Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients. PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were (...) examined to identify further eligible studies. Forty two articles were identified as eligible. Seventeen used an implicit measure, to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care. The evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics. Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed. (shrink)

Focusing on imagination and the social context in the generation of conviction narratives, we propose that these elements are dynamically related to one another, and crucially that it is the nature of this relationship that determines individuals' level of epistemic openness and capacity to respond adaptively to update their narratives in a way that increases the possibility of more successful decision-making.

This article explores the propensity of Iliadic landscape similes to encourage reflections on human fragility. Landscape in the similes is usually interpreted as a medium which conveys a consistent symbolic value (for example storms as the hostility of nature); however, landscape is often a more flexible medium. By offering close readings of three Iliadic similes (winter torrents at 4.452–6, snowfall at 12.279–89 and clear night at 8.555–9), this article argues that landscape allowed the poet to frame the main narrative in (...) various ways, both helping the listener to imagine described events and interrupting the listener's immersion in the main narrative. While many have analysed how similes offer analogies to the main narrative, the ways in which the same simile can also disrupt and reframe the narrative are less understood. This article observes that shifts in narrative space and time played a key role in changing the perspective of the listener. Taking a broadly phenomenological approach, it proposes that embodied descriptions of space, which recreate the experience of the moving body in landscape, invite the listener to consider the temporal scale of the natural world. By looking at how landscape in select similes shifts the listener's spatial and temporal experience, this article argues that landscape contributes to the wider Iliadic theme of human fragility. In particular, it identifies the potential for landscape similes to minimize the scale of human experience, question the possibility of human agency, and reveal the limitations of human perspectives and knowledge. (shrink)

Multimodal prehabilitation is increasingly recognized as an important component of the pre-operative pathway in oncology. It aims to optimize physical and psychological health through delivery of a series of tailored interventions including exercise, nutrition, and psychological support. At the core of this prescription is a need for considerable health behavior change, to ensure that patients are engaged with and adhere to these interventions and experience the associated benefits. To date the prehabilitation literature has focused on testing the efficacy of devised (...) exercise and nutritional interventions with a primary focus on physiological and mechanistic outcomes with little consideration for the role of behavioral science, supporting individual behavior change or optimizing patient engagement. Changing health behavior is complex and to maximize success, prehabilitation programs should draw on latest insights from the field of behavioral science. Behavioral science offers extensive knowledge on theories and models of health behavior change to further advance intervention effectiveness. Similarly, interventions developed with a person-centered approach, taking into consideration individual needs and preferences will increase engagement. In this article, we will provide an overview of the extent to which the existing prehabilitation literature incorporates behavioral science, as well as studies that have explored patient's attitudes toward prehabilitation. We will go on to describe and critique ongoing trials in a variety of contexts within oncology prehabilitation and discuss how current scientific knowledge may be enhanced from a behavioral science perspective. We will also consider the role of “surgery schools” and detail practical recommendations that can be embedded in existing or emerging clinical settings. (shrink)

Youth is a critical period in the development of maladaptive eating behaviors. Previous systematic reviews suggest the etiological significance of parent-child relationships for the onset of disordered eating in youth, but less is known about the role of parenting styles. This rapid scoping review aimed to identify whether research supports the role of parenting styles in the development of disordered eating symptoms among youths. Sixteen studies, retrieved from three databases, met the inclusion criteria: original studies, published in English, examined the (...) effect of parenting styles on cognitive and behavioral disordered eating outcomes, among young people up to 18 years of age. Studies supported an association between various youth disordered eating symptoms such as unhealthy weight control behaviors, and experiences of adverse parenting styles characterized by high levels of control and low levels of responsiveness. Associations between adverse parenting styles and youth disordered eating were frequently indirect and differed depending on the sex of the parent and offspring. Synthesis of findings was limited due to variation in the operationalization and measurement of parenting styles, family context and disordered eating across studies. Longitudinal and standardized research is required to better understand the dynamic associations between parenting styles and youth disordered eating. Implications for family-based care in clinical practice are discussed. (shrink)

Research that engages the experiences and insights of autistics and their caregivers can be more ethical, less stigmatizing, and innovative. To avoid reproducing established assumptions, researchers should learn how autistics and their caregivers understand behavioral and communicative differences, and how they prioritize interventions and accommodations. Fostering “autistic flourishing” requires that researchers focus on similarities between autistics and neurotypical people while allowing for autistic differences. Consulting autistics helps ensure that their personhood is acknowledged.

Awareness growth—coming to entertain propositions of which one was previously unaware—is a crucial aspect of epistemic thriving. And yet, it is widely believed that orthodox Bayesianism cannot accommodate this phenomenon, since that would require employing supposedly defective catch-all propositions. Orthodox Bayesianism, it is concluded, must be amended. In this paper, I show that this argument fails, and that, on the contrary, the orthodox version of Bayesianism is particularly well-suited to accommodate awareness growth. For it entails what I call the refinement (...) view, which allows us to capture that awareness growth consists in the increase of one’s capacity of discernment. (shrink)

The conception of conscience that dominates discussions in bioethics focuses narrowly on private regulation of behaviour resulting from explicit attitudes. It neglects to mention implicit attitudes and the role of social feedback in becoming aware of one's implicit attitudes. But if conscience is a way of ensuring that a person's behaviour is in line with her moral values, it must be responsive to all aspects of the mind that influence behaviour. There is a wealth of recent psychological work demonstrating the (...) influence of implicit attitudes on behaviour. A necessary part of having a well-functioning conscience must thus be awareness and regulation of one's implicit attitudes in addition to one's explicit attitudes; this cannot be done by an individual in isolation. On my revised conception of conscience, heeding social feedback, being emotionally self-aware and engaging in self-monitoring are important for the possession of a well-functioning conscience. Health professionals may need specific training to help them develop and maintain a well-functioning conscience, which should involve cultivation of awareness of implicit attitudes, emphasis on social feedback and techniques to enable better control over them. (shrink)

In response to two trenchant objections, radical subjective Bayesianism has been widely rejected. In this paper, I seek, if not to rehabilitate subjectivism, at least to show its critic what is attractive about the position. I argue that what is at stake in the subjectivism/anti-subjectivism debate is not, as is commonly thought, which norms of rationality are true, but rather, the conception of rationality that we adopt: there is an alternative approach to the widespread telic approach to rationality, which I (...) call the poric approach, on which subjectivism is an attractive position. I then argue that the poric approach—and therefore subjectivism—cannot be easily dismissed. (shrink)

Background Implicit biases are present in the general population and among professionals in various domains, where they can lead to discrimination. Many interventions are used to reduce implicit bias. However, uncertainties remain as to their effectiveness. -/- Methods We conducted a systematic review by searching ERIC, PUBMED and PSYCHINFO for peer-reviewed studies conducted on adults between May 2005 and April 2015, testing interventions designed to reduce implicit bias, with results measured using the Implicit Association Test (IAT) or sufficiently similar methods. (...) -/- Results 30 articles were identified as eligible. Some techniques, such as engaging with others’ perspective, appear unfruitful, at least in short term implicit bias reduction, while other techniques, such as exposure to counterstereotypical exemplars, are more promising. Robust data is lacking for many of these interventions. -/- Conclusions Caution is thus advised when it comes to programs aiming at reducing biases. This does not weaken the case for implementing widespread structural and institutional changes that are multiply justified. (shrink)

Difficulties with executive function have often been identified in individuals with various neurodevelopmental disorders such as Autism Spectrum Disorder, Attention-Deficit Hyperactivity Disorder, and Developmental Co-ordination Disorder. Additionally, in childhood and adolescence, executive functioning is an important predictor of academic achievement. However, less research has explored these relationships in adult students, and those with a high level of neurodevelopmental disorder traits but no clinical diagnosis. Therefore, the current study aimed to assess whether ASD, ADHD, and DCD traits can predict academic achievement (...) in university students, and whether traits of these neurodevelopmental conditions moderate the relationship between executive function and academic achievement. Both neurotypical students and those with a clinical diagnosis of a neurodevelopmental disorder were able to participate, with the majority being neurotypical. Participants completed four self-report questionnaires and provided a measure of academic achievement based on their university assignment results. Traits of ASD, ADHD, and DCD alone did not predict achievement, however, traits of ADHD and DCD significantly moderated the relationship between executive function and academic achievement. ASD traits did not significantly moderate this relationship. Implications and suggestions for future research are also discussed. (shrink)

Ethical issues arise in the world’s first population-level treatment of severe lead poisoning caused by small-scale mining for gold in rural Nigeria. Emergency medical intervention and environmental cleanup have reduced the mortality in children younger than 5 years from lead poisoning from over 40 to 2.5 per cent leaving little evidence of the harms caused by lead poisoning. In the absence of obvious sequelae, family adherence to long-term intensive therapy to remove accumulated lead reservoirs in children wanes and some community (...) miners challenge safer mining interventions to prevent recontamination of the environment with lead. This letter raises questions regarding community versus individual rights in public health interventions and patient autonomy. (shrink)

Arts and Humanities in Higher Education, Ahead of Print. Despite the growing interest of academia in public outreach, little is known about what university students, among who are future researchers, take away from their academic education in terms of research dissemination opportunities. In this study, we analyzed social science students’ discourses on creative dissemination practices in relation to standardized dissemination practices. Our findings reveal that student’s conceptions of creative research dissemination are diverse and influenced by varying perceptions of knowledge, the (...) public, and creativity. Discourses on CRD are also strongly linked with values such as innovation and impact on society, but the concrete meaning of these values often remains undefined. We propose rethinking the academic context at the educational level so it offers a platform for multimodal formats of research dissemination. This would require encouraging students to take a stance toward how they envision a progressive academic future. (shrink)

Theoretical perspectives on non-suicidal self-injury have long underscored the affective regulating properties of NSSI. Less attention has been given to the processes through which individuals choose to engage in NSSI, specifically, to regulate their distress. In the present study, we tested one theoretical model in which recent stressful experiences facilitates NSSI through emotional reactivity. Further, we tested whether the indirect link between stressful experiences and NSSI was moderated by several NSSI specific risk factors. Given the widespread prevalence of NSSI among (...) community-based samples of adolescents and emerging adults, we surveyed 1,125 emerging adults in first-year university at a large academic institution. Participants completed an online survey three times, reporting on their recent stressful experiences in university, emotional reactivity, NSSI, as well as three NSSI specific risk factors. As expected, path analysis revealed that there was a significant indirect effect of recent stressful experiences on NSSI engagement, through emotional reactivity. However, this effect was maintained across moderator analyses. These novel findings underscore the salient role of proximally occurring stressors in the prediction of NSSI among emerging adults in university, and can inform developing theoretical perspectives on NSSI. (shrink)

Although sexual harassment in the workplace is illegal, it often goes unreported. This study employs causal evidence to evaluate one deterrent to reporting: bias against women known to be sexual harassment targets. I theorize about the form this bias takes and test the argument with a national survey experiment run in five waves from October 2017 to February 2018, where participants were asked to propose employment outcomes for an employee with one of four harassment experiences. Participants were less likely to (...) recommend a woman for promotion if she self-reported sexual harassment relative to otherwise identical women who experienced nonsexual harassment or whose sexual harassment was reported by a coworker. The woman who self-reported sexual harassment experienced normative discrimination: that is, the promotion bias was significantly mediated by perceptions that she was less moral, warm, and socially skilled than the woman whose coworker reported her sexual harassment. These results indicate that women may hesitate to report sexual harassment because they rightly perceive that doing so could cause them to experience bias. Yet they also suggest that bias can be avoided if a bystander reports the harassment. Finally, exploratory analyses suggest that in the wake of #MeToo this bias may be fading. (shrink)

The fractious but potentially fruitful dialogue between legal history and legal theory has been the subject of much recent scholarly attention. Despite this, instances of meaningful engagement over the role of history in legal theorising remain scarce. This is particularly true in respect of normative theorising—the difficult but crucial tasks of critiquing and reforming law—where history is frequently considered to play a relativising role that threatens to destabilise strong evaluation. In this article, I argue that in order to advance the (...) dialogue it is essential to look beyond disciplinary differences and instead focus on the divide between immanence and transcendence, which arises within and also between legal history and legal theory. Reorienting our attention in this way discloses important sources of dissonance but also points towards significant opportunities for cooperation; it is therefore an essential first step in the pursuit of meaningful dialogue, either critical or collaborative. (shrink)

L’anticipation est généralement conçue comme un phénomène qui, d’un point de vue temporel et logique, est antérieur à une action ou une situation donnée. Dans cet article, nous proposons d’interroger cette conception en nous intéressant en détail à ce que l’anticipation fait à l’action qu’elle anticipe. En détail c’est-à-dire, très littéralement, en observant dans des situations d’interactions ordinaires les effets que peut produire le fait d’anticiper une action. En l’occurrence, dans des situations d’apprentissage entre hommes et chiens comme celles que (...) nous examinons, anticiper une action en l’évaluant avant qu’elle n’ait eu lieu contribue en grande part à la configurer. Cette avancée nous conduit à développer une vision proprement pragmatiste de l’action, conçue comme un procès façonné de manière émergente et collaborative par l’ensemble des participants qui l’accomplissent. (shrink)

Katie Steele and H. Orri Stefánsson argue that, to reflect an agent’s limited awareness, the algebra of propositions on which that agent’s credences are defined should be relativised to their awareness state. I argue that this produces insurmountable difficulties. But the project of relativising the agent’s algebra to reflect their partial perspective need not be abandoned: the algebra can be relativised, not to the agent’s awareness state, but to what we might call their subjective modality.

Drawing on the work of Foucault and Western confessional writings, this book challenges the transhistorical and commonsense views of confession as an innate impulse resulting in the psychological liberation of the confessing subject. Instead, confessional desire is argued to be contingent and constraining, and alternatives to confessional subjectivity are explored.

An overview of the philosophical and bioethics literature on conscientious refusals by health care professionals to provide abortion and contraceptive services.

This paper begins with a recognition that questions of climate change, environmental degradation, and our relations to the natural world are increasingly significant and requiring of a response not only as philosophers of education but also as citizens of the planet. As such the paper explores five of the key journals in philosophy of education in order to identify the extent, range, and content of current discussions related to the environment. It then organizes and summaries the articles that were located (...) while seeking to identify the extent, possibilities, and limitations of current discussions relating to the environment in the philosophy of education community. The hope is that ultimately this work is an invitation to anyone, regardless of tradition, orientation, and expertise, to contribute to the expansion and deepening of both theory and practice in the face of this most serious of challenges. (shrink)

This commentary argues the case for developmental psychopathology in understanding social learning. Informed by work on “epistemic disruption,” we have described difficulties with social learning associated with many forms of psychopathology. Epistemic disruption manifests in an inability to move between innovation and conformity, and arises from poor mentalizing, which generates difficulties in identifying social cues that trigger the correct stance.

There has long been interest in why languages are shaped the way they are, and in the relationship between sign language and gesture. In sign languages, entity classifiers are handshapes that encode how objects move, how they are located relative to one another, and how multiple objects of the same type are distributed in space. Previous studies have shown that hearing adults who are asked to use only manual gestures to describe how objects move in space will use gestures that (...) bear some similarities to classifiers. We investigated how accurately hearing adults, who had been learning British Sign Language for 1–3 years, produce and comprehend classifiers in locative and distributive constructions. In a production task, learners of BSL knew that they could use their hands to represent objects, but they had difficulty choosing the same, conventionalized, handshapes as native signers. They were, however, highly accurate at encoding location and orientation information. Learners therefore show the same pattern found in sign-naïve gesturers. In contrast, handshape, orientation, and location were comprehended with equal accuracy, and testing a group of sign-naïve adults showed that they too were able to understand classifiers with higher than chance accuracy. We conclude that adult learners of BSL bring their visuo-spatial knowledge and gestural abilities to the tasks of understanding and producing constructions that contain entity classifiers. We speculate that investigating the time course of adult sign language acquisition might shed light on how gesture became conventionalized during the genesis of sign languages. (shrink)

Bioethics scholarship considering the possibility of gestating an embryo to full term in an artificial womb (ectogenesis) often overstates the capacities of current technologies and underestimates the barriers to the development of full ectogenesis. Moreover, this debate causes harm by (1) neglecting more immediate problems in the development of artificial wombs, (2) treating abortion as a “problem with a technological solution,” bolstering anti-abortion rhetoric, and (3) presuming the stability of women’s reproductive rights. The ectogenesis conversation must consider anticipated uses of (...) the technology (neonatal intensive care) and acknowledge the immediate context (recognizing abortion as essential healthcare and existing reproductive inequities). (shrink)

The system of free expression John Milton defends in Areopagitica, a pamphlet against prior restraint in publishing, is often characterized as merely a proto-liberal, truth-based marketplace of ideas theory. But this represents a misunderstanding of Milton’s views on the freedoms of conscience, speech, and the press. The tendency in political theory, philosophy, and law to reduce the “free speech Milton” to Areopagitica, and the reduction of that essay to several soundbites, has meant sidelining both the significant exceptions to expressive liberties (...) that Milton calls for and also the role of the social in his theory. This incomplete characterization has enabled Milton’s misuse in First Amendment discourse and jurisprudence, where he is made to support hierarchical approaches to free speech that privilege public political speech and are therefore ill-equipped to address the full range of communicative experiences. More comprehensive readings of Milton, however, reveal both certain limits to free expression, and also deep consideration for a wide range of speech acts. By reading Milton’s theory of expressive liberties in light of the justifications he provides for those freedoms—i.e., virtue-building and Truth-seeking—this essay provides a fuller account of his views. What emerges is a distinctly Miltonian, virtue-driven “political theory of everyday talk” that locates value in even the most ordinary communicative acts. This theory—embracing both verbal and nonverbal expression—not only complements existing political theories of the everyday but can also help illuminate contemporary free speech concerns, many of which stem from the libertarian approach to expressive liberties that Milton (inadvertently) helped inspire. (shrink)

Qu'elle soit entendue comme état de désordre social ou qu'elle soit pensée comme ordre social sans Etat, l'anarchie reste difficilement appréhendée par les juristes autrement que par l'exclusion. Droit et anarchie seraient incompatibles, car le droit impliquerait nécessairement l'autorité (dont l'Etat moderne constitue la forme ultime, par la monopolisation du pouvoir de contrainte) que l'anarchie supprime. Aussi, l'étude de l'anarchie n'aurait plus grand chose à révéler au juriste, et sa marginalisation intellectuelle ne devrait pas surprendre. Pourtant, est-il vraiment satisfaisant de (...) cantonner la question de l'anarchie à l'histoire des idées politiques, alors que l'enjeu du débat touche les fondements mêmes de l'ordre juridique? C'est cette question complexe des rapports entre le droit et l'anarchie que cet ouvrage - qui regroupe les actes d'une journée d'étude organisée par l'Institut d'études de droit public de la faculté jean Monnet de l'Université Paris Sud - se propose d'investir à nouveau. (shrink)

While many periods of history are popularly known by their 'great men',the Enlightenment stands out for the prominence of its 'great groups'. This volume assemblesleading scholars using data-driven scholarship to study the networks that madethe Enlightenment possible, and contributed to creating a new sense of Europeanidentity. From Voltaire's correspondence with Catherine the Great, to AdamSmith's travels on the European continent, mediated and unmediatedcommunication networks were the lifeline of the Enlightenment. What is particularly notable about theEnlightenment is how these different networks (...) were central to theirparticipants' identity. One could nottake part in the Enlightenment on one's own. Although some older historical studies highlightthe importance of social networks in the Enlightenment, data-driven approachesallow for a more comprehensive and granular understanding of the many differenttypes of networks that formed the intellectual and cultural infrastructure ofthe Enlightenment throughout Europe. The recent influx of metadata from thecorrespondences of major Enlightenment figures now allows scholars to studythese networks at both the micro and macro levels, and to explore the worlds ofthe philosophes and the "nodes" intheir networks in rich detail. It is at this intersection of Enlightenmenthistoriography, data capture, and social network analysis that the essayscollected in this volume all fall, taking advantage of new data sources,configurations, and modes of analysis to deepen our understanding of howEnlightenment sociability worked, who it included, and what it meant forparticipants. (shrink)