Glucagon-like peptide-1 receptor agonists are effective for treating obesity, but the high cost of these medications endangers the financial viability of our health care system. To ensure that these drugs are available to Medicare beneficiaries, pharmaceutical manufacturers must lower their prices.

This paper addresses the explanatory role of the concept of a motive for action in economics. The aim of the paper is to show the difficulty economists have to accommodate the motive of commitment into their explanatory and predictive framework, i.e. rational choice theory. One difficulty is that the economists’ explanation becomes analytic when assuming preferences of commitment. Another difficulty is that it is highly doubtful whether commitment can be represented by current frameworks while (pre-)serving the ‘folk-psychological’ idea of what (...) is commonly understood by the idea of a commitment. Both difficulties lead to the conclusion that, although motives do matter, conceptualizing the motive of commitment would cause trouble for rational choice theory. (shrink)

Background: The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought. Objectives: This study explored nurses’ care practices at the end (...) of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity. Research Design and context: Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated. Ethical Considerations: Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals. Findings: A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting. Discussion: Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members. Conclusion: Despite the avoidance of death talk and nurses’ lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values. (shrink)

For many decades, access to human biological samples, such as cells, tissues, organs, blood, and sub-cellular materials such as DNA, for use in biomedical research, has been central in understanding the nature and transmission of diseases across the globe. However, the limitations of current ethical and regulatory frameworks in sub-Saharan Africa to govern the collection, export, storage and reuse of these samples have resulted in inconsistencies in practice and a number of ethical concerns for sample donors, researchers and research ethics (...) committees. This paper examines stakeholders’ perspectives of and responses to the ethical issues arising from these research practices. (shrink)

The aim of this article is to explore the images of nursing that were presented in the media during the recent industrial action by nurses and midwives in the Republic of Ireland. Although both nurses and midwives took industrial strike action, the strike was referred to as ‘the nurses’ strike’ and both nurses and midwives were generally referred to by the generic term ‘nurses’. Data were gathered from the printed news media of The Irish Times over a period of one (...) month - 4 October to 4 November 1999 - which included the nine days of the strike. Although we limited the source of our data to just one newspaper, the findings do provide an image of how nurses and nursing care are viewed by both health professionals and the public. This image appeared to give a higher value to masculine cultural codes and the performance of technical skills, whereas acts associated with feminine cultural codes of caring were considered of lower value. (shrink)

Motor development – traditionally studied in WEIRD populations – falls victim to assumptions of universality similar to other domains described by Henrich et al. However, cross-cultural research illustrates the extraordinary diversity that is normal in motor skill acquisition. Indeed, motor development provides an important domain for evaluating cultural challenges to a general behavioral science.

In this commentary on Osiurak and Reynaud's target article, we argue that action is largely missing in their account of the ascendance of human technological culture. We propose that an action-based developmental account can help to bridge the cognitive-sociocultural divide in explanations of the discovery, production, and cultural transmission of human tool use.

Artificial intelligence systems advising healthcare professionals will be widely introduced into healthcare settings within the next 5–10 years. This paper considers how this will sit with tort/negligence based legal approaches to compensation for medical error. It argues that the introduction of AI systems will provide an additional argument pointing towards no-fault compensation as the better legal solution to compensation for medical error in modern health care systems. The paper falls into four parts. The first part rehearses the main arguments for (...) and against no-fault compensation. The second explains why it is likely that AI systems will be widely introduced. The third part analyses why it is difficult to fit AI systems into fault-based compensation systems while the final part suggests how no-fault compensation could provide a possible solution to such challenges. (shrink)

Faculty plagiarism and fraud are widely documented occurrences but little analysis has been conducted. This article addresses the question of why faculty plagiarism and fraud occurs and suggests approaches on how to develop an environment where faculty misconduct is socially inappropriate. The authors review relevant literature, primarily in business ethics and student cheating, developing action steps that could be applied to higher education. Based upon research in these areas, the authors posit some actions that would be appropriate in higher education (...) and suggest topics for continued study. (shrink)

Despite the burgeoning literature on professionalism in other health professions, psychology lags behind in the level of attention given to this core competency. In this article, we review definitions from other health professions and how they address professionalism. Next, we review how this competency evolved within health service psychology (HSP), and we propose a definition. We offer an approach for assessing professionalism within HSP. Consideration is given to strategies and methods for providing effective education and training in this multifaceted competency. (...) Finally, recommendations are made for creating a culture of professionalism within HSP and honoring psychology’s social contract with multiple publics. (shrink)

The 21st Century Cures Act is a major act of legislation that contains numerous changes to drug and device regulation. The House of Representatives passed the Act after considerable interest group lobbying, but the bill and the key changes made during its drafting remain controversial. Using publicly disclosed records of written comments on the bill, we reviewed the key areas of lobbying activity and the compromises made in the final text. We focused on legislative provisions relating to management of the (...) National Institutes of Health, incentives for medical product development, and approval standards for new drugs and devices. By the end of the first comment period, the Committee received 118 comments. Most respondents were patient organizations, professional societies, and pharmaceutical and device companies. Overall, the majority of public comments were positive, although public health and consumer organizations were underrepresented in the number of submitted comments. As the legislative process continued, the draft bill underwent several changes relating to NIH funding, market exclusivity provisions, and scrutiny of regulatory evidentiary standards. Understanding the key statutory provisions and how they have evolved could help patients, researchers, and advocates make more informed comments on the bill and future health care legislation. (shrink)

Director compensation can potentially represent an ethical minefield. When faced with supporting strategic decisions that can lead to an increase in director pay, directors may consider their own interests and not solely those of the shareholders to whom they are legally bound to represent. In such cases, directors essentially become agents, rather than those installed to protect principals (shareholders) from agents. Using acquisitions as a study context, we employ a matched-pair design and find a statistically significant difference in outside director (...) compensation between acquiring and control firms. Outside directors of acquiring firms earn more than twice as much as their counterparts in the matched-sample. (shrink)

Five studies examined the extent to which autobiographical memory retrieval is hierarchical, whether a hierarchical search depends on central executive resources, and whether retrieving memories that are “higher” in the hierarchy impairs problem‐solving ability. The first study found that random generation (assessed using a button‐pressing task) was sensitive to changes in memory load (digit span). The second study showed that when participants fail to retrieve a target event, they respond with a memory that is higher up the hierarchy. The third (...) study showed that memory is more generic only when participants use low imageable cues under cognitive load. The final two experiments showed that experimental manipulation of memory specificity affects problem solving (MEPS performance). The data are consistent with Conway and Pleydell‐Pearce's hierarchical retrieval model of autobiographical memory, and suggest that overgeneral memory in nonclinical participants is associated with reduced executive capacity only when retrieval is “top‐down” (generative). (shrink)

The rapidly changing field of genetics affects society through advances in health-care and through implications of genetic research. This study addresses the impacts of new genetic discoveries and technologies on different segments of today's society. The book begins with a chapter on genetic complexity, and subsequent chapters discuss moral and ethical questions arising from today's genetics from the perspectives of health care professionals, the media, the general public, special interest groups and commercial interests.

Severe staffing shortages have emerged as a prominent threat to maintaining usual standards of care during the COVID-2019 pandemic. In dire settings of crisis capacity, healthcare systems assume the ethical duty to maximise aggregate population-level benefit of existing resources. To this end, existing plans for rationing mechanical ventilators and intensive care unit beds in crisis capacity focus on selecting individual patients who are most likely to survive and prioritising these patients to receive scarce resources. However, staffing capacity is conceptually different (...) from availability of these types of discrete resources, and the existing strategy of identifying and prioritising patients with the best prognosis cannot be readily adapted to fit this real-world scenario. We propose that two alternative approaches to staffing resource allocation offer a better conceptual fit: (1)prioritise the worst off: restrict access to acute care services and hospital admission for patients at relatively low clinical risk and (2)prioritise staff interventions with high near-term value: universally restrict selected interventions and treatments that require substantial staff time and/or energy but offer minimal near-term patient benefit. These strategies—while potentially resulting in care that deviates from usual standards–support the goal of maximising the aggregate benefit of scarce resources in crisis capacity settings triggered by staffing shortages. This ethical framework offers a foundation to support institutional leaders in developing operationalisable crisis capacity policies that promote fairness and support healthcare workers. (shrink)

Ohad Nachtomy restates the main points of “Plenitude and Compossibility” with admirable fidelity and economy. His proposed revisions, based on the distinction between incomplete and complete substances and on the mind-relativity of relations, are intriguing additions to his earlier paper in Studia Leibnitiana and deserve careful consideration. Some brief remarks on the context of the problem, will, I hope, help to set the stage for the assessment of our various views.

Michael A. Petersa and Fazal Rizvib aBeijing Normal University, Beijing, PR China; bMelbourne University, Melbourne, Australia Our minds are still racing back and forth, longing for a return to ‘no...

ABSTRACT This article proposes rhetorical hegemony as a new materialist intervention into the production of alternative political economic futures. It problematizes contemporary theories of hegemony that assert affect as beyond rhetorical engagement, suggesting that these accounts fail to produce viable political economic alternatives because they use, but do not reinvent, the prevailing affective relations. Turning to and extending Foucault's middle and late work to forge a different model, the article discusses rhetorical hegemony as the entangled relationships between materiality and power. (...) In conversation with other contemporary theories, it argues for a practice of rhetorical hegemony that materially recapacitates energetic potential and, consequently, the milieu. The article ends by outlining the rhetorical, political, and intellectual implications of this shift. (shrink)

This study of the metaphysics of G. W. Leibniz gives a clear picture of his philosophical development within the general scheme of seventeenth-century natural philosophy. Catherine Wilson examines the shifts in Leibniz's thinking as he confronted the major philosophical problems of his era. Beginning with his interest in artificial languages and calculi for proof and discovery, the author proceeds to an examination of Leibniz's early theories of matter and motion, to the phenomenalistic turn in his theory of substance and (...) his subsequent de-emphasis of logical determinism, and finally to his doctrines of harmony and optimization. Specific attention is given to Leibniz's understanding of Descartes and his successors, Malebranche and Spinoza, and the English philosophers Newton, Cudworth, and Locke. Wilson analyzes Leibniz's complex response to the new mechanical philosophy, his discontent with the foundations on which it rested, and his return to the past to locate the resources for reconstructing it. She argues that the continuum-problem is the key to an understanding not only of Leibniz's monadology but also of his views on the substantiality of the self and the impossibility of external causal influence. A final chapter considers the problem of Leibniz-reception in the post-Kantian era, and the difficulty of coming to terms with a metaphysics that is not only philosophically "critical" but, at the same time, "compensatory.". (shrink)

We examined the course of caregiver motherese and the course of the infant’s response based on home movies from two single cases: a boy with typical development and a boy with autistic development. We first blindly assessed infant CG interaction using the Observer computer-based coding procedure, then analyzed speech CG production using a computerized algorithm. Finally we fused the two procedures and filtered for co-occurrence. In this exploratory study we found that the course of CG parentese differed based on gender (...) and child status. The course of an infant’s response to CG vocalization differed according to the type of speech and child status. Mothers spent more time interacting with infants, and fathers appeared to interact with their child preferentially between 12 and 18 months in the TD boy, but not in the AD boy. The TD boy responded equally well to motherese compared to other speech after 1 year of age. For the AD boy, the responses to both types of speech were lower than in the boy with TD and decreased from the second to the third semester. Keywords: Autism; motherese; early interaction; computational methods. (shrink)

BackgroundThe proper and ethical inclusion of PWLHIV and their young children in research is paramount to ensure valid evidence is generated to optimize treatment and care. Little empirical data exists to inform ethical considerations deemed most critical to these populations. Our study aimed to systematically review the empiric literature regarding ethical considerations for research participation of PWLHIV and their young children.MethodsWe conducted this systematic review in partnership with a medical librarian. A search strategy was designed and performed within the following (...) electronic databases: Ovid MEDLINE, Embase and CINAHL. We screened titles and abstracts using the following inclusion criteria: (1) a study population of PWLHIV or children under 5 years of age; and (2) collection of qualitative or quantitative data regarding ethics of research participation. Excluded were reviews, commentaries, policy statements, clinical care-related ethics concerns, abstracts, case studies, or studies unrelated to HIV research. Studies were appraised for quality, data were extracted, and studies were qualitatively analyzed using a principle-based ethical framework within the Belmont Report.ResultsOf the 7470 titles identified, 538 full-text articles were reviewed for eligibility and only three articles met full criteria for inclusion within this review. While we allowed for inclusion of studies involving young children born to mothers with HIV, only articles focused on PWLHIV were identified. Within the results of these studies, four themes emerged: (1) adequacy of informed consent; (2) consideration of paternal involvement; (3) balancing risks; and (4) access to research and treatment. A strength of this review is that it included perspectives of international research investigators, community leaders, and male partners. However, only two studies collected empiric data from PWLHIV regarding their experiences participating in researchConclusionResearchers and funding agencies should be aware of these considerations and appreciate the value of and critical need for formative research to ensure clinical trials involving PWLHIV promote ethical, well-informed research participation and, ultimately, improve care outcomes. More research is needed to create a comprehensive ethical framework for researchers when conducting studies with PWLHIV. (shrink)

This paper addresses three factors that have contributed to shifts in decision making in health care. First, the notion of patient autonomy, which has changed due to the rise of patient-centred approaches in contemporary health care and the re-conceptualization of the physician-patient relationship. Second, the understanding of patient autonomy has broadened to better engage patient participation. Third, the need to develop cross-cultural health care ethics. Our paper shows that the shift in the West from the individual to the relational self (...) indicates an important change in the understanding of autonomy through the lens of culture. Practices that recognize the notion of the relational self allow for a more balanced view of autonomy and a richer conception of moral agency. (shrink)

The goal of this article is attempting to establish a research tradition of Chinese relationalism on the methodological grounds of constructive realism. Two of Ho’s key concepts, person-in-relations and persons-in-relation, are carefully examined and reinterpreted. Three of my theoretical models, namely, my Face and Favor model , Confucian ethics for ordinary people , and a conflict resolution model , are conceived of as microworlds for illustrating an account of person-in relations in Chinese culture. The manifestation of Confucian ethics for ordinary (...) people in one’s lifeworld results in the phenomenology of persons-in-relations as depicted by Fei’s differential order or Hsu’s psychosociogram. Applying constructive realism to my models and using the result as a framework for studying Chinese social behavior constitutes Chinese relationalism. (shrink)

BackgroundBiobanks are considered to be key infrastructures for research development and have generated a lot of debate about their ethical, legal and social implications. While the focus has been on human genomic research, rapid advances in human microbiome research further complicate the debate.DiscussionWe draw on two cystic fibrosis biobanks in Toronto, Canada, to illustrate our points. The biobanks have been established to facilitate sample and data sharing for research into the link between disease progression and microbial dynamics in the lungs (...) of pediatric and adult patients. We begin by providing an overview of some of the ELSI associated with human microbiome research, particularly on the implications for the broader society. We then discuss ethical considerations regarding the identifiability of samples biobanked for human microbiome research, and examine the issue of return of results and incidental findings. We argue that, for the purposes of research ethics oversight, human microbiome research samples should be treated with the same privacy considerations as human tissues samples. We also suggest that returning individual microbiome-related findings could provide a powerful clinical tool for care management, but highlight the need for a more grounded understanding of contextual factors that may be unique to human microbiome research.ConclusionsWe revisit the ELSI of biobanking and consider the impact that human microbiome research might have. Our discussion focuses on identifiability of human microbiome research samples, and return of research results and incidental findings for clinical management. (shrink)

Firearm injuries are a significant public health problem. Prior studies have analyzed firearm death data or adult firearm injury data, but few studies have analyzed firearm injury data specifically among youth. To inform the current debate surrounding gun policy in the United States, this study aims to provide an estimate of the immense burden of youth firearm injury and its associated risk factors. Therefore, we performed a descriptive analysis of the Nationwide Emergency Department Sample, the largest all-payer emergency department database (...) in the United States, from January 2006 to September 2015. All patients age < 21 who presented with any diagnosis of firearm-related injuries were included. There were an estimated 198,839 incidents of firearm-related emergency department visits for patients age < 21 from 2006 through 2015. After presenting to the ED, an estimated 11,909 cases resulted in death. The population adjusted rate of firearm-related emergency department visits was highest in the South and Midwest. This study demonstrates the significant burden of firearm injury among youth. Having a reliable estimate of the number of children harmed by firearms each year is a critical tool for policymakers — and may make common-sense gun safety measures more politically possible. (shrink)

This review considers Semantic Syntax and Slavic Transformational Syntax particularly in the light of their contributions to the theory of grammar. Semantic Syntax is shown to have a polemical bias against the Aspects model and toward generative semantics. Its editor's position in the constellation of semantic logicians is defined; pro-Chomskian objections to the logical-cognitive semantic theory are advanced. Slavic Transformational Syntax is comprised of essays with a wide range of theoretical stances; the insights of the radical case grammar of James (...) Miller are compared with those of Semantic Syntax. Remarks on deixis by Richard Brecht are discussed in relationship to semantic-logic approaches. Certain similarities of Jakobsonian functionalism and generative semantics are discussed. (shrink)

The home learning environment includes what parents do to stimulate children’s literacy and numeracy skills at home and their overall beliefs and attitudes about children’s learning. The home literacy and numeracy environments are two of the most widely discussed aspects of the home learning environment, and past studies have identified how socioeconomic status and parents’ own abilities and interest in these domains also play a part in shaping children’s learning experiences. However, these studies are mostly from the West, and there (...) has been little focus on the situation of homes in Asia, which captures a large geographical area and a wide diversity of social, ethnic, and linguistic groups. Therefore, this paper aims to review extant studies on the home literacy and numeracy environments that have been conducted in different parts of Asia, such as China, the Philippines, India, Iran, Turkey, and the United Arab Emirates. Specifically, we explore how parents in these places perceive their roles in children’s early literacy and numeracy development, the methods they regard as effective for promoting young children’s literacy and numeracy learning, and the frequency with which they engage their young children in different types of home literacy and numeracy activities. We also examine studies on the relationship of the home literacy and numeracy environment with young children’s developmental outcomes, and the effectiveness of parent training programs to improve the home literacy and numeracy environments in these contexts. By examining potential trends in findings obtained in different geographical areas, we can initially determine whether there are characteristics that are potentially unique to contexts in Asia. We propose future research directions that acknowledge the role of cultural values and social factors in shaping the home learning environment, and, by extension, in facilitating children’s early literacy and numeracy development. (shrink)

Exercer le métier d’assistant(e) maternel(le) dans le cadre spécifique d’une crèche familiale préventive à gestion associative requiert, outre des compétences « techniques » avérées, une disponibilité et un « savoir-être » bien particuliers, sur lesquels repose une large part de la qualité du service personnalisé rendu aux familles qui s’y adressent. L’ensemble de ces aptitudes se manifeste aux niveaux certes de l’accueil des enfants, mais aussi des relations intenses et complexes établies avec les parents et de l’organisation, nécessairement très minutieuse, (...) du travail en équipe. Il importe aujourd’hui de consolider et de diffuser les expériences acquises dans ce contexte par les assistant(e)s maternel(le)s de façon à en enrichir les pratiques déployées dans le champ de l’action socio-éducative et des politiques familiales. (shrink)

Machiavelli is popularly known as a teacher of tyrants, a key proponent of the unscrupulous “Machiavellian” politics laid down in his landmark political treatise The Prince. Others cite the Discourses on Livy to argue that Machiavelli is actually a passionate advocate of republican politics who saw the need for occasional harsh measures to maintain political order. Which best characterizes the teachings of the prolific Italian philosopher? With Machiavelli’s Politics, Catherine H. Zuckert turns this question on its head with a (...) major reinterpretation of Machiavelli’s prose works that reveals a surprisingly cohesive view of politics. Starting with Machiavelli’s two major political works, Zuckert persuasively shows that the moral revolution Machiavelli sets out in The Prince lays the foundation for the new form of democratic republic he proposes in the Discourses. Distrusting ambitious politicians to serve the public interest of their own accord, Machiavelli sought to persuade them in The Prince that the best way to achieve their own ambitions was to secure the desires and ambitions of their subjects and fellow citizens. In the Discourses, he then describes the types of laws and institutions that would balance the conflict between the two in a way that would secure the liberty of most, if not all. In the second half of her book, Zuckert places selected later works—La Mandragola, The Art of War, The Life of Castruccio Castracani, Clizia, and Florentine Histories—under scrutiny, showing how Machiavelli further developed certain aspects of his thought in these works. In The Art of War, for example, he explains more concretely how and to what extent the principles of organization he advanced in The Prince and the Discourses ought to be applied in modern circumstances. Because human beings act primarily on passions, Machiavelli attempts to show readers what those passions are and how they can be guided to have productive rather than destructive results. A stunning and ambitious analysis, Machiavelli’s Politics brilliantly shows how many conflicting perspectives do inform Machiavelli’s teachings, but that one needs to consider all of his works in order to understand how they cohere into a unified political view. This is a magisterial work that cannot be ignored if a comprehensive understanding of the philosopher is to be obtained. (shrink)

The concept of mutual aid is central to the anarchist tradition, but also a source of controversy. This book’s intervention is to consider solidarity and mutual aid at the intersection of politics and biology, developing out of the work of Catherine Malabou.