureau in May 2010 projected the number of Americans of this age and over to reach 88 million by 2050, more than double the current figure of 40.2 million. Parekh and Barton forecast in stark detail what it will be like to address these burgeoning numbers of older Americans with comorbidities, including the fact that over 20% of the population currently experiences at least two chronic medical conditions. (shrink)
In the absence of a well articulated conceptual framework for nursing ethics, this article argues for a theory of applied ethics - casuistics - used within a clinical reasoning model, to analyse the complicated issues presented in three cases involving adolescents receiving treatment for abuse through a rural alternative learning centre. The clinical nurse specialist, as an independent practitioner within the community, is presented with many ethical challenges arising from cultural diversity. The inherent independent nature of such practice environments combined (...) with the pluralism which exists in today's multicultural society demands that professional nurses working in these circumstances develop and utilize an ethical framework for the analysis of patient care in situations that involve moral conflict. (shrink)
The United States considers educating all students to a threshold of adequate outcomes to be a central goal of educational justice. The No Child Left Behind Act introduced evidence-based policy and accountability protocols to ensure that all students receive an education that enables them to meet adequacy standards. Unfortunately, evidence-based policy has been less effective than expected. This article pinpoints under-examined methodological problems and suggests a more effective way to incorporate educational research findings into local evidence-based policy decisions. It identifies (...) some things educators need to know and do to determine whether available interventions can play the right casual role in their setting to produce desired effects. It examines the value and limits of educational research, especially randomized controlled trials, for this task. (shrink)
_Educational Neuroscience_ provides an overview of the wide range of recent initiatives in educational neuroscience, examining a variety of methodological concerns, issues, and directions. Encourages interdisciplinary perspectives in educational neuroscience Contributions from leading researchers examine key issues relating to educational neuroscience and mind, brain, and education more generally Promotes a theoretical and empirical base for the subject area Explores a range of methods available to researchers Identifies agencies, organizations, and associations facilitating development in the field Reveals a variety of on-going (...) efforts to establish theories, models, methods, ethics, and a common language. (shrink)
FOREWORD. Gilbert Gottlieb and the Developmental Point of View. I. INTRODUCTION. 1. Developmental Systems, Nature-Nurture, and the Role of Genes in Behavior and Development: On the Legacy of Gilbert Gottlieb. 2. Normally Occurring Environmental and Behavioral Influences on Gene Activity: From Central Dogma to Probabilistic Epigenesis. II. THEORETICAL FOUNDATIONS FOR THE DEVELOPMENTAL STUDY OF BEHAVIOR AND GENETICS. 3. Historical and Philosophical Perspectives on Behavioral Genetics and Developmental Science. 4. Development and Evolution Revisited. 5. Probabilistic Epigenesis and Modern Behavioral and Neural (...) Genetics. 6. The Roles of Environment, Experience, and Learning in Behavioral Development. 7. Contemporary Ideas in Physics and Biology in Gottlieb’s Psychology. III. EMPIRICAL STUDIES OF BEHAVIORAL DEVELOPMENT AND GENETICS. 8. Behavioral Development during the Mother-Young Interaction in Placental Mammals: The Development of Behavior in the Relationship with the Mother. 9. Amniotic Fluid as an Extended Milieu Interieur. 10. Developmental Effects of Selective Breeding for an Infant Trait. 11. Emergence and Constraint in Novel Behavioral Adaptations. 12. Nonhuman Primate Research Contributions to Understanding Genetic and Environmental Influences on Phenotypic Outcomes across Development. 13. Interactive Contributions of Genes and Early Experience to Behavioural Development: Sensitive Periods and Lateralized Brain and Behaviour. 14. Trans-Generational Epigenetic Inheritance. 15. The Significance of Non-Replication of Gene-Phenotype Associations. 16. Canalization and Malleability Reconsidered: The Developmental Basis of Phenotypic Stability and Variability. IV. APPLICATIONS TO DEVELOPMENT. 17. Gene-Parenting Interplay in the Development of Infant Emotionality. 18. Genetic Research in Psychiatry and Psychology: A Critical Overview. 19. On the Limits of Standard Quantitative Genetic Modeling of Inter-Individual Variation: Extensions, Ergodic Conditions and a New Genetic Factor Model of Intra-Individual Variation. 20. Songs My Mother Taught Me: Gene-Environment Interactions, Brain Development and the Auditory System: Thoughts on Non-Kin Rejection, Part II. 21. Applications of Developmental Systems Theory to Benefit Human Development: On the Contributions of Gilbert Gottlieb to Individuals, Families, and Communities. (shrink)
In this thesis I argue that Adam Smith is committed to moral egalitarianism, which extends to his theory of political economy. While Smith’s work is often used to justify economic inequality in society, I show that his political theory is best understood as a kind of relational egalitarianism. Using Elizabeth Anderson’s Democratic Equality as a model, I examine Smith’s commitment to equality in the space of social relationships. In particular, I argue that Smith’s focus on eliminating inequalities that cause oppression (...) in society in conjunction with his efforts to design a political and economic system that will yield social conditions of freedom for individuals make him a relational egalitarian. (shrink)
A growing body of research suggests that students achieve learning outcomes at higher rates when instructors use active-learning methods rather than standard modes of instruction. To investigate how one such method might be used to teach philosophy, we observed two classes that employed Reacting to the Past, an educational role-immersion game. We chose to investigate Reacting because role-immersion games are considered a particularly effective active-learning strategy. Professors who have used Reacting to teach history, interdisciplinary humanities, and political theory agree that (...) it engages students and teaches general skills like collaboration and communication. We investigated whether it can be effective for teaching philosophical content and skills like analyzing, evaluating, crafting, and communicating arguments in addition to bringing the more general benefits of active learning to philosophy classrooms. Overall, we find Reacting to be a useful tool for achieving these ends. While we do not argue that Reacting is uniquely useful for teaching philosophy, we conclude that it is worthy of consideration by philosophers interested in creative active-learning strategies, especially given that it offers a prepackaged set of flexible, user-friendly tools for motivating and engaging students. (shrink)
‘What does the brain have to do with learning?’Prima facie, this may seem like a strange thing for anyone to say, especially educational scholars, researchers, practitioners, and policy makers. There are, however, valid objections to injecting various and sundry neuroscientific considerations piecemeal into the vast field of education. These objections exist in a variety of dimensions. After providing a working definition for educational neuroscience, identifying the ‘mindbrain’ as the proper object of study thereof, I discuss, dispel or dismiss some of (...) these objections prior to presenting my motivations, aims, and prospects for this new area of educational research. I then briefly outline a positive case for educational neuroscience in terms of theories, methods, and collaborations, and conclude with a brief discussion of some challenges, results, and implications thereof. Naturally, the following considerations are but my own, some of which may be shared to some extent by others working in this area, as the case may be. (shrink)
Planning problems arise in law when an individual (or corporation)wants to perform a sequence of actions that raises legal issues. Manylawyers make their living planning transactions, and a system thathelped them to solve these problems would be in demand.The designer of such a system in a common-law domain must addressseveral difficult issues, including the open-textured nature of legal rules,the relationship between legal rules and cases, the adversarial nature ofthe domain, and the role of argument. In addition, the system's design isconstrained (...) by the fact that the intended users are lawyers, and its operation and output must be convenient for lawyers to use.In this article, I describe a system called CHIRON that I have developed to explore solutions to these issues. This system develops simple plans from representations of statutes and cases in the domain of United States personal income tax planning. (shrink)
This chapter presents emotion as a function of brain‐body interaction, as a vital part of a multi‐tiered phylogenetic set of neural mechanisms, evoked by both instinctive processes and learned appraisal systems, and argues to establish the primacy of emotion in relation to cognition. Primarily based on Damasio's somatic marker hypothesis, but also incorporating elements of Lazarus' appraisal theory, this paper presents a neuropedagogical model of emotion, the somatic appraisal model of affect. SAMA identifies quintessential components, facets, and functions of affect (...) necessary to provide a new domain, namely educational neuroscience, with a basis on which to build a dynamic model of affect serving to critique traditional cognitivist‐oriented curricula and instruction, and to inform an alternative: neuropedagogy. (shrink)
This chapter presents emotion as a function of brain-body interaction, as a vital part of a multi-tiered phylogenetic set of neural mechanisms, evoked by both instinctive processes and learned appraisal systems, and argues to establish the primacy of emotion in relation to cognition. Primarily based on Damasio's somatic marker hypothesis, but also incorporating elements of Lazarus' appraisal theory, this paper presents a neuropedagogical model of emotion, the somatic appraisal model of affect (SAMA). SAMA identifies quintessential components, facets, and functions of (...) affect necessary to provide a new domain, namely educational neuroscience, with a basis on which to build a dynamic model of affect serving to critique traditional cognitivist-oriented curricula and instruction, and to inform an alternative: neuropedagogy. (shrink)
This paper reports on a micro-ethnography of social interaction in an urban plaza in Colombia, focusing on the plaza’s role as an arena for the acquisition of interaction skills. We investigate how children of different ages initiate and sustain interactions with same-age and older peers and the efforts they make to be recognized and ‘visible’. We interpret our data in light of three theories of socialization: Corsaro’s conception of childhood as “interpretive reproduction”, Vygotsky’s model of the “zone of proximal development”, (...) and the “structural approach” to social cognition and development. While a social form like the plaza, which is collectively enacted by members of all age groups of the local community, provides children with an extraordinarily rich array of opportunities to develop social communication skills by interacting with older and younger peers, our analysis also demonstrates that children, as they are building zones of proximal development for themselves, play a central role in assembling, integrating, and sustaining the neighborhood as a face-to-face society. In this fashion, the paper illustrates how the micro-analysis of social interaction can contribute to the analysis of social ‘macro’ forms. (shrink)
As medical professionals, we outline the science underlying disorders or differences of sexual development, discuss the nuances of sex and gender and how terminology can differ based on medical vs. non-medical context, briefly review the evidence of the ergogenic effects of hyperandrogenism, and discuss the medical complications with the hormonal contraceptive use currently dictated by World Athletics to allow DSD athletes to compete in the female category.
Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)
We report on the deliberations of an interdisciplinary group of experts in science, law, and philosophy who convened to discuss novel ethical and policy challenges in stem cell research. In this report we discuss the ethical and policy implications of safety concerns in the transition from basic laboratory research to clinical applications of cell-based therapies derived from stem cells. Although many features of this transition from lab to clinic are common to other therapies, three aspects of stem cell biology pose (...) unique challenges. First, tension regarding the use of human embryos may complicate the scientific development of safe and effective cell lines. Second, because human stem cells were not developed in the laboratory until 1998, few safety questions relating to human applications have been addressed in animal research. Third, preclinical and clinical testing of biologic agents, particularly those as inherently complex as mammalian cells, present formidable challenges, such as the need to develop suitable standardized assays and the difficulty of selecting appropriate patient populations for early phase trials. We recommend that scientists, policy makers, and the public discuss these issues responsibly, and further, that a national advisory committee to oversee human trials of cell therapies be established. **NB we did not reccommend a NAC, we think it might be appropriate**. (shrink)
In crafting our paper on addressing the ethical challenges in HIV prevention research with people who inject drugs, 1 we had hoped to stimulate further discussion and deliberation about the topic. We are pleased that three commentaries on our paper have begun this process. 2 3 4 The commentaries rightly bring up important issues relating to community engagement and problems in translating research into practice in the fraught environments in which PWID face multiple risks. These risks include acquisition of HIV (...) as well as criminalisation, stigma and lack of access to needed healthcare, prevention and social services. We take this opportunity to respond to the excellent points raised by the commentators. All of the commentaries support our emphasis on robust community engagement with PWID and other stakeholders in designing and conducting HIV prevention research, but urge us to go farther. Wolfe highlights the... (shrink)
Regardless of leaders’ efforts to do the right thing and meet performance expectations, they make mistakes, with possible ramifications for followers’ and leaders’ well-being. Some leaders will apologize following transgressions, which may have positive implications for their followers’ and their own well-being, contingent upon the nature and severity of the transgressions. We examine these relationships in two separate studies. In Study 1, leader apologies had a positive relationship with followers’ psychological well-being and emotional health, and these relationships were moderated by (...) the severity of the transgression. In Study 2, leader apologies had a positive relationship with their own psychological well-being, positive emotional health and authentic pride. In addition, the nature of transgressions moderated the relationship between leader apologies and leaders’ positive emotions and authentic pride, while the severity of transgressions moderated the relationship between leader apologies and their positive emotions, psychological health, and authentic pride. Implications and future research directions are discussed. (shrink)
If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.
The sixteen essays in Gender Struggles address a wide range of issues in gender struggles, from the more familiar ones that, for the last thirty years, have been the mainstay of feminist scholarship, such as motherhood, beauty, and sexual violence, to new topics inspired by post-industrialization and multiculturalism, such as the welfare state, cyberspace, hate speech, and queer politics, and finally to topics that traditionally have not been seen as appropriate subjects for philosophizing, such as adoption, care work, and the (...) home. (shrink)
Participant safety and data integrity, critical in trials of new investigational drugs, are achieved through honest participant report and precision in the conduct of procedures. HIV prevention post-trial access studies in middle-income countries potentially offer participants many benefits including access to proven efficacious but unlicensed technologies, ancillary care that often exceeds local standards-of-care, financial reimbursement for participation and possibly unintended benefits if participants choose to share or sell investigational drugs. This case study examines the possibility that this combination of benefits (...) may constitute an undue inducement for some participants in middle-income countries, where economic challenges are prevalent. A case study is presented of a single participant in a cohort of 382 participants who used concealment, fabrication and deception to ensure eligibility for a post-trial access study of an unlicensed HIV prevention technology at potential risk to her health and that of her fetus. A root cause analysis revealed her desire to access HIV prevention during an unplanned pregnancy with a partner whose faithfulness was in question. Researchers should consider implementation of systems to efficiently identify similar cases without inconveniencing the majority of participants Trial registration number NCT01691768. (shrink)
This article addresses the gap between what works in research and what works in practice. Currently, research in evidence-based education policy and practice focuses on randomized controlled trials. These can support causal ascriptions (“It worked”) but provide little basis for local effectiveness predictions (“It will work here”), which are what matter for practice. We argue that moving from ascription to prediction by way of causal generalization (“It works”) is unrealistic and urge focusing research efforts directly on how to build local (...) effectiveness predictions. We outline various kinds of information that can improve predictions and encourage using methods better equipped for acquiring that information. We compare our proposal with others advocating a better mix of methods, like implementation science, improvement science, and practice-based evidence. (shrink)
