Caring for critically ill and dying patients often triggers both professional and personal growth for physician trainees. In pediatrics, the neonatal intensive care unit is among the most distressing settings for trainees. We used longitudinal narrative writing to gain insight into how physician trainees are challenged by and make sense of repetitive, ongoing conflicts experienced as part of caring for very sick and dying babies. The study took place in a 45-bed, university-based NICU in an urban setting in the United (...) States. From November 2009 to June 2010 we enrolled pediatric residents and neonatology fellows at the beginning of their NICU rotations. Participants were asked to engage in individual, longitudinal narrative writing about their “experience in the NICU.” Thematic narrative analysis was performed. Thirty-seven physician trainees participated in the study. The mean number of narratives per trainee was 12; a total of 441 narratives were available for analysis. Conflict was the most pervasive theme in the narratives. Trainees experienced conflicts with families and conflicts with other clinicians. Trainees also described multiple conflicts of identity as members of the neonatology team, as members of the medical profession, as members of their own families, and as members of society. Physician trainees experience significant conflict and distress while learning to care for critically ill and dying infants. These conflicts often led them to question their own morals and their role in the medical profession. Physician trainees should be educated to expect various types of distress during intensive care rotations, encouraged to identify their own sources of distress, and supported in mitigating their effects. (shrink)

The number of children with chronic critical illness (CCI) is a growing population in the United States. A defining characteristic of this population is a prolonged hospital stay. Our study assessed the proportion of pediatric patients with chronic critical illness in U.S. hospitals at a specific point in time, and identified a subset of children whose hospital stay lasted for months to years. The potential harms of a prolonged hospitalization for children with CCI, which include over treatment, infection, disruption of (...) family life, and the intensive utilization of resources—combined with the moral distress experienced by the clinicians who care for the children, suggest the need for ethical analysis of this growing issue to identify actions that could be taken at the clinical and health systems levels to reduce the harms associated with prolonged hospital stay.In this article we present three real cases from our study that involved a very long hospital stay. We applied a framework developed by Mackenzie, Rogers, and Dodds to analyze inherent, situational, and pathogenic vulnerabilities to examine the ways that interventions intended to remedy one source of harm for the children in our cohort inadvertently created other harms. We examined the complex ways that children with protracted hospitalization are vulnerable to the choices made by their family and clinicians, as well as by healthcare systems and communities. Finally, we used this analysis to summarize actions and ethical responses to this growing patient population. Such an understanding is essential to making clinical and ethical decisions that arise for children who are at risk for a very long stay in the hospital. (shrink)

Theory and language: locating agency between free will and discursive marionettesThis article outlines a research methodology that embraces individual narratives, yet recognizes that individual narratives are nested within a backdrop of broader social and cultural understandings of who we are and how we come to understand our world. This dialectical move requires an epistemological shift, focusing on the utility of reconceptualizing the ‘environment’, not only as the social, political, or economic conditions in society, but also as language. Reconceptualizing the environment (...) as language makes it epistemologically possible to construct a bridge between varying levels of analysis, namely, between individual accounts and life stories and the cultural, social, and historical worlds from which those accounts emerge. (shrink)

(2012). Resistance! Do Teachers Dare to Strike and Insist Upon Collective Bargaining in this Neoliberal Age? Educational Studies: Vol. 48, No. 6, pp. 499-500.

During the last 10 years or so, a number of corporate social responsibility (CSR) initiatives have been introduced in global supply chains, which aim to improve the conditions of workers engaged in producing goods for export. This article discusses the observations of CSR in practice in the Costa Rican-United Kingdom (UK) banana chain. The banana chain makes for an interesting case study because there are dominant corporate actors at each end who are in a position to influence the conditions experienced (...) by workers on banana plantations. At the top of the chain there are four major UK supermarket groups who control access to the retail market and as selfappointed guardians of consumer interest are demanding that producers adopt more socially responsible practices. At the other end, banana production is highly integrated and controlled by three large North American agri-businesses who have developed their own social and environmental certification programmes. Costa Rica also makes for an interesting country to locate the study as it has a tradition of state-led policies to protect worker rights. Yet, in spite of CSR commitments made by both supermarkets and producers that emphasise health and safety and the country's established Labour Law, this article shows that there are problems for workers when they are forced to meet demanding production schedules. Furthermore, it suggests that whilst supermarkets continue to drive down consumer prices and put pressure on producers to reduce costs, a downward spiral of working conditions is created regardless of the CSR policies in place. However, this article also identifies that changes to supermarket behaviour is possible when consumer trust is at stake. (shrink)

HARDIN PK. Nursing Inquiry 2003; 10: 209–217 Shape-shifting discourses of anorexia nervosa: reconstituting psychopathologyThis article explores how the circuitous relationship between individuals, the media, and discursive systems replicate and reinforce the act of self-starvation in young women. Using a feminist poststructuralist methodology, the focus of this article is on how discourses and institutional practices operate to position young women who take up the subject position of wanting to be diagnosed as anorexic. Utilizing data from online accounts and individual interviews, I (...) attend to the ways in which young women are institutionally positioned as ‘anorexics’ and the effects that those positions have on their behaviors, in addition to reinforcing institutional practices that construct anorexia nervosa. Questions addressed through this inquiry are: How do institutional practices create and continue to constitute ‘anorexia nervosa’? How do discourses operate to position young women such that they are either included and/or excluded into the category of ‘anorexia nervosa’? What are the effects and consequences that emanate from these positionings? (shrink)

This paper delineates a postmodern discourse analysis that is positioned within a semiotic theory of language. This theory of language foregrounds the performative aspects of language usage and provides the theoretical space from which to theorize the interrelationship between social organizations or structure and social agents or individuals. Our version of discourse analysis contends that social structure is enacted (production and reproduction) through the employment of various vocabularies: social structure is not something outside of, behind, or underneath these performances, and (...) we argue that social organization is not produced by external structures operating upon or causing people to adopt certain behaviours. Rather, social structure is an effect of taking up practices and reproducing and modifying them. From this perspective, individuals are constituted by being recruited into and reproducing discursive practices. Hence, by looking at the actual employment of language – its tactical, practice dimensions – one can avoid the usual binary of seeing the person as either the autonomous origin of his or her experience or the ideological pawn of social determination. This methodology calls into question how the narratives or stories that individuals recount are imbricated within relational plays of power, and concomitantly, how subjects reauthorize their own positions. We assert that the methodological challenges of research addressing social injustice cannot be reduced to either: (i) interpersonal relationships between researcher and participants, or (ii) relegated to ‘social structures’ acting upon or outside of individuals. (shrink)

The Cambridge Texts in the History of Political Thought aim to make available to students the most important works in the field in affordable, readable, and unabridged editions, a goal eminently achieved in these two volumes, which have been edited and translated by a noted Rousseau scholar and teacher. Whether used alone or assigned together, these volumes are especially well designed for classroom use; scholars will also find them convenient and reliable, though the multivolume Collected Writings, vols. 1–6, edited by (...) Roger D. Masters and Christopher Kelly will remain the standard scholarly edition of Rousseau’s writings in English. (shrink)

The authors claim that disciplinary epistemologies—disciplinary habits of mind and ways of thinking—offer productive lenses for observing teaching practices. Furthermore, they argue that educational developers who draw from multiple epistemologies in combination provide rich evidence with regard to teaching and learning and can speak to academic colleagues from an array of disciplines. Clarity is provided for career paths in educational development for colleagues from academic disciplines who are contemplating part‐ or full‐time work in a teaching center. The authors hope that (...) this opening collection develops into a toolkit and area of inquiry about disciplinary approaches to the practice of educational development. (shrink)

For decades, psychostimulants have been the gold standard pharmaceutical treatment for attention-deficit/hyperactivity disorder (ADHD). In the United States, an astounding 9% of all boys and 4% of girls will be prescribed stimulant drugs at some point during their childhood. Recent meta-analyses have revealed that individuals with ADHD have reduced brain volume loss later in life (>60 y.o.) compared to the normal aging brain, which suggests that either ADHD or its treatment may be neuroprotective. Crucially, these neuroprotective effects were significant in (...) brain regions (e.g., hippocampus, amygdala) where severe volume loss is linked to cognitive impairment and Alzheimer’s disease. Historically, the ADHD diagnosis and its pharmacotherapy came about nearly simultaneously, making it difficult to evaluate their effects in isolation. Certain evidence suggests that psychostimulants may normalize structural brain changes typically observed in the ADHD brain. If ADHD itself is neuroprotective, perhaps exercising the brain, then psychostimulants may not be recommended across the lifespan. Alternatively, if stimulant drugs are neuroprotective, then this class of medications may warrant further investigation for their therapeutic effects. Here, we take a bottom-up holistic approach to review the psychopharmacology of ADHD in the context of recent models of attention. We suggest that future studies are greatly needed to better appreciate the interactions amongst an ADHD diagnosis, stimulant treatment across the lifespan, and structure-function alterations in the aging brain. (shrink)

In the aftermath of a terrorist attack political stakes are high: legislators fear being seen as lenient or indifferent and often grant the executive broader authorities without thorough debate. The judiciary's role, too, is restricted: constitutional structure and cultural norms narrow the courts' ability to check the executive at all but the margins. The dominant 'Security or Freedom' framework for evaluating counterterrorist law thus fails to capture an important characteristic: increased executive power that shifts the balance between branches of government. (...) This book re-calculates the cost of counterterrorist law to the United Kingdom and the United States, arguing that the damage caused is significantly greater than first appears. Donohue warns that the proliferation of biological and nuclear materials, together with willingness on the part of extremists to sacrifice themselves, may drive each country to take increasingly drastic measures with a resultant shift in the basic structure of both states. (shrink)

This book focuses in an in-depth way on the particular problems faced by nurses in various advanced practice roles across the life-span and in front-line care. It is comprehensive textbook broken out into three sections: philosophical foundation, ethics, and specialty focus.

The purpose of this research was to explore the relationship between university students’ perceptions of the overall quality of instruction they experienced since COVID-19 and their academic well-being. This relationship was examined in the context of a moderated moderation with students’ household income and the cultural value of power distance, which measures the extent to which less powerful members of an organization expect and accept that power is unequally distributed. Two countries with societally moderate levels of PD were assessed. Moderated (...) moderations between PQI, income, and PD were found for the academic well-being of students from both the United States and South Africa. The patterns of interactions were in some ways similar and other ways different, highlighting the complexity of how students may react to potential stressors in their academic environment. Potential explanations and implications of these results are discussed. (shrink)

There is a growing tendency to hyperbolize the U.S.-Mexican borderlands as a “dystopian zone of terror.” Dystopian borderlands hyperbole is double-edged. It can be used to create virulently racist mischaracterizations of borderlands life, and it can be used critically, as Alicia Gaspar de Alba and Sayak Valencia use it in Desert Blood and Capitalismo gore, to draw attention to structural forms of violence that imperil the borderlands on a daily basis. Desert Blood and Capitalismo gore exemplify a tendency in borderlands (...) literature to hyperbolically magnify borderlands crises of violence, misogyny, exploitation, and racism to all-encompassing dimensions. That magnification serves to highlight historical and structural conditions that have created and perpetuated those crises. The borderlands in Desert Blood and Capitalismo gore are hyperbolically reimagined as dystopias of neoliberal patriarchal violence. Gaspar de Alba and Valencia hyperbolize those dystopias to critique and ultimately abolish them. (shrink)

Recent experiments have been used to “edit” genomes of various plant, animal and other species, including humans, with unprecedented precision. Furthermore, editing the Cas9 endonuclease gene with a gene encoding the desired guide RNA into an organism, adjacent to an altered gene, could create a “gene drive” that could spread a trait through an entire population of organisms. These experiments represent advances along a spectrum of technological abilities that genetic engineers have been working on since the advent of recombinant DNA (...) techniques. The scientific and bioethics communities have built substantial literatures about the ethical and policy implications of genetic engineering, especially in the age of bioterrorism. However, recent CRISPr/Cas experiments have triggered a rehashing of previous policy discussions, suggesting that the scientific community requires guidance on how to think about social responsibility. We propose a framework to enable analysis of social responsibility, using two example.. (shrink)

Appeals to scrutinize the use of race and ethnicity as variables in genetics research notwithstanding, these variables continue to be inadequately explained and inconsistently used in research publications. In previous research, we found that published genetic research fails to follow suggestions offered for addressing this problem, such as explaining the basis on which these labels are assigned to populations. This study, an analysis of genetic research articles using race or ethnicity terms, explores possible features of journals that are associated with (...) improved reporting of race and ethnicity in genetic research. A journal’s expressed commitment to improving how race and ethnicity are used in genetic research, demonstrated by an editorial or in its instructions to authors, was the strongest predictor of following recommendations about reporting race and ethnicity. Journal impact factor had only a limited positive effect on attention to these issues, suggesting that editorial resources associated with higher impact factor journals are not sufficient to improve practices. Our findings reiterate that race and ethnicity variables are used inconsistently in genetic research, but also shed light on how journals might improve practices by highlighting the need for scientists to carefully scrutinize the use of these variables in their work. (shrink)

The US National Institute of Health’s Human Microbiome Project aims to use genomic techniques to understand the microbial communities that live on the human body. The emergent field of microbiome science brought together diverse disciplinary perspectives and technologies, thus facilitating the negotiation of differing values. Here, we describe how values are conceptualized and negotiated within microbiome research. Analyzing discussions from a series of interdisciplinary workshops conducted with microbiome researchers, we argue that negotiations of epistemic, social, and institutional values were inextricable (...) from the reflective and strategic category work that defined and organized the microbiome as an object of study and a potential future site of biomedical intervention. Negotiating the divergence or tension between emerging scientific and regulatory classifications also activated “values levers” and opened up reflective discussions of how classifications embody values and how these values might differ across domains. These data suggest that scholars at the intersections of science and technology studies, ethics, and policy could leverage such openings to identify and intervene in the ways that ethical/regulatory and scientific/technical practices are coproduced within unfolding research. (shrink)

Robust technology infrastructure is needed to enable learning health care systems to improve quality, access, and cost. Such infrastructure relies on the trust and confidence of individuals to share their health data for healthcare and research. Few studies have addressed consumers’ views on electronic data sharing and fewer still have explored the dual purposes of healthcare and research together. The objective of the study is to explore factors that affect consumers’ willingness to share electronic health information for healthcare and research. (...) This study involved a random-digit dial telephone survey of 800 adult Californians conducted in English and Spanish. Logistic regression was performed using backward selection to test for significant associations of each explanatory variable with the outcome variable. The odds of consent for electronic data sharing for healthcare decreased as Likert scale ratings for EHR impact on privacy worsened, odds ratio = 0.74, 95% CI [0.60, 0.90]; security, OR = 0.80, 95% CI [0.66, 0.98]; and quality, OR = 0.59, 95% CI [0.46–0.75]. The odds of consent for sharing for research was greater for those who think EHR will improve research quality, OR = 11.26, 95% CI [4.13, 30.73]; those who value research benefit over privacy OR = 2.72, 95% CI [1.55, 4.78]; and those who value control over research benefit OR = 0.49, 95% CI [0.26, 0.94]. Consumers’ choices about electronically sharing health information are affected by their attitudes toward EHRs as well as beliefs about research benefit and individual control. Design of person-centered interventions utilizing electronically collected health information, and policies regarding data sharing should address these values of importance to people. Understanding of these perspectives is critical for leveraging health data to support learning health care systems. (shrink)

Since the early 1980’s, with the clinical advent of in vitro fertilization resulting in so-called “test tube babies,” a wide array of ethical considerations and concerns regarding artificial womb technology (AWT) have been described. Recent breakthroughs in the development of extracorporeal neonatal life support by means of AWT have reinitiated ethical interest about this topic with a sense of urgency. Most of the recent ethical literature on the topic, however, pertains not to the more imminent scenario of a physiologically improved (...) method of neonatal care through AWT, but instead to the remote scenario of “complete ectogenesis” that imagines human gestation occurring entirely outside of the womb. This scoping review of the ethical literature on AWT spans from more abstract concerns about complete ectogenesis to more immediate concerns about the soon-to-be-expected clinical life support of what we term the fetal neonate or fetonate. Within an organizing framework of different stages of human gestational development, from conception to the viable premature infant, we discuss both already identified and newly emerging ethical considerations and concerns regarding AWT and the care of the fetonate. (shrink)