This article describes an equine-assisted experiential therapy approach and presents treatment outcomes in 31 participants in an equine-assisted, experiential therapy program. Participants completed psychological measures prior to treatment, immediately following treatment, and 6 months after treatment. Reported reductions in psychological distress and enhancements in psychological well being were significant immediately following treatment and were stable at 6-month follow-up. The article discusses the clinical implications and limitations of the present study and directions for further research.

BackgroundSarcomas are a diverse group of neoplasms that vary greatly in clinical presentation and responsiveness to treatment. Given the differences in the sites of involvement, rarity, and treatment modality, a multidisciplinary approach is required. Previous literature suggests patients with sarcoma suffer from poorer quality of life especially physical and functional wellbeing. Adolescent and young adult patients are an underrepresented population in cancer research and have differing factors influencing QoL.MethodsRetrospective analysis of Young Adult patients enrolled in the Sarcoma Tissue Repository at (...) University of Iowa. QoL was assessed using the self-report FACT-G questionnaire at enrollment and 12 months post-diagnosis; overall scores and the 4 wellbeing subscales were calculated. Linear mixed effects models were used to measure the association between the rate of change in FACT-G subscale scores and baseline clinical, comorbidity, and treatment characteristics.Results49 patients were identified. 57.1% of patients had a malignancy involving an extremity. Mean FACT-G scores of overall wellbeing improved from baseline to 12 months. Social and emotional wellbeing did not differ significantly between baseline and 12 months. Physical wellbeing and functional wellbeing scores improved from baseline to 12 months. No difference was seen for FACT-G overall scores for age, sex, laterality, marital status, performance status, having children, clinical stage, limb surgery, chemotherapy, or tumor size. A difference was demonstrated in physical wellbeing scores for patients with baseline limitation compared to those with no baseline limitation. A difference was demonstrated in social wellbeing based on anatomical site.ConclusionYoung adults with sarcoma treated at a tertiary center had improvements in overall reported QoL at 12 months from diagnosis. Overall baseline QoL scores on FACT-G were lower than the general adult population for YA patients with sarcoma but at 12 months became in line with general population norms. The improvements seen merit further investigation to evaluate how these change over the continuum of care. Quality of life changes may be useful outcomes of interest in sarcoma trials. (shrink)

IntroductionYounger age at diagnosis is a risk factor for poor health-related quality of life in long-term breast cancer survivors. However, few studies have specifically addressed HRQOL in young adults with breast cancer, nor have early changes in HRQOL been fully characterized.MethodsEligible female patients with breast cancer were identified through our local cancer center. To establish HRQOL, patients completed the Functional Assessment of Cancer Therapy-Breast around diagnosis and 12 months later. Sociodemographic factors, genetic susceptibility to cancer, tumor- and treatment-related factors, and (...) comorbidities were abstracted from medical records and the local oncology registry. Mixed-effects models were used to identify changes in FACT-B scores during the first year of treatment and to determine whether any demographic/treatment-related factors modulated changes in scores.ResultsHealth-related quality of life in young patients with breast cancer was within normal limits at baseline, with a FACT-B overall well-being score of 108.5. Participants reported slight improvements over a 12-month period: FACT-B overall well-being scores increased 6.6 points, functional well-being improved 3.0 points, emotional well-being improved 1.9 points, and physical well-being improved 1.5 points, on average. Participants with anxiety/depression at baseline reported greater improvements in FACT-B overall well-being and functional well-being than participants who did not have anxiety/depression at baseline. Marital status, reconstructive surgery, and baseline clinical staging were also significantly associated with changes in aspects of HRQOL, although their impact on change was relatively minimal.ConclusionYoung women with breast cancer do not report HRQOL concerns during the first year of treatment. Improvements in HRQOL during the first year of treatment may be attributable to a sense of relief that the cancer is being treated, which, in the short run, may outweigh the negative late effects of treatment. (shrink)

An exploration of the moral and ethical implications of new biotechnologies Many of the ethical issues raised by new technologies have not been widely examined, discussed, or indeed settled. For example, robotics technology challenges the notion of personhood. Should a robot, capable of making what humans would call ethical decisions, be held responsible for those decisions and the resultant actions? Should society reward and punish robots in the same way that it does humans? Likewise, issues of safety, environmental concerns, and (...) distributive justice arise with the increasing acceptance of genetically modified organisms in food production nanotechnology in engineering and medicine, and human gene therapy and enhancement. The problem of dual-use—when a technology can be used both to benefit and to harm—exists with virtually all new technologies but is central in the context of emerging 21st century technologies ranging from artificial intelligence and robotics to human gene-editing and brain-computer interfacing. In Re-Creating Nature: Science, Technology, and Human Values in the Twenty-First Century, James T. Bradley addresses emerging biotechnologies with prodigious potential to benefit humankind but that are also fraught with ethical consequences. Some actually possess the power to directly alter the evolution of life on earth including human. Specifically, these topics include stem cells, synthetic biology, GMOs in agriculture, nanotechnology, bioterrorism, CRISPR gene-editing technology, three-parent babies, robotics and roboethics, artificial intelligence, and human brain research and neurotechnologies. Offering clear explanations of these various technologies, a pragmatic presentation of the conundrums involved, and questions that illuminate hypothetical situations, Bradley guides discussions of these and other thorny issues resulting from the development of new biotechnologies. He also highlights the responsibilities of scientists to conduct research in an ethical manner and the responsibilities of nonscientists to become “science literate” in the twenty-first century. (shrink)

During the past two decades, several reports have documented substantial support from clinicians, policy-makers, and the general public for the use of advance directives, yet studies continue to find that only a minority of individuals have completed these legal documents. Advance directives are written instructions, such as living wills or durable powers of attorney for health care, which describe an individual's medical treatment wishes in the event that individual becomes incapacitated in the future. The completion and use of advance directives (...) is one of several components of the broader activity of advance care planning, that is, the overall planning and communication of personal wishes concerning future medical care.In December 1991, the federal Patient Self-Determination Act became effective. Promoted as a federal initiative to enhance an individual's control over medical treatment decision making and, therefore, patient autonomy and self-determination, PSDA placed several new requirements on health care organizations receiving Medicare or Medicaid payments. (shrink)

In his book Radical Evolution: The Promise and Peril of Enhancing Our Minds, Our Bodies—and What It Means to Be Human (2005), author-journalist Joel Garreau identifies four technologies whose synergistic activity may transform humankind into a state transcending present human nature: genetic, robotic, information, and nano (GRIN) technologies. If the GRIN technologies follow Moore's Law, as information technology has done for the past four decades, Homo sapiens and human society may be unimaginably different before the middle of this century. But (...) among scientists, futurists, and other pundits there is no agreement on the nature and ramifications of this transformation. Based on dozens of interviews, Garreau sees three possible scenarios for our species. The Heaven Scenario foresees enhanced bodies and minds in a disease-free world, perhaps even immortality; the Hell Scenario warns of losing our identity as a biological entity and perhaps the demise of liberal democracy; the Prevail Scenario predicts that we will muddle through the GRIN technology revolution basically intact, as we have prevailed during past technological upheavals. In this review, these scenarios are examined in the context of Kuhn's “normal” versus “extraordinary” science and in the context of current understanding about gene function. (shrink)

Why do we persist in the relentless pursuit of artificial nourishment and other treatments to maintain a permanently unconscious existence? In facing the future, if not the present world-wide reality of a huge number of persistent vegetative state (PVS) patients, will they be treated because of our ethical commitment to their humanity, or because of an ethical paralysis in the face of biotechnical progress? The PVS patient is cut off from the normal patterns of human connection and communication, with a (...) life unlike other forms of human existence. Why the struggle to justify ending a life which, it is said, has suffered an irreversible loss of the content of consciousness? Elsewhere, the authors have addressed the ethical controversies and confusion engendered by ambiguous terminology, misuse of medical facts and the differing interpretations of what constitutes 'effective' treatment: in particular, the issue of whether in fact artificial nutrition and hydration is a medical treatment, or simply part of the obligatory care owed to all patients, permanently unconscious or not. In this paper, we intend to argue that recent analyses of medical futility, its meaning and ethical implications, despite an absence of public consensus, permit some tentative re-evaluation of our ethical obligations to the PVS patient. (shrink)

The prevalence of ethics training in organizations rose from 50% in 2003 to 76% in 2011 (Ethics Resource Center 2012). This paper reviews the current state of ethics training in organizations and proposes a new conceptual model for designing effective ethics training programs based on Rest’s (1986) model of ethical decision-making. We argue that it is not the content of ethics training that fails to produce ethical behavior; it is the method by which ethics training is delivered. Most organizations utilize (...) training methods designed to disseminate information or facilitate ethical dilemma recognition. Few organizations utilize methods that allow for trainees to actually practice making an ethical decision. We argue that a comprehensive approach to ethics training should be used, so trainees may practice all aspects of making an ethical decision. This practice should then enhance transfer of ethics training to the job. We conclude with suggestions for how research could be conducted to empirically support these arguments and inform ethics training method choices. (shrink)

Penn et al. argue that the complexity of relational learning is beyond animals. We discuss a model that demonstrates relational learning need not involve complex processes. Novel stimuli are compared to previous experiences stored in memory. As learning shifts attention from featural to relational cues, the comparison process becomes more analogical in nature, successfully accounting for performance across species and development.

We bear witness to a sweeping social movement for change—fostered and driven by a powerful group of Black nurses and nursing students determined to call out and dismantle anti‐Black racism and discrimination within the profession of nursing. The Black Nurses Task Force, launched by the Registered Nurses' Association of Ontario (RNAO) in July 2020, is building momentum for long‐standing change in the profession by critically examining the racist and discriminatory history of nursing, listening to and learning from the lived experiences (...) of the Black nursing community, and shaping concrete, actionable steps to confront anti‐Black racism and discrimination in academic settings, workplaces, and nursing organizations. The Black Nurses Task Force and the RNAO are standing up and speaking out in acknowledgment of the magnitude of anti‐Black racism and discrimination that exist in our profession, health system, justice system, and economic system. This social movement is demonstrating, in actions, how individuals and a collective act as change agents to drive meaningful and widespread change for our present and future Black nurses. We also acknowledge the Black nurses who have gone before us. (shrink)

The alleged robustness of Z, t, and F tests against nonnormality and, when sample sizes are equal, of t and F tests against heterogeneity as well was investigated in a large-scale sampling study under conditions realistic to experimentation and testing in the behavioral sciences. Factors varied were: population shape (L or bell), σ1/σ2 (1/2, 1, or 2), size N of smallest sample (2, 4, 8, 16, 32, 64, 128, 256, 512, or 1,024), N1/N2 (1/3,1/2,1, 2, or 3), α (.05,.01, or.001), (...) and test tailedness (left, right, or two). In about 25% of the situations investigated, the test failed to meet a very lax criterion for robustness at every examined N value less than 100, and in 8% at every value less than 1,000; no test met the criterion in all of the situations studied before N=512. Robustness was strongly influenced by all of the factors investigated, and interactions among the influencing factors were often strong and complex. (shrink)

Refusal of organ donation is common, and becoming more frequent. In Australia refusal by families occurred in 56% of cases in 1995 in New South Wales, and had risen to 82% in 1999, becoming the most important determinant of the country's very low organ donation rate .Leading causes of refusal, identified in many studies, include the lack of understanding by families of brain death and its implications, and subsequent reluctance to relegate the body to purely instrumental status. It is an (...) interesting paradox that surveys of the public continue to show considerable support for organ donation programmes—in theory we will, in practice we won't .In this paper we propose that the Australian community may, for good reason, distrust the concept of and criteria for “whole brain death”, and the equation of this new concept with death of the human being. We suggest that irreversible loss of circulation should be reinstated as the major defining characteristic of death, but that brain-dead, heart-beating entities remain suitable organ donors despite being alive by this criterion. This presents a major challenge to the “dead donor rule”, and would require review of current transplantation legislation. Brain dead entities are suitable donors because of irreversible loss of personhood, accurately and robustly defined by the current brain stem criteria."Even the dead are not terminally ill any more.". (shrink)

Magnetic resonance imaging (MRI) can provide a number of measurements relevant to sport-related concussion (SRC) symptoms; however, most studies to date have used a single MRI modality and whole-brain exploratory analyses in attempts to localize concussion injury. This has resulted in highly variable findings across studies due to wide ranging symptomology, severity and nature of injury within studies. A multimodal MRI, symptom-guided region-of-interest (ROI) approach is likely to yield more consistent results. The functions of the cerebellum and basal ganglia transcend (...) many common concussion symptoms, and thus these regions, plus the white matter tracts that connect or project from them, constitute plausible ROIs for MRI analysis. We performed diffusion tensor imaging (DTI), resting-state functional MRI, quantitative susceptibility mapping (QSM), and cerebral blood flow (CBF) imaging using arterial spin labeling (ASL), in youth aged 12-18 years following SRC, with a focus on the cerebellum, basal ganglia and white matter tracts. Compared to controls similar in age, sex and sport (N= 20), recent SRC youth (N= 29; MRI at 8 ± 3 days post injury) exhibited increased susceptibility in the cerebellum (p= 0.032), decreased functional connectivity between the caudate and each of the pallidum (p= 0.035) and thalamus (p= 0.021), and decreased diffusivity in the mid-posterior corpus callosum (p< 0.038); no changes were observed in recovered asymptomatic youth (N= 16; 41 ± 16 days post injury). For recent symptomatic-only SRC youth (N= 24), symptom severity was associated with increased susceptibility in the superior cerebellar peduncles (p= 0.011) and reduced activity in the cerebellum (p= 0.013). Fewer days between injury and MRI were associated with reduced cerebellar-parietal functional connectivity (p< 0.014), reduced activity of the pallidum (p= 0.002), increased CBF in the caudate (p= 0.005), and reduced diffusivity in the central corpus callosum (p< 0.05). Youth SRC is associated with acute cerebellar inflammation accompanied by reduced cerebellar activity and cerebellar-parietal connectivity, as well as structural changes of the middle regions of the corpus callosum accompanied by functional changes of the caudate, all of which resolve with recovery. Early MRI post-injury is important to establish objective MRI-based indicators for concussion diagnosis, recovery assessment and prediction of outcome. (shrink)

In Appearance and Reality Bradley has much to say about relations. This is to be found particularly in Chapter 3 and Appendix B, but the whole of the book is on this subject in one way or another. His views aroused immediate opposition and Bertrand Russell, among others, strongly attacked the “doctrine of internal relations,” a phrase which, be it noted, does not occur in Chapter 3 at all and makes its appearance only as part of the controversy. Russell (...) argued that some relations at least are purely external, and that if one does not grant this one is left with no option but to reject pluralism, embrace monism, and regard all truths as analytic. With characteristic honesty Russell admitted that it was aversion to these consequences which stimulated his desire to rebut opinions of the kind that Bradley held. It is the thesis of this essay that while Bradley had something important to say about the “doctrine,” he made a more important point about relations and qualities which has been overlaid by the controversy about “internal relations,” and that this point is an extremely relevant one in the context of much modern philosophizing. I will therefore attempt first of all to draw out Bradley’s most important point about relations and qualities; secondly to consider what connection this has with the “internal relations” controversy; and thirdly to decide whether Russell was right in supposing what he did about pluralism, monism, and analytic truths. (shrink)

For each of the N-values 2, 4, 8, 16, 32, 64, 128, 256, 512, and 1,024, 50,000 samples of size N were drawn from an L-shaped population, and for each sample the Z and t statistics were calculated. The resulting distributions of 50,000 Z or t values at each sample size were then used to study the robustness of left-tailed, right-tailed, and two-tailed Z and t tests at α levels of.05,.01, and.001 (and, for Z only,.0001). The actually obtained proportion, ρ, (...) of Type I errors was often far greater or far smaller than the nominal proportion, α. Furthermore, although α is the expected value of ρ at infinite N, no N-value below 512 ever brought the deviation of p from α to within 10% of α for any t tests or one-tailed Z tests. (shrink)

An incomplete science begets imperfect models. Nevertheless, the target article advocates for jettisoning deep-learning models with some competency in object recognition for toy models evaluated against a checklist of laboratory findings; an approach which evokes Alan Newell's 20 questions critique. We believe their approach risks incoherency and neglects the most basic test; can the model perform its intended task.

In his recently published paper, ‘The Nature of Possibility,’ David Armstrong presents an account of possibility which, he correctly claims, is partly an elaboration of the early Wittgenstein's. Both are combinatorialists. That is to say, both hold that there is a fixed ontology of individuals, properties and relations whose combinations determine the range of all possible states of affairs, and therewith the range of all those totalities of states of affairs which they call possible worlds.But Armstrong's account, I believe, is (...) fatally flawed in ways that Wittgenstein's isn't. And this, I shall argue, is mainly because Armstrong is both an actualist, whose fixed ontology is one of actual individuals, properties and relations, and a reductionist, who tries to reduce the notion of possibility to that of ߢallߣ their combinations. Armstrong seems to think that Wittgenstein at least shares his actualism, and perhaps even his reductionism. (shrink)

I defend Pascal's Wager from a particular way of evading it, the mixed strategy approach. The mixed strategies approach suggests that Pascal's Wager does not obligate one to believe in God, because one can get the same infinite expected utility from other strategies besides the strategy of believing in God. I will show that while there's nothing technically wrong with the mixed strategy approach, rationality requires it to be applied in such a way that Pascal's Wager doesn't lose any force.

The robustness of the classical tests on means (Z, t, and F) and variances (chi square and F) was investigated by obtaining 30,000 (or, sometimes, 10,000 or 150,000) values of the test statistic under assumption-violating conditions and comparing the actual proportion of Type I errors with the proportion expected when all assumptions are met. The sampling and testing conditions investigated were: population shape (L-shape or bell-shape), relative population variance (1 or 4), sample size (8, 16, or 24), nominal significance level (...) (.05,.01, or.001), and location of rejection region (left-tailed, right-tailed, or two-tailed). All tests on means were nonrobust under most of the investigated conditions, and one was nonrobust under all of them. Both tests on variances were extremely nonrobust under virtually all conditions. The worst nonrobustness of the one- and two-independent-sample Z and t tests rivaled or exceeded that of the notoriously nonrobust chi-square and F tests on variances. (shrink)

T. H. Green was a leading member of the British Idealist movement, which adopted the continental philosophy of Hegel and Kant while rejecting utilitarianism. As well as being a prominent philosopher, Green was an influential educational reformer and an active member of the Liberal party. Green's writings can be placed into three categories: religion, philosophy and politics. This work was the most complete statement of Green's philosophy, although it remained unfinished at his death. Edited by A. C. Bradley, a (...) former student and brother of Green's fellow Idealist F. H. Bradley, the book, which contains four parts, was published posthumously in 1883. Like other Idealists, Green criticised empiricism for creating an unnecessary dualism between thought and the real. (shrink)

One might well wonder—is there a category under which every thing falls? Offering an informative account of such a category is no easy task. For nothing would distinguish things that fall under it from those that don’t—there being, after all, none of the latter. It seems hard, then, to say much about any fully general category; and it would appear to do no carving or categorizing or dividing at all. Nonetheless there are candidates for such a fully general office, including (...) thing, being, entity, item, existent, and—especially—object.[ It is not obvious that there is any fully general category (whether object or otherwise). Accordingly, not all accounts of object assign it to a fully general category, instead allowing that there are non-objects. On those views, object does indeed divide. Accounts of object, then, differ with respect to whether there are non-objects. And this is not the only fault line. Other dimensions of difference include what objects there are and what objects are. Accordingly, this entry will survey three broad questions about the category object: What, if any, is its contrast or complement? What is its extension? What is its nature? (shrink)

Metaphysicians sometimes appeal to physics to establish claims about the fundamental nature of the world. But given the current state of inquiry in physics, where there are two most fundamental theories that are incompatible, such arguments of physics-based metaphysics are problematic. I support this line of thought by focussing on two sorts of problematic arguments, special-relativity-based arguments against presentism and big-bang-based arguments in favor of the existence of God. I am not arguing that physics-based metaphysics can’t be done; I am (...) just arguing that extant examples of physics-based metaphysics are flawed. I close by considering various ways that future versions of physics-based metaphysics could potentially be successful. (shrink)

Mereological nihilism is the view that no objects have proper parts. Despite how counter‐intuitive it is, it is taken quite seriously, largely because it solves a number of puzzles in the metaphysics of material objects – or so its proponents claim. In this article, I show that for every puzzle that mereological nihilism solves, there is a similar puzzle that (a) it doesn’t solve, and (b) every other solution to the original puzzle does solve. Since the solutions to the new (...) puzzles apply just as well to the old puzzles, the old puzzles provide no motivation to be a mereological nihilist. (shrink)

What mechanisms underlie children’s language production? Structural priming—the repetition of sentence structure across utterances—is an important measure of the developing production system. We propose its mechanism in children is the same as may underlie analogical reasoning: structure-mapping. Under this view, structural priming is the result of making an analogy between utterances, such that children map semantic and syntactic structure from previous to future utterances. Because the ability to map relationally complex structures develops with age, younger children are less successful than (...) older children at mapping both semantic and syntactic relations. Consistent with this account, 4-year-old children showed priming only of semantic relations when surface similarity across utterances was limited, whereas 5-year-olds showed priming of both semantic and syntactic structure regardless of shared surface similarity. The priming of semantic structure without syntactic structure is uniquely predicted by the structure-mapping account because others have interpreted structural priming as a reflection of developing syntactic knowledge. (shrink)

Recent literature has highlighted issues of racial discrimination in medicine. In order to explore the sometimes subtle influence of racial determinants in decisions about resource allocation, we present the case of a 53-year-old Australian Aboriginal woman with end-stage renal failure. The epidemiology of renal failure in the Australian Aboriginal population and amongst other indigenous peoples is discussed. We show that the use of utilitarian outcome criteria for resource allocation may embody subtle racial discrimination where consideration is not given to issues (...) of justice, race, culture and gender. It is only where the processes by which resources are allocated are transparent, clearly defined and based upon consultation with individual patients that issues and justice are likely to be adequately addressed. (shrink)

The fundamental constants that are involved in the laws of physics which describe our universe are finely-tuned for life, in the sense that if some of the constants had slightly different values life could not exist. Some people hold that this provides evidence for the existence of God. I will present a probabilistic version of this fine-tuning argument which is stronger than all other versions in the literature. Nevertheless, I will show that one can have reasonable opinions such that the (...) fine-tuning argument doesn’t lead to an increase in one’s probability for the existence of God. (shrink)

I present a new thermodynamic argument for the existence of God. Naturalistic physics provides evidence for the failure of induction, because it provides evidence that the past is not at all what you think it is, and your existence is just a momentary fluctuation. The fact that you are not a momentary fluctuation thus provides evidence for the existence of God – God would ensure that the past is roughly what we think it is, and you have been in existence (...) for roughly the amount of time you think you have. I don’t have a definitive way for the atheist to refute this argument, but I give one suggestion that relies on physics-based simplicity considerations. I close with an epistemological discussion of self-undermining arguments. (shrink)

We argue that any superluminal theory Tis empirically equivalent to a non-superluminaltheory T★, with thefollowing constraints onT★ : T★ preservesthe spacetime intervals between events as entailedby T, T★ is naturalistic (as longas T is), and all the events which have causesaccording to T also have causes according toT★. Tim Maudlin (1996) definesstandard interpretations of quantum mechanicsas interpretations `according to which there wasa unique set of outcomes in Aspect's laboratory,which outcomes occurred at spacelike separation’, andMaudlin claims that standard interpretations must benon-local (...) in the sense that there are superluminalinfluences. We show (even assuming Aspect's experimentis ideal) that Maudlin's claim is false. (shrink)