Responding to mounting public concern about the shift to managed care, legislation to grant patient protections has dominated the health policy agenda over the past two years. Although some policies, such as laws on maternity length of stay, can be easily dismissed as “body part by body part” micromanagement of medical practice, other initiatives offer substantive, new rights to patients across the spectrum of care. At both the state and the federal levels, the right of enrollees to appeal a denial (...) of treatment or to file grievances about other plan decisions has emerged as a centerpiece of patient protection legislation. Grievance and appeal rights have been embraced as a way to empower patients, to enhance access to treatment, and to improve the quality of care by providing an external mechanism to review treatment denials. (shrink)

Recently, debate about the distribution of scarce organs for transplantation has focused on whether patients should have the right to place themselves on waiting lists at several transplant centers, thereby gaining an advantage over other potential recipients. This article explores the social and ethical issues raised by multiple listing, contrasting policies adopted at the national level with those implemented in New York State. It concludes by examining the implications of the debate for broader questions about entitlement and access to health (...) care. (shrink)

Visual representation of instruments and musical practice has long been integral to the study of the iconology and archaeology of early music. Critical to any assessment of such evidence is an understanding of the authority of the artist, and his/her knowledge and degree of participation in musical culture. Contemporary sources reveal that music played a variety of roles in the lives and public perception of the Renaissance artists. Its most tangible manifestation was that of the artist-musician, of whom Leonardo da (...) Vinci is one of the best-known examples. An association with courtliness was one of several markers of status conferred by musical practice. This chapter investigates the domestic setting of the artist, whether in a courtly environment or in a republic, to develop themes of the social elevation of the artist, entertainment and performance, as well as creativity. (shrink)

From computerized medical records to databases of pharmacological interactions and automated provisional EKG readings, the emergence of information technology has significantly altered the practice of medicine. Information technology has been widely used to enhance diagnosis and treatment and to improve communication between providers. The advent of the Internet also brings far-reaching implications for patient–physician communication, challenging physicians, patients, and policymakers to consider its impact on the delivery of medical care and the therapeutic relationship. A new set of practices by patients (...) and physicians is unfolding in cyberspace, ranging from the use of e-mail to communicate between physicians and patients in an existing relationship to one-to-one consultations with an anonymous physician and ongoing online treatment, such as psychotherapy. These practices are emerging in both the for-profit and not-for-profit spheres. (shrink)

On November 8, 1994, Oregon became the first state in the nation to legalize assisted suicide. Passage of Proposition 16 was a milestone in the campaign to make assisted suicide a legal option. The culmination of years of effort, the Oregon vote followed on the heels of failed referenda in California and Washington, and other unsuccessful attempts to enact state laws guaranteeing the right to suicide assistance. Indeed, in 1993, four states passed laws strengthening or clarifying their ban against assisted (...) suicide. No doubt, Proposition 16 is likely to renew the effort to legalize assisted suicide at the state level.The battle over assisted suicide is also unfolding in the courts. Litigation challenging Proposition 16 on the grounds that it violates the equal protection clause is ongoing in Oregon. More significantly, three cases, two in federal courts and one in Michigan state court, have been brought to establish assisted suicide as a constitutionally protected right. (shrink)

The aim of this study was to understand how incivility is viewed across multiple academic programs and respondent subgroups where different institutional and cultural power dynamics may influence the way students and faculty perceive uncivil behaviors. This study used the Conceptual Model for Fostering Civility in Nursing Education as its guiding framework. The Incivility in Higher Education Revised (IHE-R) Survey and a detailed demographic questionnaire were used to gather self-assessment and personal perspective data regarding incivility in the higher education setting. (...) This approach aspired to collect a comprehensive perspective of incivility in higher education. With data from 400 students and 69 faculty, there was limited agreement between faculty and student participants about perceptions and experiences with incivility. Faculty and students did agree that the solution to incivility may be found with the creation of a code of conduct that defines acceptable and unacceptable behavior, role-modeling professionalism and civility, and taking personal responsibility and standing accountable for actions. Despite significant differences in participants’ perceptions of incivility, they shared common solutions. With a shared goal, faculty and students can work toward cultivating civility in higher education. (shrink)

Four studies explore the role of perceptual fluency in attenuating bullshit receptivity, or the tendency for individuals to rate otherwise meaningless statements as “profound”. Across four studies, we presented participants with a sample of pseudoprofound bullshit statements in either a fluent or disfluent font and found that overall, disfluency attenuated bullshit receptivity while also finding little evidence that this effect was moderated by cognitive thinking style. In all studies, we measured participants’ cognitive reflection, need for cognition, faith in intuition, and (...) superstitious beliefs. Superstition strongly predicted bullshit receptivity regardless of fluency. Inconclusive results were found for the remaining scales. Potential links for the role of perceptual disfluency in promoting analytic thinking are discussed. (shrink)

This study aims to better understand the perceptions and experiences related to incivility by students and faculty across multiple academic programs and respondent subgroups at a regional university in the southern United States. The study used a thematic analysis to examine student and faculty responses to three qualitative questions that focused on their perceptions of recent experiences and primary causes of incivility in higher education. Clark’s ( 2007, revised 2020) Conceptual Model for Fostering Civility in Nursing Education and Daniel Goleman’s (...) ( 1995 ) Emotional Intelligence domains were used to give meaning and context to the study findings. For this group of respondents, the study found that incivility in higher education between faculty, students, and faculty and student relationships remain pervasive. Despite the global pandemic and social unrest occurring during the study period, these behaviors did not coalesce around a specific subgroup. Both faculty and students agreed that relationship management with a keen focus on communication could mitigate academic incivility. These findings can inform educators, students, and future researchers in planning meaningful interventions that address incivility in higher education. A relational approach centered on communication skill-building is needed to combat the persistent issue of incivility in higher education. (shrink)

If we are to ensure the persistence of species in an increasingly warm world, of interest is the identification of drivers that affect the ability of an organism to resist thermal stress. Underpinning any organism's capacity for resistance is a complex interplay between biological and physical factors occurring over multiple scales. Tropical coral reefs are a unique system, in that their function is dependent upon the maintenance of a coral–algal symbiosis that is directly disrupted by increases in water temperature. A (...) number of physical factors have been identified as affecting the biological responses of the coral organism under broadscale thermal anomalies. One such factor is water flow, which is capable of modulating both organismal metabolic functioning and thermal environments. Understanding the physiological and hydrodynamic drivers of organism response to thermal stress improves predictive capabilities and informs targeted management responses, thereby increasing the resilience of reefs into the future. (shrink)

Coral bleaching has impacted reefs worldwide and the predictions of near‐annual bleaching from over two decades ago have now been realized. While technology currently provides the means to predict large‐scale bleaching, predicting reef‐scale and within‐reef patterns in real‐time for all reef users is limited. In 2020, heat stress across the Great Barrier Reef underpinned the region's third bleaching event in 5 years. Here we review the heterogeneous emergence of bleaching across Heron Island reef habitats and discuss the oceanographic drivers that (...) underpinned variable bleaching emergence. We do so as a case study to highlight how reef end‐user groups who engage with coral reefs in different ways require targeted guidance for how, and when, to alter their use of coral reefs in response to bleaching events. Our case study of coral bleaching emergence demonstrates how within‐reef scale nowcasting of coral bleaching could aid the development of accessible and equitable bleaching response strategies on coral reefs. Also see the video abstract here: https://youtu.be/N9Tgb8N-vN0. (shrink)

ABSTRACT:Clinical ethics consultants bear witness to the direct harms of intersecting axes of oppression—such as racism and classism—as they impinge on elucidating and resolving ethical dilemmas in health care. Health Care Ethics Consultation (HCEC) professional guidance supports recognizing and analyzing power dynamics and social-structural obstacles to good care. However, the most relied upon bioethical principles in clinical ethics have been criticized for insufficiency in this regard. While individual ethics consultants have found ways to expand their approaches, they do so in (...) an ad hoc way without frameworks to guide consistency. Motivated by the practical expertise of clinical ethicists, this essay offers a new framework to support openness to analyzing power imbalances and respecting marginalized voices and values. This framework is grounded in transformative justice, where the aim is to take responsibility for oppression by centering and responding to moral perspectives and value systems that are all too often silenced. (shrink)

BackgroundAs a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were (...) exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk.DiscussionIn the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics.SummaryAn honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

In this case report, we describe a woman with advancing dementia who still retained decisional capacity and was able to clearly articulate her request for deactivation of her implanted cardiac pacemaker—a scenario that would result in her death. In this case, the patient had the autonomy to make her decision, but clinicians at an outside hospital refused to deactivate her pacemaker even though they were in unanimous agreement that the patient had capacity to make this decision, citing personal discomfort and (...) a belief that her decision seemed out of proportion to her suffering. We evaluated her at our hospital, found her to have decision-making capacity, and deactivated her pacer resulting in her death about 9 days later. While some clinicians may be comfortable discussing patient preferences for device deactivation in patients who are imminently dying, we can find no reports in the literature of requests for device deactivation from patients with terminal diagnoses who are not imminently dying. (shrink)

Pathogenesis in tauopathies involves the accumulation of tau in the brain and progressive synapse loss accompanied by cognitive decline. Pathological tau is found at synapses, and it promotes synaptic dysfunction and memory deficits. The specific role of toxic tau in disrupting the molecular networks that regulate synaptic strength has been elusive. A novel mechanistic link between tau toxicity and synaptic plasticity involves the acetylation of two lysines on tau, K274, and K281, which are associated with dementia in Alzheimer's disease (AD). (...) We propose that an increase in tau acetylated on these lysines blocks the expression of long‐term potentiation at hippocampal synapses leading to impaired memory in AD. Acetylated tau could inhibit the activity‐dependent recruitment of postsynaptic AMPA‐type glutamate receptors required for plasticity by interfering with the postsynaptic localization of KIBRA, a memory‐associated protein. Strategies that reduce the acetylation of tau may lead to effective treatments for cognitive decline in AD. (shrink)

The study used a thematic analysis to examine student and faculty responses to two qualitative questions focused on their perceptions of the consequence of incivility and solutions that would embed civility expectations as a key element to professional role socialization in higher education. Participants included students and faculty across multiple academic programs and respondent subgroups at a regional university in the southern United States. A new adapted conceptual model using Clark’s in _Nursing Education Perspectives_, _28_(2), 93–97 ( 2007, revised 2020) (...) Conceptual Model for Fostering Civility in Nursing Education and Daniel Goleman’s in _Emotional intelligence: Why it can matter more than IQ_. Bantam Books ( 1995 ) Emotional Intelligence domains was used as the framework for this study to give meaning and context to its findings. For this group of respondents, the study found that seventy percent of faculty and students agree that incivility has the largest impact on the emotional intelligence domain of self-management, which includes negative emotional outcomes, loss of respect, negative professional and student outcomes, poor academic outcomes, attrition, and less success. Leadership in higher education will strengthen their institutions by using a relational approach centered on communication skill-building to ensure that faculty have been socialized to the importance of civil professional behavior and that stakeholders collectively explore and agree on the meaning and organizational integration of civility. (shrink)

We advance a model of human probability judgment and apply it to the design of an extrapolation algorithm. Such an algorithm examines a person's judgment about the likelihood of various statements and is then able to predict the same person's judgments about new statements. The algorithm is tested against judgments produced by thirty undergraduates asked to assign probabilities to statements about mammals.

Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature reviews, and new analyses of published and unpublished data, to establish the effect of stillbirth on parents, families, health-care providers, and societies worldwide. Data for direct costs of this event are sparse but suggest that a stillbirth needs more resources than a livebirth, both in the perinatal period and in additional surveillance during subsequent pregnancies. Indirect and intangible costs of stillbirth are (...) extensive and are usually met by families alone. This issue is particularly onerous for those with few resources. Negative effects, particularly on parental mental health, might be moderated by empathic attitudes of care providers and tailored interventions. The value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should be considered to prevent stillbirths and reduce associated morbidity. (shrink)

Earp, Lewis, and Hart write about the racism entrenched in policies criminalizing drug use and possession and describe the disparate impact that these policies have on certain racialized com...

Graphical AbstractDriving patterns of coral bleaching over reefs are a suite of biophysical interactions where the physical environment modulates organism response through an interplay with intrinsic biological functioning. Flow conditions over reefs can mitigate the physiological impacts of thermal stress across multiple spatial scales. More details can be found in article number 1800226 by Charlotte E. Page et al., Seeking Resistance in Coral Reef Ecosystems: The Interplay of Biophysical Factors and Bleaching Resistance under a Changing Climate, DOI: 10.1002/bies.201800226.

This essay considers how scholarly approaches to the development of molecular biology have too often narrowed the historical aperture to genes, overlooking the ways in which other objects and processes contributed to the molecularization of life. From structural and dynamic studies of biomolecules to cellular membranes and organelles to metabolism and nutrition, new work by historians, philosophers, and STS scholars of the life sciences has revitalized older issues, such as the relationship of life to matter, or of physicochemical inquiries to (...) biology. This scholarship points to a novel molecular vista that opens up a pluralist view of molecularizations in the twentieth century and considers their relevance to current science. (shrink)

While tens of thousands of people across the United States serve on hospital and other healthcare ethics committees , almost no carefully prepared educational material exists for HEC members. Ethics by Committee is a one volume collection of chapters developed exclusively for this educational purpose. Experts in bioethics, clinical consultation, health law, and social psychology from across the country contribute chapters on ethics consultation, education, and policy development.

The purpose of this study was to compare working memory (WM), executive function, academic ability and problem classroom behaviors in children aged 8 to 11 years who were either identified via routine screening as having low WM, or had been diagnosed with ADHD. Standardised assessments of WM, executive function and reading and mathematics were administered to 83 children with ADHD, 50 children with low WM and 50 typically developing children. Teachers rated problem behaviors on checklists measuring attention, hyperactivity/impulsivity, oppositional behavior, (...) and difficulties associated with executive function in the classroom. The ADHD and low WM groups had highly similar WM and executive function profiles, but were distinguished in two key respects: children with ADHD had higher levels of rated and observed impulsive behavior, and children low WM had slower response times. Possible mechanisms for these common and distinct deficits are discussed. (shrink)

The neural representation of a repeated stimulus is the standard against which a deviant stimulus is measured in the brain, giving rise to the well-known mismatch response. It has been suggested that individuals with dyslexia have poor implicit memory for recently repeated stimuli, such as the train of standards in an oddball paradigm. Here, we examined how the neural representation of a standard emerges over repetitions, asking whether there is less sensitivity to repetition and/or less accrual of “standardness” over successive (...) repetitions in dyslexia. We recorded magnetoencephalography as adults with and without dyslexia were passively exposed to speech syllables in a roving-oddball design. We performed time-resolved multivariate decoding of the MEG sensor data to identify the neural signature of standard vs. deviant trials, independent of stimulus differences. This “multivariate mismatch” was equally robust and had a similar time course in the two groups. In both groups, standards generated by as few as two repetitions were distinct from deviants, indicating normal sensitivity to repetition in dyslexia. However, only in the control group did standards become increasingly different from deviants with repetition. These results suggest that many of the mechanisms that give rise to neural adaptation as well as mismatch responses are intact in dyslexia, with the possible exception of a putatively predictive mechanism that successively integrates recent sensory information into feedforward processing. (shrink)

Il genere della _medieval crime fiction_ ha preso il volo dall ’ inizio degli anni ’ 80 del secolo scorso, grazie ai romanzi di Ellis Peters e soprattutto di Umberto Eco. Da allora a oggi oltre 150 tra autrici e autori hanno proposto storie di indagine criminale ambientate nel Medioevo. In questo articolo saranno esaminati alcuni casi interessanti che stanno a cavallo tra romanzo storico medievale e _medieval crime fiction_, in cui le autrici o gli autori hanno fatto ricorso a (...) personaggi impegnati a vario titolo nella riflessione filosofica, teologica o medica medievale. Oggetto di analisi saranno in particolare sia le descrizioni del loro aspetto fisico che i rispettivi ruoli attanziali e narrativi. _The genre of _medieval crime fiction_ took off from the beginning of the 1980s, thanks to the novels of Ellis Peters and especially by Umberto Eco. Since then, more than 150 authors have proposed criminal investigation stories set in the Middle Ages. In this article we will examine some interesting cases that straddle medieval historical novel and _medieval crime fiction_, in which the authors have resorted to characters engaged in various capacities in philosophy, theology or medicine. In particular, both the descriptions of their physical aspect and their actantial and narrative roles will be analyzed_. (shrink)

L'A. esamina la teoria egidiana delle passioni, sviluppata in quattro declarationes in apertura del suo commento al II libro della Retorica. I temi analizzati sono la definizione di passio animae, la distinzione tra la facoltà irascibile e la concupiscibile, le passioni della facoltà concupiscibile e dell'irascibile. Fonte principale e punto costante di riferimento nella trattazione egidiana è la dottrina dell'Aquinate. L'A. mette costantemente a confronto le posizioni dei due filosofi evidenziando i tentativi di Egidio di staccarsi da Tommaso e criticarne (...) la dottrina, in particolare rispetto alla trattazione dell'ira. (shrink)

A number of modern theologians have concluded that the rise of natural science makes it necessary to give up the idea that God acts in particular ways to affect the course of events in the world. I reply to this claim, taking up the challenge to explain what might be meant by a ”special’ act of God. There are several ways to conceive of such acts, including the possibility that God might determine what is left determinable in the structures of (...) nature, e.g., at the quantum level. I address objections to this view, and consider metaphysical puzzles that it presents. (shrink)

El opúsculo teológico De concursu et effi caci auxilio Dei ad actus liberi arbitrii necesario escrito por Suárez en Coimbra en 1599 en el contexto de la polémica de auxiliis es un ejemplo paradigmático de la concepción filosófico-teológica que Suárez tiene de la causalidad. Según esta concepción se conjuga la causa como necesidad de la acción eficiente de la naturaleza, la causa como acción voluntaria de la libertad y la causa como ayuda eficaz de la acción de la gracia divina (...) sobre la voluntad libre del hombre. Este opúsculo se pone en relación con la doctrina de la disputación XIX, escrita tres años antes en Salamanca. Mediante esta comparación se concluye que la gracia no determina el acto de la voluntad sino que lo posibilita constituyendo así la raíz misma de la libertad. (shrink)

This paper focuses on the nature and origin of “potestas”, both human and divine, in the context of Francisco Suárez's De legibus. On the basis of a presentation of Suárez's juridical system - whic...