BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...) objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)

Detecting contract cheating in written submissions can be difficult beyond direct plagiarism detectable via technology. Successfully identifying potential cases of contract cheating in written work such as essays and reports is largely dependent on the experience of assessors and knowledge of student. It is further dependent on their familiarity with the patterns and clues evident in sections of body text and reference materials to identify irregularities. Consequently, some knowledge of what the patterns and clues look like is required. This paper (...) documents how to identify some of the patterns and clues observed in essay and report submissions. Effective assessment design with specific contextual requirements make irregularities easier to detect and interpret. The irregularities identified were confirmed as instances of contract cheating through conversations held with postgraduate students. An essential element of the conversations was the evidence presented for discussion. Irregularities were noted on a pro-forma specifically developed for this purpose. Patterns identified include misrepresented bibliographic data, inappropriate references, irrelevant material and generalised text that did not address the assessment question or grading criteria. The validated patterns formed the basis of identifying potential instances of contract cheating in later submissions. Timely conversations with students before the end of semester are essential to determining whether the patterns and clues link to poor knowledge of academic writing conventions or classified as contract cheating necessitating the application of appropriate penalties under institutional policies and procedures. (shrink)

A decade ago, conventional wisdom in the medical establishment was that physicians treating chronic pain with opioid analgesics were at a substantial risk of being sanctioned for overprescribing by state medical regulatory boards. Dozens of articles written since have alluded to this risk as an obstacle to effective pain re1ief. In the early 1990s, a number of high profile cases in which physicians were disciplined by regulatory boards for overprescribing to patients with chronic pain were reported in the press. Although (...) the board actions in many of these cases were eventually overturned by state judiciaries, the publicity heightened practitioners’. sensitivity to the regulatory risks associated with prescribing opioids.A review of the available data on state medical board actions nationwide for the period from 1990 to 1996 reveals that the perception of regulatory risk far exceeds the reality. Indeed, relatively few of the disciplinary actions taken for overprescribing by state medical boards in any given year directly concern the treatment of chronic pain—malignant or nonmalignant—in patients. (shrink)

Research on emotion and psychopathology has blossomed due in part to the translation of affective science theory and methods to the study of diverse disorders. This translational approach has helped the field to hone in more precisely on the nature of emotion deficits to identify antecedent causes and maintaining processes, and to develop promising new interventions. The future of emotion research in psychopathology will benefit from three inter-related areas, including an emphasis on emotion difficulties that cut across traditional diagnostic boundaries (...) (i.e., a transdiagnostic approach), the explicit linking of emotion and cognition in behavioral and neuroimaging studies in psychopathology, and continued translation of the latest conceptualizations of emotion to the study of psychopathology. (shrink)

How should nursing knowledge advance? This exploration contextualizes its evolution past and present. In addressing how it evolved in the past, a probable historical evolution of its development draws on the perspectives of Frank & Gills's World System Theory, Kuhn's treatise on Scientific Revolutions, and Foucault's notions of Discontinuities in scientific knowledge development. By describing plausible scenarios of how nursing knowledge evolved, I create a case for why nursing knowledge developers should adopt a post‐structural stance in prioritizing their research agenda(s). (...) Further, by adopting a post‐structural stance, I create a case on how nurses can advance their disciplinary knowledge using an engaging post‐colonial strategy. Given an interrupted history caused by influence(s) constraining nursing's knowledge development by power structures external, and internal, to nursing, knowledge development can evolve in the future by drawing on post‐structural interpretation, and post‐colonial strategy. The post‐structural writings of Deleuze & Guattari's understanding of ‘Nomadology’ as a subtle means to resist being constrained by existing knowledge development structures, might be a useful stance to understanding the urgency of why nursing knowledge should advance addressing the structural influences on its development. Furthermore, Bhabha's post‐colonial elucidation of ‘Hybridity’ as an equally discreet means to change the culture of those constraining structures is an appropriate strategy to enact how nursing knowledge developers can engage with existing power structures, and simultaneously influence that engagement. Taken together, ‘post‐structural stance’ and ‘post‐colonial strategy’ can refocus nursing scholarship to learn from its past, in order to develop relevant disciplinary knowledge in its future. (shrink)

The distinction between stakeholders and shareholders frequently employed in business ethics can illuminate challenges faced by a bioethics advisory panel. I use the distinction to reflect back on the work of an advisory panel on which I served, a panel on US transplant policy. The panel hearings were akin to a shareholders’ meeting, with many stakeholders absent. In addition to ‘hearing out’ the shareholders who were present, the panel had duties to absent stakeholders to insure their interests were included in (...) public discussion. While panel efforts to include stakeholder perspectives rightfully framed its report, such duties should have framed its operating procedures more robustly. The stakeholder/shareholder distinction also offers a critical prism on the actual evolution of organ allocation policy, which the panel failed to influence. Current policy embodies a compromise among shareholders that obscures major stakeholder interests. This results in under‐attention to likely medical benefit of transplant, compared to other allocation criteria. Recognition of duties to stakeholders amidst pressures of shareholders complicates the notion of ‘consensus’ for an advisory panel. Consensus framed on terms defined only by shareholders, not stakeholders, may be an inadequate measure of public interest. (shrink)

Research on emotion perception in schizophrenia has focused primarily on the perception of static faces displaying different emotion signals or expressions. However, perception of emotion in daily life relies on much more than just the face. In this article, we review the role of context in emotion perception among people with and without schizophrenia. We argue that not only is context central to the perception of emotion, it in fact helps to construct the perception. Implications for future research on emotion (...) perception are discussed. (shrink)

We examine the influences of social capital, source credibility, and fairness perceptions on the judgments of experienced compensation committee members who are considering a proposal to reduce management’s performance targets in the middle of a compensation cycle due to difficult circumstances. Eighty-nine U.S. public company CC members participated in a 2 × 2 experiment with social capital and source credibility each manipulated as low or high, and outcome fairness to management, process fairness to shareholders, and outcome fairness to shareholders included (...) as measured variables. While social capital and source credibility are not significant, we find that outcome fairness to the CEO and outcome fairness to shareholders are significantly related to CC members’ support for reducing performance targets during a compensation cycle. In addition, we find that more experienced CC members are less supportive of changing the performance targets. The significant interactions include one between outcome fairness to shareholders and process fairness to shareholders, which suggests that CC member support for the proposal relies on both process and outcome fairness being present. Finally, the participants’ qualitative responses reflect arguments both for and against adjusting performance targets. Overall, the results highlight the important roles of fairness and director experience in boardroom decisions and provide important insights into factors affecting CC judgments. (shrink)

Nolan, Ann MC In the past fifty years there has been a stream of commentary on the documents of Vatican II. Have we not had so much commentary, so much interpretation, that further commentary is unnecessary? Fifty years on, one might ponder how to interpret the sixteen documents for the church of our times, indeed to wonder whether they continue to have any relevance at all. Faced with this thought, we could turn to one scholar whose works span almost the (...) whole of this fifty-year period, yet whose thought in relation to the documents has not remained static: the renaissance historian John O'Malley SJ. (shrink)

Traditional theistic proofs are often understood as evidence intended to compel belief in a divinity. John Clayton explores the surprisingly varied applications of such proofs in the work of philosophers and theologians from several periods and traditions, thinkers as varied as Ramanuja, al-Ghazali, Anselm, and Jefferson. He shows how the gradual disembedding of theistic proofs from their diverse and local religious contexts is concurrent with the development of natural theologies and atheism as social and intellectual options in early modern Europe (...) and America. Clayton offers a fresh reading of the early modern history of philosophy and theology, arguing that awareness of such history, and the local uses of theistic argument, offer important ways of managing religious and cultural difference in the public sphere. He argues for the importance of historically grounded philosophy of religion to the field of religious studies and public debate on religious pluralism and cultural diversity. (shrink)

Recently, we reported that melanoma risk in redheads is linked not only to pale skin, but also to the synthesis of the pigment – called pheomelanin – that gives red hair its color. We demonstrated that pheomelanin synthesis is associated with increased oxidative stress in the skin, yet we have not uncovered the chemical pathway between the molecule pheomelanin and the DNA damage that drives melanoma formation. Here, we hypothesize two possible pathways. On one hand, pheomelanin might generate reactive oxygen (...) species (ROS) that directly or indirectly cause oxidative DNA damage. On the other hand, pheomelanin synthesis might consume cellular antioxidant stores and make the cell nucleus more vulnerable to other endogenous ROS. Uncovering the mechanistic pathway between pheomelanin and oxidative DNA damage will be an important step in developing strategies to lower melanoma risk in redheads. (shrink)

The United States National Preparedness System has evolved significantly in the recent past. These changes have affected the system structures and goals for disaster response. At the same time, actors such as private businesses have become increasingly involved in disaster efforts. In this paper, we begin to fill the gap in the cross-sector literature regarding interactions that have systemic impacts by investigating how the simultaneous processes of systemic change and intensifying cross-sector interaction worked and interacted in the context of the (...) preparedness system. We examine these inter-linkages through a qualitative study in the setting of Hurricane Sandy. Drawing from systems theory, we develop a grounded model that provides an explanation for the system change and highlights how cross-sector interaction relates to the changes observed in the system. (shrink)

This paper suggests that Dante’s writings on language provide elements for the construction of a philosophy of language. The main emphasis is on the theoretical treatment of language in De Vulgari Eloquentia, but it also considers La Vita Nouva and Il Convivio, earlier works providing insights into the development of Dante’s views on the nature and use of language. De Vulgari Eloquentia is an extended justification for the use of a vernacular language capable of treating the worthiest topics in a (...) manner appropriate to them. Two main purposes of language are to instruct and delight. Dante shows that others must be addressed in a language they understand, but if it is to lift them, it must have a beauty and power beyond them. (shrink)

The central questions addressed in this paper are: (1) how are forms related to predication? And (2) what role do forms and predication play in the discovery and articulation of truth? The first section of the paper provides—in broad strokes—a synopsis of Plato’s account of forms. The second section considers predication in relation to forms showing that the existence and nature of forms is a necessary condition for predication, and that Plato’s account of predication is consistent with, in fact, anticipates, (...) Aristotle’s treatment of reality in the Categories. The conclusion of the paper is that forms and predication are central to philosophical hermeneutics, to the discovery and articulation of truth. (shrink)

Ansel Adams, Robert Adams, Carlos Almaraz, Robert Arneson, John Baldessari, Lewis Baltz, Robert Bechtle, Jeff Brouws, Laurie Brown, Angela Buenning, Darlene Campbell, Mark Campbell, Gary Carlos, Fandra Chang, Stephane Couturier, Robert Dawson, Joe Deal, Richard Diebenkorn, John Divola, Beth Yarnelle Edwards, Kota Ezawa, William A. Garnett, Jeff Gillette, Joe Goode, Todd Hido, David Hockney, Salomon Huerta, Robert Isaacs, Thomas Lawson, Jean Lowe, Alex MacLean, Richard Meisinger, Jr., Richard Misrach, Rick Monzon, Barrie Mottishaw, Martin Mull, Deborah Oropallo, Bill Owens, Rondal Partridge, (...) John Register, Ed Ruscha, Peter Saul, Mary Snowden, Joel Sternfeld, Larry Sultan, Rudy Vanderlans, Camilo Jose Vergara, Henry Wessel, Amir Zaki. (shrink)

" With more than one hundred photographs, many from the collection of the Getty Museum, Railroad Vision illustrates the parallel histories of railroads and photography-from a photograph of George Stephenson's steam engine Locomotion, to ...

This paper explores the notion of practical wisdom asan alternative to current formulations of criticalthinking. The practical realm is that ofill-structured problems that emerge from life aslived; it is a realm of legitimate uncertainty andambiguity that requires an ethical responsiveness orpractical wisdom. The death of a child is a case inpoint. The author identifies and examines threeaspects of practical wisdom – the ethical claims ofpartiality, a yielding responsiveness and the play ofthought – and juxtaposes them with aspects of criticalthinking. The (...) work of Martha Nussbaum and RichardPaul are interwoven throughout the discussion. Theauthor concludes that the discourse of criticalthinking is in danger of lapsing into a form of moralescapism wherein all we are rationally responsible foris thinking correctly. Practical wisdom, on theother hand, recognizes that thinking is not simply anintellectual cognitive act of an individual but adance between the life of a child and the love of anelder, a conversation between what is and what couldbe, an openness to passionate sorrow and surprise, aplay between understanding and perception. As such,practical wisdom provides a more likely account ofliving in good faith with oneself and others. (shrink)

The purpose of this study was to extend the previous research on ethics in retailing. Prior research of Dornoff and Tankersley (1985–1976), Gifford and Norris (1987), Norris and Gifford (1988), and Burns and Rayman (1989) examined the ethics orientation of retail sales persons, sales managers, and business school students. These studies found the college students less ethically-oriented than retail sales people and retail managers. The present study attempts to extend the research on ethics formation to a geographically and academically diverse (...) sample, and to determine if retail management experience in the form of a professional practicum or internship, or entry level management training programs, such as experienced by recent graduates, are critical factors in the formation of business ethics. The sample consisted of thirty-three students majoring in Human Ecology with a concentration in Retail Merchandising and 51 recent graduates of the retail Merchandising program. The series of fourteen vignettes developed by Dornoff and Tankersley (1975–1976) was used. An acknowledged limitation of this study is the validity of the questionnaire developed by Dornoff and Tankersley due to the method of development and new laws concerning warranties and credit etc. which have occurred since 1976. The instrument was used, however, to maintain consistency with earlier studies for the purpose of comparison of groups. No significant differences were found in the students' perceptions of the fourteen actions presented in the vignettes, but the range of the responses in the post-internship tests increased in many cases. The alumni appeared to be slightly more ethical than the students but not as ethical as the managers surveyed in 1986 by Norris and Gifford. Indications are that the critical point of ethics formation may be at the mid-management level and that internships and management training programs have little effect on the ethical perceptions of participants. These findings are consistent with studies such as Gable and Topol (1988), and Jordan and Davis (1990) which showed high Machiavellian scores among young retailing executives, often buyers, as opposed to upper level retailing management. Scales with measure Machiavellianism, or manipulativeness, have been used as an alternative method of examining business ethics. (shrink)

A central feature of our waking mental experience is that our attention naturally toggles back and forth between “external” and “internal” stimuli. In the midst of an externally demanding task, attention can involuntarily shift internally with no clear reason how or why thoughts momentarily shifted inward. In the case of external attention, we are typically exploring and encoding aspects of our external world, whereas internal attention often involves searching for and retrieving potentially relevant information from our memory networks. Cognitive science (...) has traditionally focused on understanding forms of internal and external attention separately, leaving a mystery about what sparks the seemingly automatic shifts between the two. Specifically, what shifts attentional focus from being outward‐directed to being inward‐directed? We present a candidate mechanism: Familiarity‐detection. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Maurice Blondel on the Practice of Supernatural ReligionAnne M. CarpenterIntroductionMaurice Blondel attended daily Mass to the very end of his life.1 This essay is, in a way, a meditation on this fact. But it is more nearly a confrontation with Blondel's philosophical argument in defense of human action's capacity for affirming the infinite, for "containing" the infinite in its affirmation of the infinite, an affirmation achieved in action's finitude. (...) That is, this is an essay on Blondel's argument for a supernatural religion that can be literally practiced. Much like Blondel's larger philosophical works, this essay spends its time exploring the coordinating ground of supernatural religion, which is the natural world split open in two directions: in its very existence, which is a supposition of what absolutely outstrips its power; in its very action, which in ecstasy takes the shape of a desire for a reversal that it cannot offer itself. So the natural world presupposes the supernatural and desires the supernatural while remaining, of its own power, natural. Blondel makes a theoretical distinction in the universe that, concretely, is a natural–supernatural one committed to a single destiny. This theory and this concreteness cohere in order to make the literal practice of religion both possible and necessary, terms that this essay explains. [End Page 1305]Action: The Problem of Theory and PracticeBlondel's later writing in the 1930s expands on an important paradox that appears in the very early L'Action (1893). That paradox has to do with a distinction between theory—that is, the world of ideas and reflection—and practice, by which Blondel means the concrete world of human action, a world that for Blondel is an expansive range or "body" of action. It is true, after all, that an idea is not a deed. And yet no deed is without its idea, without the mediatory power of the act of consciousness, nor without the mediation of this consciousness's rationality—a further synthesizing act within consciousness—even when the deed contradicts reason. "Hence," says Blondel, "it is because we find in our acts a kind of creative sovereignty that we have a consciousness of ourselves and reason; it is because we are reasonable and conscious of ourselves that we judge ourselves capable of voluntary initiative."2 The paradox, at one angle, is this leap or gap, this difference nevertheless sustained by a mediation, where ideas and deeds are non-identical yet inseparable. At another angle, it is a paradox that a "science of practice" has to straddle, since it studies (as science) what it is not: concrete action (practice). Blondel, whether young or of his latter days, is after the possibility of such a science. He is also after the bond between reasoning and acting. In this section, I also seek that bond, and I make use of Blondel's early and later works together to give a sense not of Blondel's development, but of the Gestalt of his life's work with respect to the bond between thought and action.3The bond first requires the rejection of monism. Though Blondel's stance toward theologies of his day tends to be more well-known among theologians, and therefore filtered through questions of nature and grace and carried through to a rejection of a two-tiered conception of the universe, still, his nearer interlocutors are often monists: modern philosophers and the modern sciences, and their strange compatriots in history, the spiritual movements of the fin de siècle, involving spiritualisms of various kinds, recollected in our popular imagination today in visions of crystal balls and séance tables. The positivism of the modern sciences and of modern (French) philosophy poses a totally self-contained "nature" that can be explained [End Page 1306] without religion, in a form of what English speakers might call "secularism," but which is more accurately filtered through French Republican desires for laïcité.4 While Blondel was writing, there were not only these political and scientific and philosophical trends, but also the semi-pantheistic, variously agnostic religious movements that dominated privileged circles in Europe at the time. These are a kind of... (shrink)

Euthanasia advocates have recently begun counseling people to create advance directives calling for oral food and water to be withheld if the person reaches a certain stage of dementia. The author shows that these directives are in fact requests for euthanasia, and they leave vulnerable people subject to poor-quality care. Both surrogate decision makers and Catholic institutions have a moral obligation not to implement such directives, and surrogates, rather than withdrawing as proxies, have a moral obligation to advocate for the (...) life and proper care of the incompetent person. Finally, the author argues that society is morally culpable if it does not strongly resist euthanasia in all its forms. National Catholic Bioethics Quarterly 16.3 : 421–434. (shrink)

Precarious Others: Valuing Singularity -- Alienation and Exclusion: Appreciating Proximity -- Shamed and Shaming: Honouring Students -- Destitute and Dying: Preserving Dignity -- Fears and Frustrations: Acknowledging Desire -- Revitalizing Teaching as Vocation.

We propose that IAM and déjà vu may not share a placement on the same gradient, per se, but the mechanism of cue familiarity detection, and a major differentiating factor between the two metacognitive experiences is whether the resulting inward directed search of memory yields retrieved content or not. Déjà vu may manifest when contentless familiarity detection is inexplicable by the experiencer.

Over one-third of older adults in many countries have a companion animal, and pets may harbor health-promoting potential. Few studies have considered pet-ownership in relation to economic vulnerability, and pet-ownership has not been often considered within policy efforts to promote ageing-in-place. We conducted a mixed methods case study to understand perspectives of both community agencies that support ageing-in-place and older adults themselves. A shortage of affordable, appropriate pet-friendly housing emerged as a challenge, even when framed as a legitimate choice and (...) preference for many older adults. In this manuscript, we share the trajectories of three economically vulnerable older adults whose affordable housing needs became entangled with commitments to pets. Guided by dialogical narrative methodology, we offer each narrative as a short vignette to illustrate the extent to which older adults will practice ‘more-than-human solidarity’ for a pet, even when their own well-being is compromised as a result; and highlight incongruence between the underlying moral values that shape solidaristic practices of individuals versus solidaristic arrangements that shape affordable housing opportunities. We suggest that housing rules and legislation that disrupt, rather than confirm, more-than-human solidarity may render older adults susceptible to, rather than protected from, deteriorating physical, mental and social well-being. We propose that collective solidaristic practices must reflect and subsume the moral complexity of solidarity practiced by individuals, to enable fair and equitable ageing-in-place. (shrink)

Facial expression is a mode of close‐proximity non‐vocal communication used by primates and is produced by mimetic/facial musculature. Arguably, primates make the most‐intricate facial displays and have some of the most‐complex facial musculature of all mammals. Most of the earlier ideas of primate mimetic musculature, involving its function in facial displays and its evolution, were essentially linear “scala natural” models of increasing complexity. More‐recent work has challenged these ideas, suggesting that ecological factors and social systems have played a much larger (...) role in explaining the diversity of structures than previously believed. The present review synthesizes the evidence from gross muscular, microanatomical, behavioral and neurobiological studies in order to provide a preliminary analysis of the factors responsible for the evolution of primate facial musculature with comparisons to general mammals. In addition, the unique structure, function and evolution of human mimetic musculature are discussed, along with the potential influential roles of human speech and eye gaze. BioEssays 30:212–225, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

Agricultural intensification and extensification are standard responses to ecological and economic vulnerability among smallholder communities. Climate change has exacerbated this vulnerability and thrown the complexity of and critical need for managing a healthy natural resource base while increasing on-farm productivity into sharp light. Sustainable intensification is one of many mechanisms for accomplishing this balancing act. This study examines the adoption of sustainable intensification practices, namely input packages focused on tef row planting—designed to boost yield and promote more efficient use of (...) inputs. This study utilized a mix methods approach to survey 115 smallholder farmers in the South Wollo zone of the Amhara region in Ethiopia. This study found that cash and capital, more so than contact with the AIS, influenced farmers’ decisions to adopt row planting input packages. Khat production was an important source of cash for inputs and was more likely to be available to farmers with irrigation schemes. Long-term, farmers who cultivate khat may not successfully engage in SI, as khat replaces traditional food crop production in the region. Yet, for farmers who do not grow khat, long-term investment in SI practices is unlikely unless access to affordable credit options is improved. (shrink)