Istarted my nursing career as a pediatric nurse working with children and their families at the Children's Hospital National Medical Center in Washington, DC. My first position was a staff nurse on a busy surgical floor called 4 Blue. To some degree, and as I reflect on that time, one is never truly prepared as a newly minted nurse or physician for the realities of becoming a clinician. So it was for me. I initially worked a rotational schedule of two (...) weeks of days and two weeks of nights where textbook pediatric cases became everyday experiences. Caring for the most complex of childhood illnesses included patients with osteosarcoma, Wilms tumor, neuroblastoma, short gut syndrome, biliary... (shrink)

In this engagingly written book, Colin McGinn advances a number of related theses, most prominent among them, that moral philosophy is in need of new methodologies in order to get at neglected questions about moral character. The methodology McGinn urges involves drawing upon literature for its deep and intricate portrayals of ethical themes. This would seem a natural approach given McGinn’s substantive views about ethics. He contends that our ethical knowledge is aesthetically mediated ; he speculates that the “innateness” of (...) ethics may be “a by-product of our innate grasp of folk psychology” which comes into play when we interpret literature; and he defends an “aesthetic theory of virtue” according to which virtue coincides with beauty of soul. (shrink)

Signed utterances are densely packed with pointing signs, reaching a frequency of one in six signs in spontaneous conversations . These pointing signs attain a wide range of functions and are formally highly diversified. Based on corpus analysis of spontaneous pointing signs in Kata Kolok, a rural signing variety of Bali, this paper argues that the full meaning potentials of pointing signs come about through the integration of a varied set of linguistic and extralinguistic cues. Taking this hybrid nature of (...) pointing phenomena into account, it is argued that pointing signs may become an intrinsic aspect of sign language grammars through two mechanisms: morphemization and syntactic integration. Although not entailed in this research, this approach could implicate that some highly systematized pointing systems of speaking communities may to a degree be grammatical as well. (shrink)

In this essay, I focus on what appear to be Shapiro’s views about the normativity of law, as well as with his surprising claim that law necessarily has a moral aim. I argue that even if Shapiro offers a more compelling reply to the problem of the normativity of law than Hart offers in The Concept of Law, the moves that he makes appear to be equally available to a defender of Hart’s theory, and so in this respect, the planning (...) theory has no particular advantage over the practice theory. As for the Moral Aim Thesis, it appears to be in tension with Shapiro’s positivism. If he is right that law has a moral aim and law claims moral legitimacy, then he should embrace a richer account of the nature and normativity of law than the one that he has offered. (shrink)

(2001). Autonomous Learners and the Learning Society: systematic perspectives on the practice of teaching in Higher Education. Educational Philosophy and Theory: Vol. 33, No. 3-4, pp. 381-395.

Introduces tolerance through examples of everyday situations where this character trait can be used"--Provided by publisher.

Adapter molecules in a variety of signal transduction systems link receptors to a limited number of commonly used downstream signaling pathways. During T‐cell development and mature T‐cell effector function, a multichain receptor (the pre‐T‐cell antigen receptor or the T‐cell antigen receptor) activates several protein tyrosine kinases. Receptor and kinase activation is linked to distal signaling pathways (PLC‐γ1 activation, Ca2+ influx, PKC activation and Ras/Erk activation) via the adapter protein LAT (Linker for Activation of T cells). Structure/function studies of LAT including (...) expression of selected LAT point mutations in vivo reveals that these multiple pathways are integrated at the level of the LAT adapter. These studies suggest that similar levels of control may be found in other systems where adapter molecules are known to have important functions. BioEssays 26:61–67, 2004. Published 2003 Wiley Periodicals, Inc. (shrink)

Caring for seriously ill patients and their families during times of extreme stress is a privilege, but it can also bring much sadness and ethical turmoil for everyone involved, particularly at end of life. Patients and their families and the nurses and physicians who care for them are uniquely bonded together as they discuss, discern, and deliberate on some of the most heart-wrenching life and death decisions any patient, parent, family member, or partner can make. Shifting from a curative mode (...) of thinking is never easy, simple, or clear-cut. All of us share hopeful moments with our patients when we see, for example, an unexpected limb movement, a period of lucidity, or short-term physiological stability in... (shrink)

The effects of psycholinguistic variables on reading development are critical to the evaluation of theories about the reading system. Although we know that the development of reading depends on both individual differences (endogenous) and item-level effects (exogenous), developmental research has focused mostly on average-level performance, ignoring individual differences. We investigated how the development of word recognition in Chinese children in both Chinese and English is affected by (a) item-level, exogenous effects (word frequency, radical consistency, and curricular grade level); (b) subject-level, (...) endogenous individual differences (orthographic awareness and phonological awareness); and (c) their interactive effect. We tested native Chinese (Putonghua)-speaking children (n = 763) in grades 1 to 6 with both Chinese character and English word identification (lexical) decision tasks. Our findings show that (a) there were effects of both word frequency and age of acquisition in both Chinese and English, but these item-level effects generally weakened with increasing age; (b) individual differences in phonological and orthographic awareness each contributed to successful performance; and (c) in Chinese, item-level effects were weaker for more proficient readers. We contend that our findings can be explained by theoretical models that incorporate cumulative learning as the basis for development of item-level effects in the reading system. (shrink)

The idea that normativity and agency are importantly connected goes back at least as far as Kant. But it has recently become associated with a view called “constitutivism.” Perhaps the best-known critique of constitutivism appears in David Enoch’s article, “Agency, Shmagency,” which is the focus of this chapter. His critique of my article, “Agency and the Open Question Argument,” is briefly addressed, explaining why, contrary to his claims, I do not therein defend a form of constitutivism. It is then explained (...) why his “shmagency challenge” does not effectively expose the real challenge faced by those who might wish to develop constitutivist theories. Finally, the chapter considers why we should take seriously the idea that normativity and agency are importantly connected, an idea that neither Enoch’s challenge nor the challenge articulated for constitutivism here does anything to defeat. Enoch has not shown that normativity won’t come from what is constitutive of agency. (shrink)

Background The COVID-19 pandemic continues to disrupt every society as SARs-CoV-2 variants surge among the populations. Health care providers are exhausted, becoming ill themselves, and in some instances have died. Indeed, hospitals are struggling to find staff to care for critically ill patients most in need. Previous work has reported on the unending work-related conditions that hospital staff are laboring under and their subsequent mental and physical health strains. Health care providers need support, but it is not clear where that (...) support is to come from. While much research has reported on the COVID-19-related fears of nurses and physicians, fewer studies have focused on supportive features of the hospital work environment and how it may provide relief to front-line health care providers.Purpose This purpose of this study was to explore an often-overlooked resource within hospital systems across the United States—clinical ethicists—and examine their many roles during COVID-19 and the types of ethical issues they addressed with nurses, physicians, administrators, and others.Methods This was a primary analysis of semi-structured, qualitative interviews with 23 clinical ethicists across the United States. The interviews were conducted from November 2020–April 2021 and were audiotaped, transcribed verbatim, and de-identified; both inductive and deductive analyses were used to identify qualitative themes.Results Five major themes were identified: ethical issues that were increasingly more complex, moral distress that was “endemic,” shifting ethical paradigms from the focus on the individual to the population, fostering a supportive environment, and organizational ethics: variation in the value, roles, and policy input of clinical ethicists.Conclusions Our findings report on the integral and expanded role of clinical ethicists at an unprecedented time in our nation, and how they stepped forward to support front-line clinicians in hospitals across the country. (shrink)

Connie Wang ABSTRACT: Accounts of deep disagreements can generally be categorized as optimistic or pessimistic. Pessimistic interpretations insist that the depth of deep disagreements precludes the possibility of rational resolution altogether, while optimistic variations maintain the contrary. Despite both approaches’ respective positions, they nevertheless often, either explicitly or implicitly, agree on the underlying assumption that...

It is no secret that there are problems within hospitals and other healthcare settings across the United States that have been simmering for some time. With the emergence of the deadly SARs-CoV-2 v...

Moral distress is indeed distressing for those who experience it and whose sense of integrity can be shaken by exposure to events or situations that test their core values and ethical belief system...

Proponents of numerous recent theories of a person's good hold that a plausible account of the good for a person must satisfy existence internalism. Yet little direct defense has been given for this position. I argue that the principal intuition behind internalism supports a stronger version of the thesis than it might appear--one that effects a "double link" to motivation. I then identify and develop the main arguments that have been or might be given in support of internalism about a (...) person's good, showing how these arguments support this stronger version of internalism. (shrink)

This essay explores the nature of narrative representations of individual lives and the connection between these narratives and personal good. It poses the challenge of determining how thinking of our lives in story form contributes distinctively to our good in a way not reducible to other value-conferring features of our lives. Because we can meaningfully talk about our lives going well for us at particular moments even if they fail to go well overall or over time, the essay maintains that (...) our good must consist in something more than an accumulation of good discrete moments. Since persons have the capacities to reason, remember, and imagine, our good depends on a larger view of our lives that integrates its particular moments in a narrative. That narrative provides shape and texture to our lives. Storytelling serves to connect the events of our lives to each other, and to explain why the meaning and value of past events or features of our lives can shift as the life, and hence the story of the life, continues to unfold. The essay concludes that narrative enables us to see our lives in ways that support, encourage, or promote our self-concept and self-worth as agents who have controlling authority over our own lives. (shrink)

In a digital era that neglects handwriting, the current study is significant because it examines the mechanisms underlying this process. We recruited 9- to 10-year-old Chinese children, who were at an important period of handwriting development, and adult college students, for both behavioral and electroencephalogram experiments. We designed four learning conditions: handwriting Chinese, viewing Chinese, drawing shapes followed by Chinese recognition, and drawing shapes followed by English recognition. Both behavioral and EEG results showed that HC facilitated visual word recognition compared (...) to VC, and behavioral results showed that HC facilitated visual word recognition compared to drawing shapes. HC and VC resulted in a lateralization of the N170 in adults, but not in children. Taken together, the results of the study suggest benefits of handwriting on the neural processing and behavioral performance in response to Chinese characters. The study results argue for maintaining handwriting practices to promote the perception of visual word forms in the digital age. (shrink)

Book Information Moral Realism: A Defence. Moral Realism:\nA Defence Russ Shafer-Landau , Oxford : Clarendon Press ,\n2003 , x + 322 , {Â}\textsterling35 ( cloth ) By Russ\nShafer-Landau. Clarendon Press. Oxford. Pp. x + 322.\n{Â}\textsterling35 (cloth:).

Volume 20, Issue 6, June 2020, Page 68-70.

Importance Informed consent is essential to ethical, rigorous research and is important to recruitment and retention in cancer trials.Objective To examine cancer clinical trial (CCT) participants’ perceptions of informed consent processes and variations in perceptions by cancer type.Design and Setting and Participants Cross-sectional survey from mixed-methods study at National Cancer Institute–designated Northeast comprehensive cancer center. Open-ended and forced-choice items addressed: (1) enrollment and informed consent experiences and (2) decision-making processes, including risk-benefit assessment. Eligibility: CCT participant with gastro-intestinal or genitourinary, hematologic-lymphatic (...) malignancies, lung cancer, and breast or gynecological cancer (N = 334).Main Outcome Measures Percentages satisfied with consent process and information provided; and assessing participation’s perceptions of risks/benefits. Multivariable logistic or ordinal regression examined differences by cancer type.Results Most patient-participants felt well informed by the consent process (more than 90% overall and by cancer type) and. most (87.4%) reported that the consent form provided all the information they wanted, although nearly half (44.8%) reported that they read the form somewhat carefully or less. More than half (57.9%) said that talking to research staff (i.e., the consent process) had a greater impact on participation decisions than reading the consent form (2.1%). A third (31.1%) were very sure of joining in research studies before the informed consent process (almost half of lung cancer patients did—47.1%). Most patients personally assessed the risks and benefits before consenting. However, trust in physicians played an important role in the decision to enroll in CCT.Conclusions and Relevance Cancer patients rely less on written features of the informed consent process than on information obtained from the research staff and their own physicians. Research should focus on information and communication strategies that support informed consent from referring physicians, researchers, and others to improve patient risk-benefit assessment and decision-making. (shrink)

Who carries the burden of proof in analytic philosophical debates, and how can this burden be satisfied? As it turns out, the answer to this joint question yields a fundamental challenge to the very conduct of metaphysics in analytic philosophy. Empirical research presented in this book indicates that the vastly predominant goal pursued in analytic philosophical dialogues lies not in discovering truths or generating knowledge, but merely in prevailing over one’s opponents. Given this goal, the book examines how most effectively (...) to allocate and discharge the burden of proof. It focuses on premises that must prudently be avoided because a burden of proof on them could never be satisfied, and in particular discusses unsupportable bridge premises across inference barriers, like Hume’s barrier between ‘is’ and ‘ought’, or the barrier between the content of our talk or thought, and the world beyond such content. Employing this content/world barrier for a critical assessment of mainstream analytic philosophical methods, this book argues that we must prudently avoid invoking intuitions or other content of thought or talk in support of claims about the world beyond content, that is, metaphysically significant claims. Yet as content-located evidence is practically indispensable to metaphysical debates throughout analytic philosophy, from ethics to the philosophy of mathematics, this book reaches the startling conclusion that all such metaphysical debates must, prudently, be terminated. (shrink)

Few bioethicists are educated with a view into nursing. Thus, much of the conceptual and empirical research on ethical issues in nursing practice has been conducted by nurse ethicists themselves and, to a lesser degree, by individuals with a strong interest in nursing ethics. Although this work has internally shaped nursing practice, education, and policy, the broader field of bioethics has seldom examined and acknowledged the everyday ethical concerns of practicing nurses and their important contributions to bioethics discourse. In this (...) special report of the Hastings Center Report —the first to focus on nursing—Christine Grady, Ann Hamric, and I, along with consulting editor Nancy Berlinger, strive to give voice to the contributions of nurses in addressing some of our obstinate everyday ethics and health policy challenges. (shrink)

BackgroundAdolescents living with human immunodeficiency virus (HIV) experience challenges, including lack of involvement in their care as well nondisclosure of HIV status, which leads to poor adherence to antiretroviral therapy (ART). Parents have authority over their children, but during adolescence there is an increasing desire for independence. The aim of the study was to explore adolescents’ experience of challenges identified by adolescents ages 10–19 years attending HIV care and treatment at Temeke Regional Referral Hospital in Tanzania. MethodsAn exploratory descriptive qualitative (...) design was employed in the HIV Care and Treatment Centre (CTC) in the Out-Patient Department at the Temeke Regional Referral Hospital in Tanzania with adolescents living with HIV who were 10–19 years of age. A total of 22 adolescents participated in semi-structured face-to-face interviews after parental consent and adolescent assent were obtained. Participants were interviewed about their participation in decisions to be tested for HIV and enrolled in the CTC, concerns surrounding disclosure of their HIV status to the adolescent or to others, stigma and discrimination, and the effect of these challenges on their adherence to medication. All interviews were audio-taped, transcribed verbatim in Swahili, and back-translated to English. Data analysis included both inductive and deductive thematic analysis.ResultsQualitative themes identified included lack of participation in decisions about HIV testing, challenges to enrollment in care and treatment; issues around disclosure of HIV status, such as delays in disclosure to the adolescent and disclosure to other persons and benefits and harms of such disclosures; and factors supporting and interfering with adherence to ART, such as parental support, organizational (clinic) support and problems, and self-stigmatization and shame.ConclusionLack of adolescents’ involvement in their care decision making and delayed disclosure of HIV status to the adolescent were identified concerns, leading to poor adherence to ART among adolescents. Disclosure to others, especially teachers, helped adolescents at school to take their medication properly. Disclosure to others led to stigma and discrimination for some adolescents. More research is needed to better understand the role of disclosure and its benefits and challenges for HIV-positive adolescents in Tanzania. (shrink)

Dialogical egalitarianism is the thesis that any proposition asserted in dialogue, if questioned, must be supported or else retracted. Dialogical foundationalism is the thesis that some propositions are privileged over this burden of proof, standing in no need of support unless and until support for their negation is provided. I first discuss existing arguments for either thesis, dismissing each one of them. Absent a successful principled argument, I then examine which thesis it is pragmatically more advantageous to adopt in analytic (...) philosophical dialogue. This requires identifying the goal of such dialogue, to the attainment of which the thesis would be so advantageous. To identify this goal, I draw on Douglas Walton’s typology of dialogues for an analysis of the types of dialogue of 110 representatively selected journal articles in current analytic philosophy. 95% of articles are found to instantiate persuasion dialogue. In light of the thus prevalent goal of persuading one’s opponent, I argue that the adoption of dialogical egalitarianism in analytic philosophical dialogue is pragmatically inescapable. (shrink)

In our everyday lives, we confront a host of moral issues. Once we have deliberated and formed judgments about what is right or wrong, good or bad, these judgments tend to have a marked hold on us. Although in the end, we do not always behave as we think we ought, our moral judgments typically motivate us, at least to some degree, to act in accordance with them. When philosophers talk about moral motivation, this is the basic phenomenon they seek (...) to understand. Moral motivation is an instance of a more general phenomenon—what we might call normative motivation—for our other normative judgments also typically have some motivating force. When we make the normative judgment that something is good for us, or that we have a reason to act in a particular way, or that a specific course of action is the rational course, we also tend to be moved. Many philosophers have regarded the motivating force of normative judgments as the key feature that marks them as normative, thereby distinguishing them from the many other judgments we make. In contrast to our normative judgments, our mathematical and empirical judgments, for example, seem to have no intrinsic connection to motivation and action. The belief that an antibiotic will cure a specific infection may move an individual to take the antibiotic, if she also believes that she has the infection, and if she either desires to be cured or judges that she ought to treat the infection for her own good. All on its own, however, an empirical belief like this one appears to carry with it no particular motivational impact; a person can judge that an antibiotic will most effectively cure a specific infection without being moved one way or another. (shrink)

Background The field of nursing has long been concerned with ethical issues. The history of the nursing profession has a rich legacy of attention to social justice and to societal questions regarding issues of fairness, access, equity, and equality. Some nurses have found that their clinical experiences spur an interest in ethical patient care, and many are now nurse bioethicists, having pursued additional training in bioethics and related fields (e.g., psychology, sociology). Purpose The authors describe how the clinical and research (...) experiences of nurses give them a unique voice in the field of bioethics. Results Authors present reasons for the relative invisibility of nurse bioethicists, compared with physician, theologian, or philosopher bioethicists, as well as current efforts to increase the visibility of nurse bioethicists. They also describe four specific areas where nurse bioethicists have made and continue to make important contributions: as ethics consultants to colleagues in hospitals and other settings; as bioethics researchers or as advisers to researchers conducting trials with human subjects; as educators of trainees, patients and families, healthcare providers, and the public; and in helping to draft humane and ethical policies for the care of vulnerable patients and underserved populations. Conclusion Nurse bioethicists are central to the future goals of healthcare bringing a unique perspective to the day-to-day ethical challenges of both clinical care and research, as well as to the education of health professionals and the public. (shrink)

Adaptive immunity provides the unique ability to respond to a nearly infinite range of antigenic determinants. Given the inherent plasticity of the adaptive immune system, a series of tolerance mechanisms exist to reduce reactivity toward self. While this reduces the probability of autoimmunity, it also creates an important gap in adaptive immunity: the ability to recognize microbes that look like self. As a variety of microbes decorate themselves in self‐like carbohydrate antigens and tolerance reduces the ability of adaptive immunity to (...) react with self‐like structures, protection against molecular mimicry likely resides within the innate arm of immunity. In this review, we will explore the potential consequences of microbial molecular mimicry, including factors within innate immunity that appear to specifically target microbes expressing self‐like antigens, and therefore provide protection against molecular mimicry. (shrink)

There is a certain measure of perplexity concerning the significance of endopolyploidy. It seems that this results from a narrow frame of reference from which investigators view the phenomenon; that is, a predilection for emphasizing the specialized functional aspect of endopolyploidy as it operates in species at the present time overrides any consideration of the rôle that this state may play in the life of a species in its encounter with the forces of natural selection either in the past or (...) in the future.There does not seem to be any obvious relationship between the degree of endopolyploidy that a species can exhibit and either its basic DNA content or the structure of its nucleus. The significance of endopolyploidy may reside not so much in any specialized function that the condition can support, but rather in the properties that are consequent upon the endopolyploid condition itself and which are distinct from those that apply to diploid cells. Some of the properties of the endopolyploid state, and examples of their manifestation in plants and animals, are discussed. The conclusion is that these properties have a potential that opens possibilities for new paths of development and serves as a factor upon which natural selection can operate. (shrink)