Responding to a major pandemic and planning for allocation of scarce resources under crisis standards of care requires coordination and cooperation across federal, state and local governments in tandem with the larger societal infrastructure. Maryland remains one of the few states with no state-endorsed ASR plan, despite having a plan published in 2017 that was informed by public forums across the state. In this article, we review strengths and weaknesses of Maryland’s response to COVID-19 and the role of the Maryland (...) Healthcare Ethics Committee Network in bridging gaps in the state’s response to prepare health care facilities for potential implementation of ASR plans. Identified “lessons learned” include: Deliberative Democracy Provided a Strong Foundation for Maryland’s ASR Framework; Community Consensus is Informative, Not Normative; Hearing Community Voices Has Inherent Value; Lack of Transparency & Political Leadership Gaps Generate a Fragmented Response; Pandemic Politics Requires Diplomacy & Persistence; Strong Leadership is Needed to Avoid Implementing ASR … And to Plan for ASR; An Effective Pandemic Response Requires Coordination and Information-Sharing Beyond the Acute Care Hospital; and The Ability to Correct Course is Crucial: Reconsidering No-visitor Policies. (shrink)

Aim: The aim of this paper is to present the development and evaluation of an art psychotherapy brief treatment method for complex depression for patients referred to mental health services.Background: Art Psychotherapy literature describes a range of processes of relational change through the use of arts focused and relationship focused interventions. Complex depression has a prevalence of 3% of the population in the West and it is recorded that in 2016 only 28% of that population were receiving psychological treatment. This (...) study was developed to test the hypothesis of whether an accessible and acceptable approach to the treatment of complex depression could be developed in relation to existing evidence-based practice within mental health services.Method: The United Kingdom Medical Research Council phased guidance for complex intervention development was used to develop the intervention. The process included producing a literature overview, systematic description of clinical practice, including a logic model and a clinical protocol. The art psychotherapy protocol described an arts-based dynamic interpersonal therapy approach, offered 1:1 over 24 sessions. Further to this the intervention was tested for referrer acceptability. The intervention is in the early stages of evaluation, using changes to the patient's depression and anxiety measured pre- and post-treatment with a follow-up measure at 3 months following completion of treatment.Results: Phase I of the study provided a good basis for developing a logic model and protocol. The authors found that there was good clinical consensus about the use of a structured clinical art psychotherapy method and the literature overview was used to support specific examples of good practice. The verification of clinical coherence was represented by a logic model and clinical protocol for delivering the intervention. The acceptability study demonstrated very high levels of acceptability for referrers reporting that ADIT was acceptable for patients with complex/major depression, that they were likely to refer to ADIT in the future that the use of arts was likely to improve accessibility the use of arts was likely to improve outcomes and that offering ADIT was an effective use of mental health resources.Discussion: Phase I of this intervention development study demonstrated theoretical and practice coherence resulting in a clinical protocol and logic model. Whilst Phase II of this study showed promising results, Phase II would need to be sufficiently scaled up to a full trial to further test the intervention and protocol. (shrink)

The Repugnant Conclusion served an important purpose in catalyzing and inspiring the pioneering stage of population ethics research. We believe, however, that the Repugnant Conclusion now receives too much focus. Avoiding the Repugnant Conclusion should no longer be the central goal driving population ethics research, despite its importance to the fundamental accomplishments of the existing literature.

"These essays make a splendid book. Ignatieff's lectures are engaging and vigorous; they also combine some rather striking ideas with savvy perceptions about actual domestic and international politics.

Research within the H2020 PROGRESSIVE project has identified good practices in user co-production strategies and methodologies. Early findings from research in the PROGRESSIVE project were shared with relevant stakeholders outside the consortium for consultation and review. The outcomes of that initial investigation highlighted the need to focus on the objectives, processes, and methods used in user and older people co-production. This guide adapts these insights and makes them relevant specifically for standardisation in ICT for active and healthy ageing. This guide (...) was approved by representatives of the PROGRESSIVE project on 22 February 2018. The consortium has requested comments from interested stakeholders in an enquiry from 1 March to 30 April 2018. The PROGRESSIVE guide was approved on 5 June 2018. (shrink)

The judgement of human ability is ubiquitous, from school admissions to job performance reviews. The exact make-up of ability traits, however, is often narrowly defined and lacks a comprehensive basis. We attempt to simplify the spectrum of human ability, similar to how five personality traits are widely believed to describe most personalities. Finding such a basis for human ability would be invaluable since neuropsychiatric disease diagnoses and symptom severity are commonly related to such differences in performance. Here, we identified four (...) underlying ability traits within the National Institutes of Health Toolbox normative data (n= 1, 369): (1) Motor-endurance, (2) Emotional processing, (3) Executive and cognitive function, and (4) Social interaction. We used the Human Connectome Project young adult dataset (n= 778) to show that Motor-endurance and Executive and cognitive function were reliably associated with specific brain functional networks (r2= 0.305 ± 0.021), and the biological nature of these ability traits was also shown by calculating their heritability (31 and 49%, respectively) from twin data. (shrink)

Background The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario’s protocols were presented to the public in a democratic deliberation during the summer of 2022. Objectives (1) To explore the perspectives of Quebec and Ontario (...) citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. Methods This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. Results A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value – a less acceptable tiebreaker. Conclusion Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria. (shrink)

This paper is intended to stimulate debate amongst stakeholders in the international research community on the topic of returning individual genetic research results to study participants. Pharmacogenetics and disease genetics studies are becoming increasingly prevalent, leading to a growing body of information on genetic associations for drug responsiveness and disease susceptibility with the potential to improve health care. Much of these data are presently characterized as exploratory (non‐validated or hypothesis‐generating). There is, however, a trend for research participants to be permitted (...) access to their personal data if they so choose. Researchers, sponsors, patient advocacy groups, ethics committees and regulatory authorities are consequently confronting the issue of whether, and how, study participants might receive their individual results. Noted international ethico‐legal guidelines and public policy positions in Europe and the United States are reviewed for background. The authors offer ‘Points‐to‐Consider’ regarding returning research results in the context of drug development trials based on their knowledge and experience. These considerations include: the clinical relevance of data, laboratory qualifications, informed consent procedures, confidentiality of medical information and the competency of persons providing results to participants. The discussion is framed as a benefit‐to‐risk assessment to balance the potential positive versus negative consequences to participants, while maintaining the integrity and feasibility of conducting genetic research studies. (shrink)

Recent incidences of fraud and the growing globalization of business have focused attention on the effect of culture on ethical decision making within organizations. Because fraud can be extremely costly and is more likely to be committed by employees than persons external to the organization, employees willing to report un-ethical acts are an important supplemental control tool. The current study provides evidence of the effects of culture (Canadian and Chinese) and the type of reporting (whistle-blowing and peer reporting) on reporting (...) unethical acts within organizations. Chinese and Canadian participants were asked to respond to scenarios describing unethical acts committed within organizations. Results indicate that Chinese are more likely to report the unethical acts of peers than Canadians. Chinese also appear more likely to report the unethical acts of peers than supervisors. The results also suggest that Graham’s model of principled organizational dissent may not be applicable to Chinese and perhaps other non-Western cultures. (shrink)

How do young children learn how to talk about ethical concepts, such as fairness and equity? The current research assesses the effects of philosophy-based anti-bias lessons aimed at three to five-year-olds in a laboratory preschool and explores the relationship between socioemotional skills, language development, and understanding of ethical concepts. The constructivist curriculum was grounded in storybook lessons with corresponding activities. In a pre-posttest design, we interviewed children before and after lessons in fairness education that included book reading, related games, and (...) philosophical discussions. We found that children showed a significant increase in comprehension of equity-related terms and skin color awareness, and we found a positive relationship between children’s observed levels of community membership skills and their receptive vocabulary. In addition, receptive vocabulary skills predicted participant’s skin color awareness and their ability to tell a fairness narrative involving skin color following the lessons. The current study provides a framework for teachers to integrate ethical reasoning into a preschool curriculum and identifies some abilities occurring earlier than predicted by Jean Piaget. Given the divisive political climate surrounding anti-bias education, we hope that the present study encourages educators to put social emotional learning at the forefront of preschool pedagogy. (shrink)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

Introduction Future HIV vaccine efficacy trials with adolescents will need to ensure that participants comprehend study concepts in order to confer true informed assent. A Hepatitis B vaccine trial with adolescents offers valuable opportunity to test youth understanding of vaccine trial requirements in general. Methods Youth reviewed a simplified assent form with study investigators and then completed a comprehension questionnaire. Once enrolled, all youth were tested for HIV and confirmed to be HIV-negative. Results 123 youth completed the questionnaire (mean age=15 (...) years; 63% male; 70% Hispanic). Overall, only 69 (56%) youth answered all six questions correctly. Conclusions Youth enrolled in a Hepatitis B vaccine trial demonstrated variable comprehension of the study design and various methodological concepts, such as treatment group masking. (shrink)

It has been argued that infants possess a rich, sophisticated theory of mind that is only revealed with tasks based on spontaneous responses. A mature theory of mind implies the understanding that mental states are person-specific. Previous studies on infants’ understanding of motivational mental states such as goals and preferences have revealed that, by 9 months of age, infants do not generalize these motivational mental states across agents. However, it remains to be determined if infants also perceive epistemic states as (...) person-specific. Therefore, the goal of the present study was to use a switch agent paradigm with the classic false belief violation-of-expectation task. Results revealed that 16-month-old infants attributed true and false beliefs to a naïve agent—they did not perceive beliefs as person-specific. These findings indicate that infants’ understanding of beliefs is not as sophisticated as the rich mentalistic view suggests. (shrink)

This book provides practical and research-based chapters that offer greater clarity about the particular kinds of teacher reflection that matter and avoids talking about teacher reflection generically, which implies that all kinds of reflection are of equal value.

Several lines of evidence suggest that children born via Cesarean section are at greater risk for adverse health outcomes including allergies, asthma and obesity. Vaginal seeding is a medical procedure in which infants born by C-section are swabbed immediately after birth with vaginal secretions from the mother. This procedure has been proposed as a way to transfer the mother's vaginal microbiome to the child, thereby restoring the natural exposure that occurs during vaginal birth that is interrupted in the case of (...) babies born via C-section. Preliminary evidence indicates partial restoration of microbes. However, there is insufficient evidence to determine the health benefits of the procedure. Several studies, including trial, are currently underway. At the same time, in the clinic setting, doctors are increasingly being asked to by expectant mothers to have their babies seeded. This article reports on the current research on this procedure and the issues it raises for regulators, researchers, physicians, and patients. (shrink)

The success of fecal microbiota transplantation as a treatment for Clostrioides difficile infection has stirred excitement about the potential for microbiota transplantation as a therapy for a wide range of diseases and conditions. In this article, we discuss vaginal microbiota transplantation as “the next frontier” in microbiota transplantation and identify the medical, regulatory, and ethical challenges related to this nascent field. We further discuss what we anticipate will be the first context for testing VMT in clinical trials, prevention of the (...) recurrence of a condition referred to as bacterial vaginosis. We also compare clinical aspects of VMT with FMT and comment on how VMT may be similar to or different from FMT in ways that may affect research design and regulatory decisions. (shrink)

This study is unique in that it presents the first empirically developed framework for use as a tool for measuring historical empathy. The Historical Empathy Measurement Tool (HEMT) was developed using a design-based research method with three iterative macrocycles of design, experiment, and retrospective analysis. The study involved question responses from 276 students in grade 8 studying WWI trench warfare. The research resulted in a framework of seven levels. (0) Non-response, (1) Facts, (2) Assumptions and Deficits, (3) General Comparison of (...) the Past and Present, (4) Emotional Comparison of the Past and Present, (5) Understanding Motives, Behaviors, Thoughts, & Emotions in the Past, and (6) Acknowledgement of Differences from those in the Past. The inter-rater reliability at the end of macrocycle three was 95%. (shrink)

The current work investigated whether differences in phonological overlap between the past- and present-tense forms of regular and irregular verbs can account for the graded neurophysiological effects of verb regularity observed in past-tense priming designs. Event-related potentials were recorded from 16 healthy participants who performed a lexical-decision task in which past-tense primes immediately preceded present-tense targets. To minimize intra-modal phonological priming effects, cross-modal presentation between auditory primes and visual targets was employed, and results were compared to a companion intra-modal auditory (...) study (Justus, T., Larsen, J., de Mornay Davies, P., Swick, D. (2008). Interpreting dissociations between regular and irregular past-tense morphology: evidence from event-related potentials. Cognitive, Affective, Behavioral Neuroscience, 8, 178–194.). For both regular and irregular verbs, faster response times and reduced N400 components were observed for present-tense forms when primed by the corresponding past-tense forms. Although behavioral facilitation was observed with a pseudopast phonological control condition, neither this condition nor an orthographic-phonological control produced significant N400 priming effects. Instead, these two types of priming were associated with a post-lexical anterior negativity (PLAN). Results are discussed with regard to dual- and single-system theories of inflectional morphology, as well as intra- and cross-modal prelexical priming. (shrink)

A recent target article in the American Journal of Bioethics (AJOB) considered the right of transgender (trans) children to access pubertal suppression (Priest 2019). We were concerned by publicati...

In two experiments, we tested whether fearful facial expressions capture attention in an awareness-independent fashion. In Experiment 1, participants searched for a visible neutral face presented at one of two positions. Prior to the target, a backward-masked and, thus, invisible emotional or neutral face was presented as a cue, either at target position or away from the target position. If negative emotional faces capture attention in a stimulus-driven way, we would have expected a cueing effect: better performance where fearful or (...) disgusted facial cues were presented at target position than away from the target. However, no evidence of capture of attention was found, neither in behavior, nor in event-related lateralizations. In Experiment 2, we went one step further and used fearful faces as visible targets, too. Thereby, we sought to boost awareness-independent capture of attention by fearful faces. However, still, we found no significant attention-capture effect. Our results show that fearful facial expressions do not capture attention in an awareness-independent way. Results are discussed in light of existing theories. (shrink)

Introduction : but is it ethics? -- Alterity : the problem of transcendence -- Singularity : the unrepresentable face -- Responsibility : the infinity of the demand -- Ethics : normativity and norms -- Scarce resources? : Levinas, animals, and the environment -- Failures of recognition and the recognition of failure : Levinas and identity politics.

Based on responses from 1078 human resource (HR) professionals, this study concludes that there is not an ethical crisis in the work place. Seven of 37 situations were rated as serious problems by more than 25% of the respondents. HR reported that their organizations are serious about uncovering and disciplining ethical misconduct, top management has a commitment to ethical business conduct, personal principles are not compromised to conform to company expectations, and performance pressures do not lead to unethical conduct.

This article explores staff work patterns in an Australian residential aged care facility and the implications for high‐quality care. Rarely available minute by minute, time and motion, and ethnographic data demonstrate that nurses and care staff engage in high degrees of multitasking and mental switching between residents. Mental switching occurs up to 18 times per hour (every 3 min); multitasking occurs on average for 37 min/h. Labor process theory is used to examine these outcomes and to explore the concepts of (...) high demand and high commitment as core components of work intensification. These conditions of work result in high levels of cognitive burden and stress on staff in managing the multitasking and mental switching, exacerbated by lack of knowledge about residents associated with labor force casualization. These new interpretations of data in relation to mental and manual labor can contribute to understanding, and, therefore, problem solving, in the aged care sector. (shrink)

Feminism and Deconstruction incisively examines the contemporary relevance of setting these movements beside one another. Diane Elam has written an intelligent and accessible introduction, which explores how feminism and deconstruction have been linked -- as theories and movements, as philosophies and disciplines. Elam's work allows the reader to rethink the political and contemplate the possibility that there is indeed life after identity politics. Feminism and Deconstruction is essential reading for anyone who needs a no-nonsense but stimulating guide through one (...) of the mazes of contemporary theory. (shrink)