This article mitigates the challenges of previously reported literature by reducing the operating cost and improving the performance of network. A genetic algorithm-based tabu search methodology is proposed to solve the link capacity and traffic allocation problem in a computer communication network. An efficient modern super-heuristic search method is used to influence the fixed cost, delay cost, and variable cost of a link on the total operating cost in the computer communication network are discussed. The article analyses a large number (...) of computer simulation results to verify the effectiveness of the tabu search algorithm for CFA problems and also improves the quality of solutions significantly compared with traditional Lagrange relaxation and subgradient optimization algorithms. The experimental results show that with the increase of the weighted coefficient of variable cost, the proportion of variable cost in the total cost increases from 10 to 35%. The growth is relatively slow, and the fixed cost is still the main component. In addition, due to the increase in the variable cost, the tabu search algorithm will also choose the link with large luxury to reduce the variable cost, which makes the fixed cost slightly increase, while the network delay cost and average delay slightly decrease. The proposed method, when compared with the genetic algorithm, has more advantages for large-scale or heavy-load networks. (shrink)

The topology optimization of computer communication network is studied based on improved genetic algorithm, a network optimization design model based on the establishment of network reliability maximization under given cost constraints, and the corresponding improved GA is proposed. In this method, the corresponding computer communication network cost model and computer communication network reliability model are established through a specific project, and the genetic intelligence algorithm is used to solve the cost model and computer communication network reliability model, respectively. It has (...) been proved that GA can solve the complex problems of computer working environment better, which is 80% higher than the general algorithm, and can select the optimal scheme pertinently. (shrink)

With the many changes occurring in today's healthcare organizations, patients are increasingly equipped with a vast quantity of health care data and being more included in the healthcare decision-making process. The new approach we propose incorporates a new patient-organization framework that examines relevant historical, legal and ethical elements within the doctrine of informed consent in addition to examining the role of new healthcare organizations' obligations to include data to support addressing issues such as population health, health outcomes and health disparities (...) within the informed consent. There is a growing consensus among healthcare professionals that using an evidencebased organizational informed consent framework to improve the informed consent process can lead to better comprehension, health outcomes, transparency and improved patient trust and retention overall. (shrink)

Some of the most difficult consultations for an ethics consultant to resolve are those in which the patient is ready to leave the acute-care setting, but the patient or family refuses the plan, or the plan is impeded by deficiencies in the healthcare system. Either way, the patient is “stuck” in the hospital and the ethics consultant is called to help get the patient “unstuck.” These encounters, which we call “complex discharges,” are beset with tensions between the interests of the (...) institution and the interests of the patient as well as tensions within the ethics consultant whose commitments are shaped both by the values of the organization and the values of their own profession. The clinical ethics literature on this topic is limited and provides little guidance. What is needed is guidance for consultants operating at the bedside and for those participating at a higher organizational level. To fill this gap, we offer guidance for facilitating a fair process designed to resolve the conflict without resorting to coercive legal measures. We reflect on three cases to argue that the approach of the consultant is generally one of mediation in these types of disputes. For patients who lack decision making capacity and lack a surrogate decision maker, we recommend the creation of a complex discharge committee within the organization so that ethics consultants can properly discharge their duties to assist patients who are unable to advocate for themselves through a fair and transparent process. (shrink)

The American Society for Bioethics and Humanities has created a quality attestation process for clinical ethics consultants; the pilot phase of reviewing portfolios has begun. One aspect of the QA process which is particularly challenging is assessing the interpersonal skills of individual clinical ethics consultants. We propose that using case simulation to evaluate clinical ethics consultants is an approach that can meet this need provided clear standards for assessment are identified. To this end, we developed the Assessing Clinical Ethics Skills (...) tool, which identifies and specifies specific behaviors that a clinical ethics consultant should demonstrate in an ethics case simulation. The aim is for the clinical ethics consultant or student to use a videotaped case simulation, along with the ACES tool scored by a trained rater, to demonstrate their competence as part of their QA portfolio. The development and piloting of the tool is described. (shrink)

In this paper, we will consider the role of oaths and codes of ethics in undergraduate medical education. Studies of ethics syllabi suggest that ethics educators typically use well-known bioethics texts such as Beauchamp and Childress. Yet, many issues that medical students will face are addressed by codes of ethics and oaths. We will first provide a historical survey of oaths and codes and then address how these sources of ethical guidance can be effectively used in ethics education of medical (...) students. Oaths and codes can be engagingly taught using a range of techniques including visual narrative. Excerpts from television and film can be used to highlight challenging ethical dilemmas in a variety of settings, taking the learning from the theoretical to the more applied while offering context. (shrink)

Public intellectuals have long played a role in American culture, filling the gap between the academic elite and the educated public. According to some commentators, the role of the public intellectual has undergone a steady decline for the past several decades, being replaced by the academic expert. The most notable cause of this decline has been both the growth of the academy in the twentieth century,which has served to concentrate intellectual activity within its confines, and the changing nature of the (...) media, which has framed the way in which information is conveyed to the public. We argue that although bioethics has developed primarily within the academic tradition and utilized the role of expert when dealing with the public, bioethicists are well suited to don the mantle of the public intellectual. Indeed, because they address issues in medicine and science of great relevance for the general public, bioethicists have a duty to revitalize the tradition of public intellectuals as a necessary complement to the important, but narrower role of expert. (shrink)

Oral health is a critical part of overall health. The current COVID-19 pandemic has highlighted the importance of oral health. In this article, we describe how dental practice has been impacted by COVID-19, identify the public health response to COVID-19, and explain the gradual resumption of dental care after the initial disruption due to the pandemic. Finally, we discuss how long-standing health disparities in oral health have been exacerbated by the current pandemic.

In lieu of an abstract, here is a brief excerpt of the content:Growing Up With Autism: Challenges and Opportunities of Parenting Young Adult Children with Autism Spectrum DisordersKayhan Parsi and Nanette ElsterAs the parent and stepparent of a child with autism, we witness a world that is quite different from parents with only neurotypical children. Tantrums don’t vanish after the age of three. Aggression is a way of life. Simple communication is a constant challenge. And dreams of a child’s future (...) have to be altered and adapted. In the narratives that accompany this commentary, we see that the challenges of raising a child with autism do not necessarily diminish with age; they may, however, change because children with autism become adults with autism and this presents a new set of both challenges and opportunities.The current epidemic of young children with autism is giving rise to yet another epidemic—the rising number of young adults who are autistic. As one of the authors here mentioned, “the system is in for a tsunami of new individuals needing medical care of all types, needing continued supports for housing and vocational training, communication, occupational and physical therapy” (Cornell). According to a recent study published in Pediatrics, “[y]outh with an ASD have poor postsecondary employment and education outcomes, especially in the first 2 years after high school” (Shattuck, 2012). With the rising number of children being diagnosed with autism, this employment disparity is likely to be exacerbated until or unless the workforce adapts to and accommodates the needs and skills of persons with autism.The needs of young adults with autism are only recently beginning to receive more attention from the media. But for these children’s parents, this issue has always been personal. The emotions on display in these narratives are heartfelt—even raw at times—and seem to swell like the wave of a tsunami itself as parents are now confronting what should be the independence of adulthood. With barriers to employment, health care and housing, young adults with autism remain largely dependent upon their parents. While the topic of transition to adulthood for those with autism is a vast one, implicating the need for wide scale policy change, certain themes emerge in these personal narratives that we wish to focus on here, which may well serve as a guide for that change.The Advocate MotherThe Advocate Mother is a common theme in many narratives of autism and the ones presented here are not different. In fact, nearly all of the narratives presented are written by mothers. Mothers in these narratives exemplify sacrifice, dashed hopes, and even heartbreak. Although there is steely determination in many of these narratives, there is also [End Page 207] self–doubt, anxiety and guilt. As Laura Shumaker recounts the story of taking her adult son to Washington, DC, she experiences great anxiety when her son is mocked. She speaks of “the heavy feeling in [her] chest that mothers get when people laugh at their children.”The advocate mother can easily become the overly consumed mother. Take, for example, the powerful narrative of Nancy Coughlin. She confesses that her daughter’s autism took over her life and the life of her family: “my own mental health was disintegrating, as was my marriage, and in our family’s last–ditch effort to ease the burden we bought a second home; a cheap little place just a few blocks down the road from where we lived. We called it our ‘respite house’.”Others confess that raising a child with autism becomes a “full time job.” (Van der Poel). And the demands of this job do not diminish simply because the child reaches adulthood; it may, in fact, become not only a personal job for some parents but their vocation as well. For instance, Anonymous Four states, “I felt so strongly that parents and young adults needed to know about CIP [College Internship Program], that I applied for a part time job there where I could utilize my background in marketing to help parents like me find the services their son or daughter may desperately need.”While the inability to express appropriate emotions is a hallmark feature of autism, it seems that mothers in particular compensate by... (shrink)

The triumvirate of HIV/AIDS, tuberculosis, and malaria have dominated our public health focus in the developing world. Having claimed millions of lives, these infectious diseases have prompted a large-scale response. Concomitant with these efforts has been a burgeoning bioethics literature examining global health and distributive justice. A scholarly waste-land only a decade ago, there is now a growing and rich literature that aims to unpack our moral obligations when it comes to diseases that affect the majority of the world (many (...) living in absolute poverty). Now, added to the persistent challenges posed by infectious diseases is the growing burden of diseases such as cancer, which disproportionately affect .. (shrink)

Based on a general review of international, representative tissue banking policies that were described in the medical, ethics, and legal literature, this paper reviews the range of standards, both conceptually and in existing regulations, relevant to four main factors:(1) commercialization, (2) confidentiality, (3) informed consent, and (4) quality of research. These four factors were selected as reflective of some of the major ethical considerations that arise in the conduct of tissue banking research. The authors emphasize that any policy or ethical (...) guidelines designed to regulate tissue bank research should address all four factors. Whenever this sort of research is conducted between several institutions or several countries, the paper suggests that the relevant entities work collaboratively to harmonize their standards. (shrink)

As the field of clinical ethics consultation sets standards and moves forward with the Quality Attestation process, questions should be raised about what ethical issues really do arise in practice. There is limited data on the type and number of ethics consultations conducted across different settings. At Loyola University Medical Center, we conducted a retrospective review of our ethics consultations from 2008 through 2013. One hundred fifty-six cases met the eligibility criteria. We analyzed demographic data on these patients and conducted (...) a content analysis of the ethics consultation write-ups coding both the frequency of ethical issues and most significant, or key, ethical issue per case. Patients for whom ethics consultation was requested were typically male, white, between 50 and 69 years old, of non-Hispanic origin, and of Roman Catholic faith. Nearly half were in the intensive care unit and 44.2 % died in the hospital. The most frequent broad ethical categories were decision-making, goals of care/treatment, and end-of-life. More specifically, capacity, patient’s wishes/autonomy, and surrogate decision maker were the most frequent particular ethical issues. The most common key ethical issues were withdrawing/withholding treatment, patient wishes/autonomy, and capacity. Our findings provide additional data to inform the training of clinical ethics consultants regarding the ethical issues that arise in practice. A wider research agenda should be formed to collect and compare data across institutions to improve education and training in our field. (shrink)

The field of clinical ethics consultation has matured into a multidisciplinary profession, with clinical ethics consultants (CECs) being trained in bioethics, philosophy, theology, law, medicine, n...

Federal regulations require that the level of risk posed by pediatric research be classified as “minimal,” “greater than minimal,” or “a minor increase over minimal.” Interpretation of the meaning of the levels has produced a significant literature exploring the ethical basis for making these determinations. This article examines the ethical basis of a variety of approaches proposed in the literature for classifying pediatric research risk. These approaches strive to take into account how society decides which risks are routinely accepted for (...) children outside of research. It is concluded that ways of classifying risk should compare research risks to normal risks for children without special disability and take into account the concerns of the research subject’s community. (shrink)

_Telling Stories to Change the World_ is a powerful collection of essays about community-based and interest-based projects where storytelling is used as a strategy for speaking out for justice. Contributors from locations across the globe—including Uganda, Darfur, China, Afghanistan, South Africa, New Orleans, and Chicago—describe grassroots projects in which communities use narrative as a way of exploring what a more just society might look like and what civic engagement means. These compelling accounts of resistance, hope, and vision showcase the power (...) of the storytelling form to generate critique and collective action. Together, these projects demonstrate the contemporary power of stories to stimulate engagement, active citizenship, the pride of identity, and the humility of human connectedness. (shrink)

The implementation of the thoracoabdominal normothermic regional perfusion in organ donation after circulatory determination of death (TANRP-DCDD) protocol is garnering increasing attention and pre...

This paper examines the perceived ethical values of Malaysian managers. It is based on the opinions of 15 hypothetical ethical/unethical business situations from the 81 managers who agreed to participate in the survey. The findings of this study showed that these Malaysian managers have high ethical values. However 53% of the respondents believed that the ethical standards of today are lower than that of 15 years ago. Apparently, this is related to the existence of many unethical business practices prevalent in (...) the modern business world. The behavior of one's immediate superior is the most important factor in influencing managers to commit unethical practices. The results also indicate only a slight variation among the managers in terms of perceived ethical values by virtue of job position, job specialization, type of business activity or the size of the business organization. (shrink)

Background The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. Methods The GFBR is an annual meeting organized by the World Health (...) Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022. Results We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships. Conclusions The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research. (shrink)

The standard approach to treatment decision making for incapacitated patients often fails to provide treatment consistent with the patient’s preferences and values and places significant stress on surrogate decision makers. These shortcomings provide compelling reason to search for methods to improve current practice. Shared decision making between surrogates and clinicians has important advantages, but it does not provide a way to determine patients’ treatment preferences. Hence, shared decision making leaves families with the stressful challenge of identifying the patient’s preferred treatment (...) option. To address this concern, the present paper proposes to incorporate the use of a “Patient Preference Predictor” (PPP) into the shared decision-making process between surrogates and clinicians. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual’s characteristics and information on what treatment preferences are correlated with these characteristics. Use of a PPP is likely to increase the chances that incapacitated patients are treated consistent with their preferences and values and might reduce the stress and burden on their surrogates. Including a PPP in the shared decision-making process therefore has the potential to realize important ethical goals for making treatment decisions for incapacitated patients. The present paper justifies this approach on conceptual and normative grounds. (shrink)

Public speakers like politicians carefully craft their words to maximize the clarity, impact, and persuasiveness of their messages. However, these messages can be shaped by more than words. Gestures play an important role in how spoken arguments are perceived, conceptualized, and remembered by audiences. Studies of political speech have explored the ways spoken arguments are used to persuade audiences and cue applause. Studies of politicians’ gestures have explored the ways politicians illustrate different concepts with their hands, but have not focused (...) on gesture's potential as a tool of persuasion. Our paper combines these traditions to ask first, how politicians gesture when using spoken rhetorical devices aimed at persuading audiences, and second, whether these gestures influence the ways their arguments are perceived. Study 1 examined two rhetorical devices—contrasts and lists—used by three politicians during U.S. presidential debates and asked whether the gestures produced during contrasts and lists differ. Gestures produced during contrasts were more likely to involve changes in hand location, and gestures produced during lists were more likely to involve changes in trajectory. Study 2 used footage from the same debates in an experiment to ask whether gesture influenced the way people perceived the politicians’ arguments. When participants had access to gestural information, they perceived contrasted items as more different from one another and listed items as more similar to one another than they did when they only had access to speech. This was true even when participants had access to only gesture (in muted videos). We conclude that gesture is effective at communicating concepts of similarity and difference and that politicians (and likely other speakers) take advantage of gesture's persuasive potential. (shrink)

The total ideology of the revolutionary-political themes of Ukrainian consciousness of the twentieth century, the poetization of the absurdly inverted hierarchy of values, was opposed by the new generation of artists with their philosophical and ethical orientation of their creativity. As I.Franko notes, they "... sought a completely modern European way to portray the peculiarity of the life of the Ukrainian people," revealing the unique collisionality of human existence, the diversity of psychological types, ideological orientations, and the human experience of (...) its existence on the background of this difficult time. However, Ukrainian writersphilosophers who talently laid the foundations of national culture, but are now returning to the generations of the Shattered Renaissance, filling black and bloody spots of troubled history of Ukraine. Among them are V. Pidmogylny, B. Antonovenko-Davidovich, G. Kosinka, D. Falkivsky, M.Ivchenko, T.Osmachka, E.Pluzhnik. This is a non-exhaustive list of the leading figures of the post-revolutionary period who were removed from the creative field, whose works are the golden fund of Ukrainian culture. (shrink)

Annotation "Fearful Symmetry" brings the incredible discoveries of contemporary physics within everyone's grasp. A. Zee, a distinguished physicist and skillful expositor, tells the exciting story of how today's theoretical physicists are following Einstein in their search for the beauty and simplicity of Nature. Animated by a sense of reverence and whimsy, the book describes the majestic sweep and accomplishments of twentieth-century physics. In the end, we stand in awe before the grand vision of modern physics--one of the greatest chapters in (...) the intellectual history of humankind. (shrink)

The problem of human religious consciousness can be attributed to the category of "eternal" philosophical problems, which have never been removed and cannot be removed from the agenda of humanity. The world outlook of a person is updated throughout history as the person, conditions and content of his life, his goals, ideals and perspectives are constantly changing. In each era, this problem retains its fundamental importance, and, being part of all significant philosophical systems, means not a simple continuation of a (...) particular tradition, but the identification of the changing aspects and historical perspectives of human existence. The question of what consciousness, which is its nature and essence, is of great ideological, ideological and practical importance, since it touches upon the foundations of human existence, content and purpose of life. (shrink)

Christian preaching, the main purpose of which is to educate a person in the spirit of the Christian worldview, should answer the questions of the present, give believers concrete recommendations and patterns of behavior in life situations. At the same time, the sermon is based not on the personal opinion of a priest or pastor, but expresses a confessional point of view on one or another problem of modern life facing believers. This point of view, as a rule, is formulated (...) in special documents of confessions, the totality of which is called "Social doctrine of the church". (shrink)

In six experiments, we investigated the role of resource valence in intergenerational attitudes and allocations. We found that, compared to benefits, allocating burdens intergenerationally increased concern with one’s legacy, heightened ethical concerns, intensified moral emotions (e.g., guilt, shame), and led to feelings of greater responsibility for and affinity with future generations. We argue that, because of greater concern with legacies and the associated moral implications of one’s decisions, allocating burdens leads to greater intergenerational generosity as compared to benefits. Our data (...) provide support for this effect across a range of contexts. Our results also indicate that the differential effect of benefits versus burdens in intergenerational contexts depends on the presence of two important structural characteristics that help enact concerns about legacies, including (1) future impact of decisions, and (2) a self-other tradeoff. Overall, our findings highlight how considering resource valence brings to the fore a number of key psychological characteristics of intergenerational decisions—especially as they relate to legacies and ethics. (shrink)

It has been argued that organizational structures (the way tasks are defined, allocated, and coordinated) can influence moral agency in organizations. In particular, low values on different structural parameters (functional concentration, specialization, separation, and formalization) are said to foster an organizational context (allowing for relating to the goals and output of the organization, moral deliberation, and social connectedness) that is conducive to moral agency. In this paper, we investigate the relation between the organizational structure and moral agency in the case (...) of a.s.r. (a large Dutch insurance company). While our empirical results fit the thesis that low values on structural parameters positively relate to moral agency, they also refine our understanding of the influence of structural parameters. In particular, our data suggest that the influence of functional concentration not only depends on whether it is low, but also on the type of criterion used for identifying business units; they suggest that the specific organizational context may put a limit to lowering design parameters and points at several non-structural factors that have an influence on the relation between structure and moral agency. In all, the paper contributes to a more detailed understanding of the conditions conducive to moral agency in organizations. (shrink)