No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

Peppered throughout with previously unreported, and sometimes incendiary, higher education anecdotes, Nelson is at his flame-throwing best.The book calls on ...

Magnetic resonance imaging is a noninvasive imaging tool that utilizes a strong magnetic field and radio frequency waves to visualize in great detail organs, soft tissue, and bone. Unlike conventional x-rays, there is no exposure to ionizing radiation and at most field strengths the procedure is considered safe for nearly every age group. Because it is non-invasive and possesses excellent spatial resolution, the use of MRI as a research tool has increased exponentially over the past decade. Uses have ranged from (...) add-ons to a clinical study to studies of brain development in typically developing children. In addition, a major effort has been made in recent years to use MRI to study brain function. Because the clinical utility of fMRI has not yet been realized, fMRI is still considered highly exploratory, and we cannot yet identify incidental findings of a functional nature. (shrink)

As moral injury is a still-emerging concept within the area of military mental health, prevalence estimates for moral injury and its precursor, potentially morally injurious events (PMIEs), remain unknown for many of the world’s militaries. The present study sought to estimate the prevalence of PMIEs in the Canadian Armed Forces (CAF), using data collected from CAF personnel deployed to Afghanistan, via logistic regressions controlling for relevant sociodemographic, military, and deployment characteristics. Analyses revealed that over 65% of CAF members reported exposure (...) to at least one event that would be considered a PMIE. The most commonly PMIEs individuals reported included seeing ill or injured women and children they were unable to help (48.4%), being unable to distinguish between combatants and non-combatants (43.6%), and finding themselves in a threatening situation where they were unable to respond due to the rules of engagement under which they were required to operate (35.4%). These findings provide support for both the presence of exposure to PMIEs in CAF members and the need for formal longitudinal data collection regarding PMIE exposure and moral injury development. (shrink)

IntroductionEvery day, it seems, we advance into darkness we have not known before. It is not a journey we have sought out or chosen for ourselves. We are swept along by a current of malice that can only be avoided if we hide from the news. The spectacle of a mass anti-Zionist and antisemitic “Gaza Solidarity Encampment” on Columbia University’s central quad and elsewhere has structural predecessors, to be sure, like the Occupy Wall Street movement, but parallels with mass antisemitism (...) require comparison with earlier historical moments. As the University of Chicago’s president, Paul Alivisatos, wrote straightforwardly in a public letter, “the impact of an encampment depends on the degree to which it disrupts study, scholarship, and free movement around campus.”1 The Occupy Wall Street movement was notably accompanied by a substantial body of theoretical work, whereas the Columbia occupation is supported by little more than a Manichaean view of a world divided between oppressor and oppressed peoples. The chants are sounded without any plausible theory of how they could actually lead to the dissolution of the Jewish state. The students breaking windows and occupying a building at Columbia were certainly employing theory of a sort when they asserted that the university had a moral responsibility to deliver meals to them, but observers found the theory difficult to endorse. The students promise to remain until Columbia meets their divestment demands—which presumably means they will be in their tents for a very long time indeed, since for governing boards to cede their investment authority to mob action means giving up their other responsibilities as well. But Brown University’s governing corporation has agreed to meet with student representatives and hold a vote on divestment in the fall.2 I expect the results of the vote will disappoint the protestors. (shrink)

Throughout his authorship, Kierkegaard appears remarkably uninterested in the tradition of Christian mysticism. Indeed, in the only two places in the authorship where he broaches the topic directly, the discussion is disclaimed in such a way as to suggest that Kierkegaard really has nothing to say about it at all. However, attending to the successive incarnations of the character(s) named “Ludvig” throughout the authorship – an appellation that harbors an especially self-referential dimension for Kierkegaard – the present paper attempts to (...) elucidate what may, with due reservation, be referred to as the mystical element in Kierkegaard’s thought. The ultimate yield of this endeavor is a vision of “mysticism” that is more act than thought oriented, and a vision of the author “Kierkegaard” that is more delightful than melancholy. (shrink)

Sontag is certainly attracted to the aesthetic she describes but not so wholeheartedly as many readers have assumed.1 One of the ironies of her career has been her reputation as an enthusiast for works toward which she actually expresses considerable ambivalence. Many of her essays include overt advocacy, but it is rarely uncomplicated or uncompromised.2 Despite her reputation for partisanship, she more typically begins her essays by recounting an experience of alienation, annoyance, uncertainty, or shock. For example, she describes the (...) "happening" as an event "designed to tease and abuse the audience"3 and speaks of the "profoundly discouraging," even "hopeless," emotions of her first days in North Vietnam. She is, therefore, often motivated by her sense of difference from the event or object she describes. But it is not her wish merely to find ways of assimilating and dominating unpleasant or alien experience; while that is certainly one of the main impulses in her work - to control apparently impossible subjects, to exhilarate in the Nietzschean will to power over the text - her will to power is always countered by a need to credit and honor the text's otherness. Sontag never finally assumes an easy familiarity with her subject but rather draws its difficult and negating otherness ever closer to herself. Her work may be understood, in a way, as a search for a text that is utterly unknowable, a text that will always elude and contradict what we may say about it, a text, in short, that cannot be contaminated by critical rhetoric. That is a quality she has recently attributed to Artaud's work: "Like Sade and Reich, Artaud is relevant and understandable, a cultural monument, as long as one mainly refers to his ideas without reading much of his work. For anyone who reads Artaud through, he remains fiercely out of reach, an unassimilable voice and presence."4 · 1. There is, to be sure, an atmosphere of iconoclasm and intellectual challenge about Sontag's criticism, but it is not especially self-congratulatory. She is only interested in difficult topics or in topics whose difficulties have been repressed, partly because that context energizes her mind and partly, as she has written of Diane Arbus, because she wants "to violate her own innocence, to undermine her sense of being privileged" · 2. The exception is some of the early reviews included in Against Interpretation, where the polemical requirements of the occasion distinguish those brief judgments from her more careful and extended pieces.· 3. Sontag, Against Interpretation , p. 267.· 4. Sontag, "Artaud," Antonin Artaud: Selected Writings , p. lix. Cary Nelson teaches critical theory at the University of Illinois. He is the author of The Incarnate Word: Literature as Verbal Space and Our Last First Poets: Vision and History in Contemporary American Poetry and Reading Criticism: The Literary Status of Critical Discourse. (shrink)

This paper examines the argument that scientific thinkers who embrace a religious tradition can promote intellectual integration between religion and science rather than fragmented discourse. It is argued that God’s Word as an event and the concept of structural directedness, an organized movement toward a future that does not demand a consciously intended end, may be helpful in understanding God’s actions in an indeterminant way.

In clinical ethics an enduring case takes on a life of its own and comes to closure over a long period of time. This essay describes the evolution of such a case over a 1–year period. The case involves a 90–year old male patient with multiple chronic medical conditions who lacked decision–making capacity, was a resident of a long–term care facility, and did not have known previously expressed wishes regarding medical treatment. The ethics consultation initially revolved around this question: What (...) method or process must be employed so that medical treatment decisions could be ethically reviewed and could include a shared decision–making process for Mr. Smith? This case analysis describes the evolution of this case and argues that the good of the patient must remain paramount throughout an enduring case. (shrink)