Dementia is highly prevalent and incurable. The participation of dementia patients in clinical research is indispensable if we want to find an effective treatment for dementia. However, one of the primary challenges in dementia research is the patients’ gradual loss of the capacity to consent. Patients with dementia are characterized by the fact that, at an earlier stage of their life, they were able to give their consent to participation in research. Therefore, the phase when patients are still competent to (...) decide offers a valuable opportunity to authorize research, by using an advance research directive. Yet, the use of ARDs as an authorization for research participation remains controversial. In this paper we discuss the role of autonomous decision-making and the protection of incompetent research subjects. We will show why ARDs are a morally defensible basis for the inclusion of this population in biomedical research and that the use of ARDs is compatible with the protection of incompetent research subjects. (shrink)

Volume 20, Issue 6, June 2020, Page 70-72.

Institutional review boards are almost universally considered to be overworked and understaffed. They also require substantial commitments of time and resources from their members. Although some surveys report average IRB memberships of 15 people or more, federal regulations require only five. We present data on IRB meetings at eight of the top 25 academic medical centers in the United States funded by the National Institutes of Health. These data indicate substantial contributions from primary reviewers and chairs during protocol discussions but (...) little from other members, which implies that it may be possible for smaller IRBs to accomplish the same tasks with no reduction in the quality of review. (shrink)

Volume 19, Issue 10, October 2019, Page 63-65.

Discipline and passion: meaning, masochism and mythology in popular medical romancesThis paper is an interpretive analysis of the discourses within popular romance literature, with a particular focus on the genre that includes constructions of the images of nurses and nursing. An historical contrast is made along with examinations of the uses and meanings encompassed within this body of literature, and its messages for women as nurses as it reflectdcreates societal change. Deviations from the formulaic nature of these works are explored. (...) Discipline and passion are the recurring themes evident throughout in juxtapositions of romance and power differentials in the hospital/medical scene. The soft‐core, sado‐masochistic images evident in many titles are explored in a way that raises questions about sexuality, romance, nursing mythology, and the future of this sub‐genre of the popular romance. (shrink)

California is a landmark setting for studying produce recovery efforts and policy implications because of its global relevance in agricultural production, its complex network of food recovery organizations, and its environmental and public health regulations. Through a series of focus groups with organizations involved in produce recovery (gleaning organizations) and emergency food operations (food banks, food pantries), this study aimed to deepen our understanding of the current produce recovery system and determine the major challenges and opportunities related to the produce (...) recovery system. Operational and systematic barriers to produce recovery were highlighted by both gleaning and emergency food operations. Operational barriers, such as the lack of appropriate infrastructure and limited logistical support were found to be a challenge across groups and were directly tied to inadequate funding for these organizations. Systematic barriers, such as regulations related to food safety or reducing food loss and waste, were also found to impact both gleaning and emergency food organizations, but differences were observed in how each type of regulation impacted each stakeholder group. To support the expansion of food recovery efforts, participants expressed need for better coordination within and across food recovery networks and more positive and transparent engagement from regulators to increase understanding of the specifics of their unique operational constraints. The focus group participants also provided critiques on how emergency food assistance and food recovery are inscribed within the current food system and for longer term goals of reducing food insecurity and food loss and waste a systematic change will be required. (shrink)

Literacy is an essential skill. Learning to read is a requirement for becoming a self-providing human being. However, while spoken language is acquired naturally with exposure to language without explicit instruction, reading and writing need to be taught explicitly. Decades of research have shown that well-structured teaching of phonological awareness, letter knowledge, and letter-to-sound mapping is crucial in building solid foundations for the acquisition of reading. During the COVID-19 pandemic, children worldwide did not have access to consistent and structured teaching (...) and are, as a consequence, predicted to be behind in the development of their reading skills. Subsequent evidence confirms this prediction. With the best evidence-based practice in mind, we developed an online version of a well-structured early literacy training program for 5-year-old children. This 2-week online Reading Camp program is designed for pre-K children. It incorporates critical components of the fundamental skills essential to learning to read and is taught online in an interactive, multi-sensory, and peer-learning environment. We measure the participants’ literacy skills and other related skills before and after participating in the online Reading Camp and compare the results to no-treatment controls. Results show that children who participated in the online Reading Camp improved significantly on all parameters in relation to controls. Our results demonstrate that a well-structured evidence-based reading instruction program, even if online and short-term, benefits 5-year-old children in learning to read. With the potential to scale up this online program, the evidence presented here, alongside previous evidence for the efficacy of the in-person program, indicates that the online Reading Camp program is effective and can be used to tackle a variety of questions regarding structural and functional plasticity in the early stages of reading acquisition. (shrink)

In this chapter we reflect on the relevance of peer review for assessing the quality of clinical ethics consultation. We contend that peer review in the narrative form as presented in this book provides an alternative to the formal clinical ethics consultation review procedures typically found in the clinical ethics literature. We elaborate on peer review as a reflection on clinical ethics consultation practice, the elements which a story should contain in order to provide a basis for peer review, and (...) the differences between the assessments of the peer reviewers. We argue that a narrative approach to assessing the quality of ethics consultation can be further developed by allowing all stakeholders who are involved in the clinical ethics practice to actively take part in the evaluation process, following a “responsive evaluation” approach. An example of this is creating a Community of Practice, the aim of which is to foster a joint learning process of all parties involved. At the end of this chapter, we draw conclusions on peer review as a dialogical tool for evaluating quality of clinical ethics consultation. (shrink)

Existing literature on counterproductive work behaviors (CWBs) has focused on the influence that interpersonal and organizational factors have on predicting said behavior. However, more recent studies have begun to explore the dimensionality of CWB in relation to the likelihood of coworkers reporting coworkers’ CWBs. Likelihood of reporting CWB across various types of CWB, and the relationships between self-reported CWB were assessed across two studies. The studies did so utilizing two different measures of CWB and two different measures of CWB reporting, (...) and found very similar results. Results suggest those employees who report one type of CWB behavior would also be more willing to report other types of CWBs, and those who have lower self-reported CWB are more likely to report CWB. (shrink)

In recent years, the possible benefits of mindfulness meditation have sparked much public and academic interest. Mindfulness emphasizes cultivating awareness of our immediate experience and has been associated with compassion, empathy, and various other prosocial traits. However, neurobiological evidence pertaining to the prosocial benefits of mindfulness in social settings is sparse. In this study, we investigate neural correlates of trait mindful awareness during naturalistic dyadic interactions, using both intra-brain and inter-brain measures. We used the Muse headset, a portable electroencephalogram device (...) often used to support mindfulness meditation, to record brain activity from dyads as they engaged in naturalistic face-to-face interactions in a museum setting. While we did not replicate prior laboratory-based findings linking trait mindfulness to individual brain responses, self-reported mindful awareness did predict dyadic inter-brain synchrony, in theta and beta frequencies. These findings underscore the importance of conducting social neuroscience research in ecological settings to enrich our understanding of how neural correlates of social traits such as mindful awareness manifest during social interaction, while raising critical practical considerations regarding the viability of commercially available EEG systems. (shrink)

Music-based interventions (MBI) have become increasingly widely adopted for dementia and related disorders. Previous research shows that music engages reward-related regions through functional connectivity with the auditory system, but evidence for the effectiveness of MBI is mixed in older adults with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). This underscores the need for a unified mechanistic understanding to motivate MBIs. The main objective of the present study is to characterize the intrinsic connectivity of the auditory and reward systems in (...) healthy aging individuals with MCI, and those with AD. Using resting-state fMRI data from the Alzheimer’s Database Neuroimaging Initiative, we tested resting-state functional connectivity within and between auditory and reward systems in older adults with MCI, AD, and age-matched healthy controls (N = 105). Seed-based correlations were assessed from regions of interest (ROIs) in the auditory network (i.e., anterior superior temporal gyrus, posterior superior temporal gyrus, Heschl’s Gyrus), and the reward network (i.e., nucleus accumbens, caudate, putamen, and orbitofrontal cortex). AD individuals were lower in both within-network and between-network functional connectivity in the auditory network and reward networks compared to MCI and controls. Furthermore, graph theory analyses showed that the MCI group had higher clustering and local efficiency than both AD and control groups, whereas AD individuals had lo... (shrink)

Has exclusion of Darwin's views on evolution distorted 20c philosophy? Cunningham suggests a reappraisal.

Many of the negative connotations of corporate social responsibility (CSR) are linked to its perceived role as a public relations exercise. Following on calls for more positive engagement by public relations professionals in organisational strategic planning and given the rapidly increasing interest in CSR as a business strategy, this article addresses the question of how the theory and practice of public relations can provide direction and support for CSR. To this end, this article explores leadership styles and motivations of a (...) sample of corporate leaden from prominent Australian-based corporations in relation to their chosen CSR activities to examine the current position of, and potential for, professional communicators' impact in shaping CSR-driven policies at a strategic level. We find that while public relations theory has evolved, many leaders still see public relations professionals only as a source of positive publicity. Our findings suggest that the model of distributive leadership has more relevance to an emerging idea of public relations involvement in CSR than more traditional understandings of leadership. We conclude that the public relations profession needs to develop a greater understanding of senior management approaches to the development and dissemination of CSR activities to support organisational leadership as it currently operates with respect to CSR. (shrink)

Individuals are faced with the many opportunities to pirate. The decision to pirate or not may be related to an individual''s attitudes toward other ethical issues. A person''s ethical and moral predispositions and the judgments that they use to make decisions may be consistent across various ethical dilemmas and may indicate their likelihood to pirate software. This paper investigates the relationship between religion and a theoretical ethical decision making process that an individual uses when evaluating ethical or unethical situations. An (...) ethical decision making model was studied for general unethical scenarios and for the unethical behavior of software piracy. The research model was tested via path analysis using structural equation modeling and was found to be appropriate for the sample data. The results suggest that there is a relationship between religion and the stages of an ethical decision making process regarding general ethical situations and software piracy. (shrink)

"In recent years, we have grown accustomed to philosophical language that is intensely self-conscious and rhetorically thick, often tragic in tone. It is enlivening to read Bergson, who exerts so little rhetorical pressure while exacting such a substantial effort of thought.... Bergson's texts teach the reader to let go of entrenched intellectual habits and to begin to think differently—to think in time.... Too much and too little have been said about Bergson. Too much, because of the various appropriations of his (...) thought. Too little, because the work itself has not been carefully studied in recent decades."—from Thinking in Time Henri Bergson, whose philosophical works emphasized motion, time, and change, won the Nobel Prize for Literature in 1927. His work remains influential, particularly in the realms of philosophy, cultural studies, and new media studies. In Thinking in Time, Suzanne Guerlac provides readers with the conceptual and contextual tools necessary for informed appreciation of Bergson's work. Guerlac's straightforward philosophical expositions of two Bergson texts, Time and Free Will and Matter and Memory, focus on the notions of duration and memory—concepts that are central to the philosopher's work. Thinking in Time makes plain that it is well worth learning how to read Bergson effectively: his era and our own share important concerns. Bergson's insistence on the opposition between the automatic and the voluntary and his engagement with the notions of "the living," affect, and embodiment are especially germane to discussions of electronic culture. (shrink)

Kant formulated a secular argument against suicide’s permissibility based on what he regarded as the intrinsic value of humanity. In this paper, I first show that Kant’s moral framework entails that some types of suicide are morally permissible. Just as some homicides are morally permissible, according to Kant, so are suicides that are performed according to equivalent maxims. Intention, foreseeability, voluntariness, diminished responsibility, and mental capacity determine the moral characterization of the killing. I argue that a suicide taxonomy that differentiates (...) types of suicide according to morally relevant criteria is compatible with Kantian ethics; it establishes that even where we hold a robust deontological sanctity of life position, we are not obligated to preserve the lives of people whose future life only offers profound suffering, and helping them to die may be justifiable if doing so honors their dignity and autonomy. Nevertheless, homicide and suicide are only weakly morally symmetrical in that even if a given suicide is morally impermissible, we do not normally have the right to prevent it forcibly, though this may be altered by juridical laws under some circumstances. (shrink)

BackgroundExisting clinical ethics support (CES) instruments are considered useful. However, users report obstacles in using them in daily practice. Including end users and other stakeholders in developing CES instruments might help to overcome these limitations. This study describes the development process of a new ethics support instrument called CURA, a low-threshold four-step instrument focused on nurses and nurse assistants working in palliative care. MethodWe used a participatory development design. We worked together with stakeholders in a Community of Practice throughout the (...) study. Potential end users (nurses and nurse assistants in palliative care) used CURA in several pilots and provided us with feedback which we used to improve CURA.ResultsWe distinguished three phases in the development process. Phase one, Identifying Needs, focused on identifying stakeholder and end user needs and preferences, learning from existing CES instruments, their development and evaluation, and identify gaps. Phase two, Development, focused on designing, developing, refining and tailoring the instrument on the basis of iterative co-creation. Phase three, Dissemination, focused on implementation and dissemination. The instrument, CURA, is a four-step low-threshold instrument that fosters ethical reflection.ConclusionsParticipatory development is a valuable approach for developing clinical ethics support instruments. Collaborating with end users and other stakeholders in our development study has helped to meet the needs and preferences of end users, to come up with strategies to refine the instrument in order to enhance its feasibility, and to overcome reported limitations of existing clinical ethics instruments. (shrink)

: This essay examines the increasing commodification of the body with respect to tissues, gametes, and embryos. Such commodification contributes to a diminishing sense of human personhood on an individual level, even as it erodes commitments to human flourishing at the societal level. After the case for social harm resulting from the increasing commodification of the body is made, the question becomes whether that harm is best remedied by following any of three approaches by which government traditionally seeks to promote (...) the flourishing of its citizens. The author concludes that it is not, and that what is needed is a pragmatic and somewhat casuistic approach to the regulation of contested commodities--that which legal scholar Margaret Jane Radin calls "incomplete commodification.". (shrink)

Embodied Fantasies: From Awe to Artifice is a compilation of twenty-one essays on the subject of fantasy as it relates to art history, philosophy and the visual arts.

In this book, Suzanne Kirschner traces the origins of contemporary psychoanalysis back to the foundations of Judaeo-Christian culture, and challenges the prevailing view that modern theories of the self mark a radical break with religious and cultural tradition. Instead, she argues, they offer an account of human development which has its beginnings in biblical theology and neoplatonic mysticism. Drawing on a wide range of religious, literary, philosophical and anthropological sources, Dr Kirschner demonstrates that current Anglo-American psychoanalytic theories are but (...) the latest version of a narrative that has been progressively secularized over the course of nearly two millennia. She displays a deep understanding of psychoanalytic theories, while at the same time raising provocative questions about their status as knowledge and as science. (shrink)

summary, crtiques, strengths and limitation of the article.

This article presents an ethics support instrument for healthcare professionals called CURA. It is designed with a focus on and together with nurses and nurse assistants in palliative care. First, we shortly go into the background and the development study of the instrument. Next, we describe the four steps CURA prescribes for ethical reflection: (1) Concentrate, (2) Unrush, (3) Reflect, and (4) Act. In order to demonstrate how CURA can structure a moral reflection among caregivers, we discuss how a case (...) was discussed with CURA at a psychogeriatric ward of an elderly care home. Furthermore, we go into some considerations regarding the use of the instrument in clinical practice. Finally, we focus on the need for further research on the effectiveness and implementation of CURA. (shrink)

The current process towards formalization within evaluation research, in particular the use of pre-set standards and the focus on predefined outcomes, implies a shift of ownership from the people who are actually involved in real clinical ethics support services in a specific context to external stakeholders who increasingly gain a say in what ‘good CESS’ should look like. The question is whether this does justice to the insights and needs of those who are directly involved in actual CESS practices, be (...) it as receivers or providers. We maintain that those actually involved in concrete CESS practices should also be involved in its evaluation, not only as respondents, but also in setting the agenda of the evaluation process and in articulating the criteria by which CESS is evaluated. Therefore, we propose a participatory approach to CESS evaluation. It focuses on the concrete contexts in which CESS takes place, reflective and dialogical learning processes, and how to be democratic and inclusive. In particular, this approach to CESS evaluation is akin to realist evaluation, dialogical evaluation, and responsive evaluation. An example of a participatory approach to evaluating CESS is presented and some critical issues concerning this approach are discussed. (shrink)

The standard medical case report often reduces patients and caregivers to complexes of medical facts and clinical decisions. Restructuring the genre itself to acknowledge the human dimensions of both patients and physicians allows questions of human values to regain their stature as integral components of the discourse.