When skeletal dysplasias are suspected in the prenatal period, investigation, counseling, and management become especially challenging. By better understanding the complex forces at play and parental values, prenatal health care providers may improve the ways in which they counsel patients to improve the decision-making process under conditions of significant uncertainty, including in cases of prenatally suspected skeletal dysplasia.

Sustainable development (SD) has contested meanings, and perspectives vary within and across societies. Emphases can range dramatically from recycling advocacy to eradication of poverty. Assumptions and approaches to sustainable development inherently contain many ethical considerations, yet U.S. students often have a limited understanding of ethical considerations in non-Western and global contexts. This paper describes an academic program on sustainable development we ran to Morocco and Spain. We describe the program’s pedagogy and assess learning related to ethics. The largest impact on (...) students’ awareness of ethics resulted from their observations and experiences with socioeconomic inequities and unequal access to infrastructure. However, without explicitly teaching ethical frameworks to sustainability students, they tend to equate sustainability with morality, imputing their own normative presuppositions of right versus wrong onto the concept of sustainable development. Therefore, we conclude with a discussion on how ethics could be more systematically integrated into education for sustainable development abroad. (shrink)

Firearm violence in the United States produces over 36,000 deaths and 74,000 sustained firearm-related injuries yearly. The paper describes the burden of firearm violence with emphasis on the disproportionate burden on children, racial/ethnic minorities, women and the healthcare system. Second, this paper identifies factors that could mitigate the burden of firearm violence by applying a blend of key ethical theories to support population level interventions and recommendations that may restrict individual rights. Such recommendations can further support targeted research to inform (...) and implement interventions, policies and laws related to firearm access and use, in order to significantly reduce the burden of firearm violence on individuals, health care systems, vulnerable populations and society-at-large. By incorporating a blended public health ethics to address firearm violence, we propose a balance between societal obligations and individual rights and privileges. (shrink)

This multi-faceted collection of women's perspectives on the renaissance in philosophical practices provides an international overview on the professional practice of philosophical counseling as rooted in the ancient philosophical discipline of life and its essential difference from modern mainstream philosophy.

For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (73/80) (...) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress. (shrink)

Two aspects of mothering—using drugs during pregnancy and giving up the rearing of one's children—are the focus of this analysis of 58 addicted Chicana mothers who spent their adolescent years in barrio gangs. From a traditional stance, such women were doubly deviant, since they violated gender-role prescriptions by joining a barrio gang and by becoming involved in heroin and street life. Half of these women added to this deviance by using heroin during pregnancy, and 40 percent relinquished at least one (...) of their children. This article explores what distinguishes these classically “bad mothers” from addicts who maintain some degree of conventionality in their mothering. We found that Mexican gender-role traditionalism is not the only influence on these women. Many came from cholo or underclass families with a tradition of street involvement. In addition, their involvement in gang and heroin worlds may influence their behavior as mothers. We found that women who used drugs during pregnancy were more likely than abstainers to be cholas and to reject traditional gender-role values. However, those who gave up their children were more likely than those who kept their children to be from traditional families. We discuss the implications of these findings for research on deviance and the underclass among Hispanic women. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Wonder, Imagination, and the Matter of Theatre in The TempestMary MooreAriel occurs. Recounting his performance of "the tempest" in Act I, scene 1 of The Tempest, he presents himself as being and action, fracturing grammar, spatial and temporal logic in ways that amaze and confound:I boarded the King's ship; now on the beak, Now in the waist, the deck, in every cabin, I flamed amazement. Sometime I'd divide, And (...) burn in many places; on the topmast, The yards, and bowsprit would I flame distinctly, Then meet and join...(1.2.195–201) 1"I flamed" means that Ariel emits or is flames, which in the normal order of things would consume him. His very narration, however, proves his survival, evoking wonder through the utterance itself. Forceful and compacted syntax, a recognized source of wonder in Classical and Renaissance accounts of style (Biester, pp. 14; 35–40), magnifies this effect. 2 Shakespeare's transitive use of the usually intransitive verb flame reflects a not uncommon practice, as E. A. Abbott shows; 3 but this syntactic device also reflects The Tempest's own logic. Ariel crosses boundaries between [End Page 496] deed and being, verb and noun, subject and object, matter and spirit: he both is and does flames. What could be more jarring to syntax and semantics than a singular subject whose utterance claims that he can flame, divide, meet and join? Just as "a" fire consists of many flames yet functions grammatically as a singular substance in English, just as the Christian Trinity is both singular and multiple, Ariel burns in many places at once. Meanwhile, this extraordinary language seems belied by the actor's very embodiment. Ariel cannot have done what he claims; yet the prior scene has represented the very storm in which Ariel flamed. In that sense, the actor's embodiment represents what we imagine to be matter's intractability, while Ariel's claims, coupled with the storm we have just witnessed, reveal matter's fluidity and permeability to imagination. Fluidity and intractability co-exist, another source of wonder. Sound mimics these paradoxes: the assonance and consonance in flame and amazement create a near rhyme that echoes the near identity of fire and human amazement. If, as Gurr and Ichikawa observe, a Renaissance audience expected to hear more than see a play, this echo calls attention to Ariel's marvelous powers. 4 Lest the noises and pleasures of the Renaissance theatre, which recent scholarship deems to be considerable, distract audience members from this bit of language, similar moments reinforce Ariel's play in and with language and matter throughout the play. Marvelous poetic language is of a piece with a "fever" that is of "the mind," with music that "creeps," actors who vanish, new found goddesses who speak the discoverers' own language.Amazement provides our cue: it and its cognates name the appropriate response to Ariel, his language, and to The Tempest itself. Attention to Ariel's poetic language reveals that it, like the plot, conforms to the marvels of the play and to the period's well documented love for marvels in several ways. Wonder, an aesthetic "'object of desire'" in itself, and a response to the inexplicable in classical and early modern views, may be evoked by the unexpected in style (and through other strategies that the era's handbooks taught). 5 The clause "I flamed amazement" epitomizes the unexpected in syntax as well as differing from one of the few sources found for The Tempest, William Strachey's 1610 letter, which describes just such a storm. 6 While St. Elmo's fire itself may elicit wonder, Shakespeare's syntax and diction reinforce that marvel. And no wonder: rhetoric and theatre alike depend upon audience attention, and wonders naturally evoke it. Jarring language also harmonizes with The Tempest's structural marvels—loose ends, disrupted actions, unforeseen futures—issues several critics explore. 7 [End Page 497]The wonders of The Tempest, however, also involve imagination—in early modern psychology, the human faculty that permits perception of the world and invention of images. 8 Wonder responds to how the perceived differs from the expected, how the imagined supplants the usual, how an... (shrink)

On July 18, 1988, workers at the Metropolitan YWCA Women's Services, a Chicago-area center designed to assist women and children who are survivors of violence and sexual assault, agreed to record in a journal their thoughts at a chosen hour during that day. Each section was written by a different worker. The purpose was to bring together separate voices, all connected through their common work with survivors to begin to understand the impact of this work on their own lives.

Ή νέα αὐτή μελέτη δέχεται τήν ταύτιση τοῦ θέματος μέ τήν κρίση τοῦ Πάρι καί προτείνει τήν παρακάτω ἀποκατάσταση γιά τά τμήματα πού λείπουν : πάνω στό σφηνόλιθο, ἀνάμεσα στούς λίθους Ρ καί Q, ὐπῆρχε ἕνα φοινικόδεντρο · πάνω στή χαμένη τρίτη πλάκα, ὑπῆρχε δεύτερο φοινικόδεντρο, ὁ Πάρις καθισμένος σέ βράχο, κατόπιν ἡ Ἥρα πού ἀνεβαίνει στό ἀρμα καί κλείνοντας τή σύνθεση, ἕνας ὑπηρέτης γιά τό ζευγάρι τῶν ζώων. Ή νέα ἀποκατάσταση δείχνει σέ τί βαθμό ό σχεδιαστής φρόντισε νά ἐνσωματώσει (...) τή σύνθεση του μέ τά ἀρχιτεκτονικά μέλη τῆς πρόσοψης. (shrink)

The Association for Core Texts and Courses asserts its commitment to coming together and speaking about the scientific, the political, and the artistic to live together in an enlightened fashion. ACTC's Tenth Annual Conference re-affirmed and re-examined the value of serious reading and discussion focused through core texts.

There is a national movement supporting the retention and use of bio-specimens from deceased individuals for the purpose of genetic testing. This manuscript discusses the significance of postmortem genetic testing in the context of death determination by medical examiners. We highlight distinctive concerns that are raised in the areas of consent, confidentiality, and return of results when genetic testing is performed as part of a public molecular autopsy. We believe our manuscript will contribute to the development of a robust ethical (...) and legal framework for genetic testing in this context. (shrink)

The human being as a constituted objectivity is a fragile ‘figure’ who lives in through their individual and shared experience. As a constituted objectivity, it influences our experiences, actions and the constitution of our community. Nevertheless, it appears to us, who actually constitute it, as a completely independent and immutable object, as a mere fact our experience has to comply with, and as a normative representation of the human being. This paper inquires - from a phenomenological point of view - (...) about the structure that underlies the norm at work in our experience, as well as in the high- and low-level dimensions of the intersubjective community. Indirectly, such a structure can be identified through the connection between Husserl’s understanding of normality and objectivity. My claim is that normativity can be understood as a necessary function and thus can be distinguished from objectivity and normality. Normativity appears, therefore, as a function of objectivity, which allows one to distinguish the latter from normality. As such, normativity should not be confused with an active agreement or regulation, but rather identified as a necessary constitutive structure arising from experiential intersubjective sense-borrowing performance. At the same time, due to its connection to objectivity, normativity also appears to strongly influence the social production of validity, therefore being endorsed by institutions. (shrink)

This anthology of articles provides contemporary international feminist perspectives on issues of identity, agency, and difference as they pertain to both feminist politics in particular, and contemporary western politics more generally.

Improving how health care providers respond to medical injury requires an understanding of patients’ experiences. Although many injured patients strongly desire to be heard, research rarely involves them. Institutional review boards worry about harming participants by asking them to revisit traumatic events, and hospital staff worry about provoking lawsuits. Institutions’ reluctance to approve this type of research has slowed progress toward responses to injuries that are better able to meet patients’ needs. In 2015–2016, we were able to surmount these challenges (...) and interview 92 injured patients and families in the USA and New Zealand. This article explores whether the ethical and medico‐legal concerns are, in fact, well‐founded. Consistent with research about trauma‐research‐related distress, our participants’ accounts indicate that the pervasive fears about retraumatization are unfounded. Our experience also suggests that because being heard is an important (but often unmet) need for injured patients, talking provides psychological benefits and may decrease rather than increase the impetus to sue. Our article makes recommendations to institutional review boards and researchers. The benefits to responsibly conducted research with injured patients outweigh the risks to participants and institutions. (shrink)

The recent death of Peter McHugh becomes an occasion for the remembrance and recollection of the distinctive form of reflexive or analytic social inquiry, which framed his work and that of his longtime friend and collaborator, Alan Blum. Following dual appointments at York University, Toronto, Canada in 1972, Blum and McHugh’s partnership formed the basis for a community of scholars and students throughout the 1970s, 1980s, and 1990s. A brief review of McHugh and Blum’s works shows theoretical roots in social (...) constructivism and a deep appreciation of the linguistic turn, which in turn lead to the development of a form of social analysis that meets the stringent requirements of a reflexive sociology by repudiating any claim to a privileged exemption of theoretical speech (practice) from the hermeneutical circle of speech and language. Blum and McHugh are shown to embrace and not to evade the hermeneutical circle by a form of social inquiry that subverts the inherent possibilities available within speech and social convention to make available an encounter with the (moral) authority or form of life for that self-same speech. With each example of everyday life or conventional usage, McHugh (and Blum) move from theorizing which formulates the complexity of a particular instance of social interaction through its rules, to the question of the form of life that make that particular instance of the rules possible. It is the pursuit of transparency between speech and its roots in language that informed and continues to inform the distinctive style of social theory fostered at York-Toronto under the orchestration of McHugh and Blum. (shrink)

How should clinical ethicists be trained? Scholars have stated that clinical ethics fellowships create well-trained, competent ethicists. While this appears intuitive, few features of fellowship programs have been publicly discussed, let alone debated. In this paper, we examine how fellowships can foster effective mentoring relationships. These relationships provide the foundation for the fellow’s transition from novice to competent professional. In this essay, we begin by discussing our pedagogical commitments. Next, we describe the structures our program has created to assist our (...) fellows in becoming competent ethicists. We then outline the kinds of knowledge, skills, and professional attributes mentors should possess. Following this, we focus on the knowledge, skills, and professional attributes that fellows develop as they co-create effective mentoring relationships. We will not prescribe a single approach to fellowship training; instead, our perspective will, we hope, become a catalyst for further conversation on training and mentoring clinical ethics fellows. (shrink)

Research FocusThe promotion of domain-specific knowledge is a central goal of higher education and, in the field of medicine, it is particularly essential to promote global health. Domain-specific knowledge on its own is not exhaustive; confidence regarding the factual truth of this knowledge content is also required. An increase in both knowledge and confidence is considered a necessary prerequisite for making professional decisions in the clinical context. Especially the knowledge of human physiology is fundamental and simultaneously critical to medical decision-making. (...) However, numerous studies have shown difficulties in understanding and misconceptions in this area of knowledge. Therefore, we investigate how preclinical medical students acquire knowledge in physiology over the course of their studies and simultaneously gain confidence in the correctness of this knowledge as well as the interrelations between these variables, and how they affect the development of domain-specific knowledge.MethodIn a pre–post study, 169 medical students’ development of physiology knowledge and their confidence related to this knowledge were assessed via paper-pencil questionnaires before and after attending physiology seminars for one semester. Data from a longitudinal sample of n = 97 students were analyzed using mean comparisons, regression analyses, and latent class analyses. In addition, four types of item responses were formed based on confidence and correctness in the knowledge test.ResultsWe found a significant and large increase in the students’ physiology knowledge, with task-related confidence being the strongest predictor. Moreover, a significantly higher level of confidence at t2 was confirmed, with the level of prior confidence being a strong predictor. Furthermore, based on the students’ development of knowledge and confidence levels between measurement points, three empirically distinct groups were distinguished: knowledge gainers, confidence gainers, and overall gainers. The students whose confidence in incorrect knowledge increased constituted one particularly striking group. Therefore, the training of both knowledge and the ability to critically reflect on one’s knowledge and skills as well as an assessment of their development in education is required, especially in professions such as medicine, where knowledge-based decisions made with confidence are of vital importance. (shrink)

ObjectiveApproximately half of all people living with amyotrophic lateral sclerosis experience persistent or recurrent emotional distress, yet little is known about the psychological processes that maintain emotional distress in this population. The self-regulatory executive functioning model specifies that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. This study explored whether maladaptive metacognitive beliefs are associated with emotional distress after controlling for demographic factors, time since diagnosis, and current level of physical functioning.DesignIn a cross-sectional (...) design, 75 adults with a diagnosis of ALS completed self-report questionnaires. Participants had a mean age of 60.40 years, mean duration of symptoms 63.92 months, and male:female gender ratio of 14:11.Main Outcome MeasuresQuestionnaires assessed emotional distress, physical functioning, repetitive negative thinking, metacognitive beliefs, and demographic factors.ResultsMaladaptive metacognitive beliefs explained additional variance in emotional distress after controlling for age, gender, time since diagnosis, physical functioning, and repetitive negative thinking. Repetitive negative thinking partially mediated the relationships between positive and negative metacognitive beliefs and emotional distress.ConclusionsThese data support the utility of the metacognitive model in understanding emotional distress in people with ALS. Examination of the temporal relationship between maladaptive metacognitive beliefs and emotional distress in people living with ALS may help to guide the development of therapeutic approaches. (shrink)

This chronological collection of Moore's most compelling and dramatic images, taken as the movement progressed through Alabama, Mississippi, Tennessee, and Georgia, highlights activity from 1958 to 1965. Included are the iconic scenes of black protestors huddled in a doorway to escape the crippling blasts of fire hoses in Birmingham; a white bigot swinging a baseball bat seconds before cracking it on the head of a black woman during the desegregation of the Capitol Cafeteria in Montgomery; a young and stunned (...) Dr. Martin Luther King Jr. pinned to the counter of a police precinct, his arm twisted behind his back; the devastating aftermath of "Bloody Sunday" on the Edmund Pettus Bridge in Selma; and Bull Connor's police dogs tearing mercilessly at the legs of a protestor in downtown Birmingham. Celebrity protestors--comedian Dick Gregory, poet Galway Kinnell, singers Joan Baez, Mary Travers, Pete Seeger, and Harry Bellafonte, actor Pernell Roberts, and writer James Baldwin--are featured alongside the many nameless but committed participants and the recognized major leaders of the movement. (shrink)

This paper summarizes (in German) recent tendencies in the philosophy of the life sciences.

Summary The addition of ‘fire’ to the European battle repertoire resulted in the close-order drill for manoeuvres of the line. Begun in late sixteenth-century Netherlands and perfected in eighteenth-century Prussia under Frederick the Great, the drill's precision marching evolved into a military science which conceived what infantry acquired through rigorous training as a lawful ‘second nature’ of men. In contrast, the liberal Webers' 1836 locomotion research orientation was, as was that of French skirmishing, one of natural self-regulation. Later Prussian military (...) science, restored in Imperial Germany, was merged into locomotion science. (shrink)