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)
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)
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)
‘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)
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)
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)
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 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)
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)
_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)
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)
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.
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)
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)
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)
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)
Initial assessments of the potential for geologic carbon sequestration rely on existing subsurface data, most of it collected for oil and gas exploration. We document the challenges of assessing the [Formula: see text] storage potential based on archived data, for the case of the Upper Ordovician Queenston Formation in New York. In central New York, the entirely subsurface Queenston Formation consists primarily of sandstones. In contrast, in western New York where the Queenston Formation crops out, it is composed of shale, (...) siltstone, and sandstone. A foremost interpretation challenge is to obtain porosity data from the borehole logs. Intercomparisons of various measures of porosity and of the availability of those data led to the decision to use neutron porosity data for the hematite- and clay-rich sandstone. To map porosity regionally, a second challenge is to establish the physical correlation between four regionally extensive stacked petrophysical zones in central New York, each recording base-level fall trends in fluvial sandstones, and four petrophysical zones in western New York, each characterized by base-level rise deposits of marginal marine and shallow marine deposits. Two alternative correlations can be justified with differing implications for pore volumes in a transition region. This analysis estimates that the Queenston Formation of central New York can sequester up to approximately [Formula: see text] metric tons of [Formula: see text] at depths greater than 3000 ft in sandstones with porosity exceeding 10%. The Queenston Formation is not suitable for [Formula: see text] storage in western New York. (shrink)
In Use and Abuse Revisited: Response to Pluhar and Varner, Kathryn Paxton George misunderstands the point of my essay, In Defense of the Vegan Ideal: Rhetoric and Bias in the Nutrition Literature. I did not claim that the nutrition literature unambiguously confirms that vegans are not at significantly greater risk of deficiencies than omnivores. Rather than settling any empirical controversy, my aim was to show how the literature can give the casual reader a skewed impression of what is known (...) about the risks of a vegan diet. In this brief rejoinder, I illustrate how two essays by nutritionists in the same volume as George's and my essays, and a referee's report on my manuscript which was authored by a nutritionist, confirm the soundness of this basic insight. (shrink)
The question of what firms do internally in the fight against bribery is probably as important to the successful outcome of that fight as formal anti-bribery law and enforcement. This paper looks at corporate approaches to anti-bribery commitment and compliance management using an inventory of 246 codes of conduct. It suggests that, while bribery is often mentioned in the codes of conduct, there is considerable diversity in the language and concepts adopted in anti-bribery commitments. This diversity is a feature of (...) the language used in describing parties to bribery and in defining which activities are prohibited (e.g. promising bribes versus actually giving them, gifts and entertainment, and solicitation. This diversity of language and concepts suggests that it might be useful to extend and deepen efforts in business associations and international organisations to build consensus on the meaning of bribery and corruption. In contrast, the bribery codes show evidence of an emerging consensus on managerial approaches to combating bribery. This involves the deployment of a distinctive mix of management tools, including financial record keeping, statements by executive officers, internal monitoring, whistle-blowing facilities, creation of compliance offices and threats of disciplinary action. (shrink)
Human cooperation is highly unusual. We live in large groups composed mostly of non-relatives. Evolutionists have proposed a number of explanations for this pattern, including cultural group selection and extensions of more general processes such as reciprocity, kin selection, and multi-level selection acting on genes. Evolutionary processes are consilient; they affect several different empirical domains, such as patterns of behavior and the proximal drivers of that behavior. In this target article, we sketch the evidence from five domains that bear on (...) the explanatory adequacy of cultural group selection and competing hypotheses to explain human cooperation. Does cultural transmission constitute an inheritance system that can evolve in a Darwinian fashion? Are the norms that underpin institutions among the cultural traits so transmitted? Do we observe sufficient variation at the level of groups of considerable size for group selection to be a plausible process? Do human groups compete, and do success and failure in competition depend upon cultural variation? Do we observe adaptations for cooperation in humans that most plausibly arose by cultural group selection? If the answer to one of these questions is “no,” then we must look to other hypotheses. We present evidence, including quantitative evidence, that the answer to all of the questions is “yes” and argue that we must take the cultural group selection hypothesis seriously. If culturally transmitted systems of rules that limit individual deviance organize cooperation in human societies, then it is not clear that any extant alternative to cultural group selection can be a complete explanation. (shrink)
As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed (...) the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed. (shrink)
Marketers use autobiographical advertising as a means to create nostalgia for their products. This research explores whether such referencing can cause people to believe that they had experiences as children that are mentioned in the ads. In Experiment 1, participants viewed an ad for Disney that suggested that they shook hands with Mickey Mouse as a child. Relative to controls, the ad increased their confidence that they personally had shaken hands with Mickey as a child at a Disney resort. The (...) increased confidence could be due to a revival of a true memory or the creation of a new, false one. In Experiment 2, participants viewed an ad for Disney that suggested that they shook hands with an impossible character (e.g., Bugs Bunny). Again, relative to controls, the ad increased confidence that they personally had shaken hands with the impossible character as a child at a Disney resort. The increased confidence is consistent with the notion that autobiographical referencing can lead to the creation of false or distorted memory. ᭧ 2002 John Wiley & Sons, Inc. (shrink)
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)
