Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Ins...

Volume 20, Issue 7, July 2020, Page 112-114.

The health system is, in particular ways, a microcosm of society and both reflects and contributes to its ills of racism, inequities, and disparities. As such, the house of medicine is obligated to...

Although ethics is increasingly integrated in the curriculum of U.S. medical schools, it remains not well integrated with system issues, and social and structural contexts of illness. Moreover, ethical analysis is not often taught as a clinical skill. To address these issues, an outcomes driven course in Social Sciences, Humanities, Ethics and Professionalism (SHEP) was created. Within the course, a web-based concept mapping device, SHEP Case Analysis Tool (SCAT), was created which schematizes the structure and flow of clinical cases from (...) diagnosis to treatment options, to shared decision making to outcome, and includes key stakeholders, influences, and structural features of the health system. In the course, each student analyzes a case in which they were directly involved using SCAT and presents their analysis to faculty and peers. This exercise 1) reinforces knowledge-based portions of the course pedagogy, 2) supports meta-cognition and critical thinking through concept mapping, 3) applies multidimensional analysis to identify ethical, social, and system issues that impact patient-care. 4) develops problem solving skills, 5) counters the hidden curriculum/support professional identity formation, and 6) develops skills in reflective discourse. This paper outlines the development and use of this concept mapping case analysis tool in an undergraduate medical education curriculum. (shrink)

Individuals differ greatly in their ability to learn and navigate through environments. One potential source of this variation is “directional sense” or the ability to identify, maintain, and compare allocentric headings. Allocentric headings are facing directions that are fixed to the external environment, such as cardinal directions. Measures of the ability to identify and compare allocentric headings, using photographs of familiar environments, have shown significant individual and strategy differences; however, the neural basis of these differences is unclear. Forty-five college students, (...) who were highly familiar with a campus environment and ranged in self-reported sense-of-direction, underwent fMRI scans while they completed the Relative Heading task, in which they had to indicate the direction of a series of photographs of recognizable campus buildings (i.e., “target headings”) with respect to initial “orienting headings”. Large individual differences were found in accuracy and correct decision latencies, with gender, self-reported sense-of-direction, and familiarity with campus buildings all predicting task performance. Using linear mixed models, the directional relationships between headings and the experiment location also impacted performance. Structural scans revealed that lateral orbitofrontal and superior parietal volume were related to task accuracy and decision latency, respectively. Bilateral hippocampus and right presubiculum volume were related to self-reported sense-of-direction. Meanwhile, functional results revealed clusters within the superior parietal lobule, supramarginal gyrus, superior frontal gyrus, lateral orbitofrontal cortex, and caudate among others in which the intensity of activation matched the linear magnitude of the difference between the orienting and target headings. While the retrosplenial cortex and hippocampus have previously been implicated in the coding of allocentric headings, this work revealed that comparing those headings additionally involved frontal and parietal regions. These results provide insights into the neural bases of the variation within human orientation abilities, and ultimately, human navigation. (shrink)

In 1988, the control of the American Psychological Association shifted to those advocating the interests of professional practice and a substantial segment of the scientific community in psychology seceded to form the American Psychological Society, devoted to scientific psychology and scientific-based practice. In this climate, it has become increasingly difficult for scientists and practitioners to maintain analytical discussions of the philosophical and methodological issues that divide these two groups. For over 25 years, the authors have been fortunate to have the (...) professional and intellectual luxury of just such a discussion, and present here a dialogue that attempts to capture their initial stark differences in perspective and the process by which differences have been clarified, and areas of agreement established. 2012 APA, all rights reserved). (shrink)

Arithmetic optimization algorithm (AOA) is one of the recently proposed population-based metaheuristic algorithms. The algorithmic design concept of the AOA is based on the distributive behavior of arithmetic operators, namely, multiplication (M), division (D), subtraction (S), and addition (A). Being a new metaheuristic algorithm, the need for a performance evaluation of AOA is significant to the global optimization research community and specifically to nature-inspired metaheuristic enthusiasts. This article aims to evaluate the influence of the algorithm control parameters, namely, population size (...) and the number of iterations, on the performance of the newly proposed AOA. In addition, we also investigated and validated the influence of different initialization schemes available in the literature on the performance of the AOA. Experiments were conducted using different initialization scenarios and the first is where the population size is large and the number of iterations is low. The second scenario is when the number of iterations is high, and the population size is small. Finally, when the population size and the number of iterations are similar. The numerical results from the conducted experiments showed that AOA is sensitive to the population size and requires a large population size for optimal performance. Afterward, we initialized AOA with six initialization schemes, and their performances were tested on the classical functions and the functions defined in the CEC 2020 suite. The results were presented, and their implications were discussed. Our results showed that the performance of AOA could be influenced when the solution is initialized with schemes other than default random numbers. The Beta distribution outperformed the random number distribution in all cases for both the classical and CEC 2020 functions. The performance of uniform distribution, Rayleigh distribution, Latin hypercube sampling, and Sobol low discrepancy sequence are relatively competitive with the Random number. On the basis of our experiments’ results, we recommend that a solution size of 6,000, the number of iterations of 100, and initializing the solutions with Beta distribution will lead to AOA performing optimally for scenarios considered in our experiments. (shrink)

We use a result due to Rolin, Speissegger, and Wilkie to show that definable sets in certain o-minimal structures admit definable parameterizations by mild maps. We then use this parameterization to prove a result on the density of rational points on curves defined by restricted Pfaffian functions.

What effect does witnessing other students cheat have on one's own cheating behavior? What roles do moral attitudes and neutralizing attitudes (justifications for behavior) play when deciding to cheat? The present research proposes a model of academic dishonesty which takes into account each of these variables. Findings from experimental (vignette) and survey methods determined that seeing others cheat increases cheating behavior by causing students to judge the behavior less morally reprehensible, not by making rationalization easier. Witnessing cheating also has unique (...) effects, controlling for other variables. (shrink)

Conservation can occur anywhere regardless of scale, political jurisdiction, or landownership. We present a framework to help managers at protected areas practice conservation at the scale of relationships. We focus on relationships between stakeholders and protected areas and between managers and other stakeholders. We provide a synthesis of key natural resources literature and present a case example to support our premise and recommendations. The purpose is 4-fold: 1) discuss challenges and threats to conservation and protected areas; 2) outline a relationship-scale (...) approach to address conservation threats; 3) describe the tools and techniques that can be used to implement this approach; and 4) present a case example from rural Alaska, USA, to illustrate relationship-scale conservation. Our case example illustrates how aspects of this approach to conservation were applied to address a wildlife population decline. Tools needed to implement relationship-scale conservation include 1) collecting and documenting narratives of place; 2) measuring and monitoring trust and commitment; and 3) identifying and mitigating threats. We recommend that planners and managers, working with their research partners, redefine and refocus their goals and objectives to include these practices. Doing so will enable them to gain substantial applied knowledge about their stakeholders and foster and maintain place relationships as desired outcomes of conservation. The ultimate outcome is a better prognosis for long-term global survival of protected areas and biodiversity. Published 2014. This article is a U.S. Government work and is in the public domain in the USA. (shrink)

This Element is a philosophical history of Social Darwinism. It begins by discussing the meaning of the term, moving then to its origins, paying particular attention to whether it is Charles Darwin or Herbert Spencer who is the true father of the idea. It gives an exposition of early thinking on the subject, covering Darwin and Spencer themselves and then on to Social Darwinism as found in American thought, with special emphasis on Andrew Carnegie, and Germany with special emphasis on (...) Friedrich von Bernhardi. Attention is also paid to outliers, notably the Englishman Alfred Russel Wallace, the Russian Peter Kropotkin, and the German Friedrich Nietzsche. From here we move into the twentieth century looking at Adolf Hitler - hardly a regular Social Darwinian given he did not believe in evolution - and in the Anglophone world, Julian Huxley and Edward O. Wilson, who reflected the concerns of their society. (shrink)

The use of growth attenuation therapy (GAT) is becoming more common in order to enable a family to care for a child with profound cognitive and physical disabilities (PCPD) as they age into adulthood. The first published study on the use of GAT was done with the family of a six-year-old girl with PCPD by Daniel Gunther and Douglas Diekema in Pediatrics in 2006. The ethical application of GAT generated considerable discussion on the use among children with PCPD in the (...) medical and ethics communities. This paper discusses the use of GAT for children with profound cognitive and physical disabilities from a Catholic bioethics perspective. (shrink)

A central idea in moral and political philosophy, 'autonomy' is generally understood as some form of self-governance or self-direction. Certain Stoics, modern philosophers such as Spinoza, and most importantly, Immanuel Kant, are among the great philosophers who have offered important insights on the concept. Some theorists analyze autonomy in terms of the self being moved by its higher-order desires. Others argue that autonomy must be understood in terms of acting from reason or from a sense of moral duty independent of (...) the passions. Autonomy seems closely related to the notion of freedom, but in what sense: freedom from coercion, freedom from psychological constraints, or freedom from material necessity? Various approaches to these and similar questions yield different implications for public policy. Is capitalism, social democracy or socialism more favorable to autonomy? The essays in this volume address these important questions. (shrink)

Background Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses’ experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. Research aim To analyze frontline U.S. nurses’ experiences of ethics during the COVID-19 pandemic. Research design Qualitative analysis using a directed content (...) methodology. Participants and research context The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. Ethical considerations Participant privacy and data confidentiality were addressed. Findings Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. Discussion This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. Conclusions Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available. (shrink)

Two experiments investigated the role that mental set plays in reading aloud using the task choice procedure developed by Besner and Care [Besner, D., & Care, S. . A paradigm for exploring what the mind does while deciding what it should do. Canadian Journal of Experimental Psychology, 57, 311–320]. Subjects were presented with a word, and asked to either read it aloud or decide whether it appeared in upper/lower case. Task information, in the form of a brief auditory cue, appeared (...) 750 ms before the word, or at the same time as the word. Experiment 1 yielded evidence consistent with the claim that at least some pre-lexical processing can be carried out in parallel with decoding the task cue . Experiment 2 provided evidence that such processing is restricted to pre-lexical levels . These data suggest that a task set is a necessary preliminary to lexical processing when reading aloud. (shrink)

These essays assess market liberal or libertarian political theory. They provide insights into the limits of government, develop market-oriented solutions to pressing social problems, and explore some defects in traditional libertarian theory and practice. Some of the essays deal with crucial theoretical issues, asking whether the promotion of citizens' welfare can serve as the justification for the establishment of government, or inquiring into the constraints on individual behavior that exist in a liberal social order. Some essays explore market liberal or (...) libertarian positions on specific public policy issues, such as affirmative action, ownership of the airwaves, the provision of healthcare, or the regulation of food and drugs. Other essays look at property rights, the morality of profit-making, or the provision of public goods. Still others address libertarianism as a political movement, suggesting ways in which libertarians can reach out to those who do not share their views. (shrink)

The Securities and Exchange Commission requires publicly held US corporations to disclose all information, whether it is positive or negative, that might be relevant to an investor's decision to buy, sell, or hold a company's securities. The decisions made by corporate managers to disclose such information can significantly affect the judgments and decisions of investors. This paper examines academic accounting research on corporate managers' voluntary disclosures of earnings forecasts and non-GAAP earnings measures. Much of the evidence from this research indicates (...) that some managers engage in opportunistic disclosure behavior that often benefits one group (managers and shareholders) at the expense of other groups (often other investors). The paper concludes by discussing the ethical implications of this behavior. (shrink)

There are two kinds of time bias: near bias and future bias. While philosophers typically hold that near bias is rationally impermissible, many hold that future bias is rationally permissible. Call this normative hybridism. According to arbitrariness objections, certain patterns of preference are rationally impermissible because they are arbitrary. While arbitrariness objections have been leveled against both near bias and future bias, the kind of arbitrariness in question has been different. In this article we investigate whether there are forms of (...) arbitrariness that are common to both kinds of preferences and, hence, whether there are versions of the arbitrariness objection that are objections to both near bias and future bias. If there are, then this might go some way toward undermining normative hybridism and to defending thoroughgoing time-neutralism. (shrink)

Deception is a useful methodological device for studying attitudes and behavior, but deceptive studies fail to fulfill the informed consent requirements in the U.S. federal regulations. This means that before they can be approved by Institutional Review Boards, they must satisfy the four regulatory conditions for a waiver or alteration of these requirements. To illustrate our interpretation, we apply the conditions to a recent study that used deception to show that subjects judged the same wine as more enjoyable when they (...) believed it had a higher price. (shrink)

Technological innovations and social developments have led to dramatic changes in the practice of medicine and in the way that scientists conduct medical research. Change has brought beneficial consequences, yet these gains have come at a cost, for many modern medical practices raise troubling ethical questions: Should life be sustained mechanically when the brain's functions have ceased? Should potential parents be permitted to manipulate the genetic characteristics of their embryos? Should society ration medical care to control costs? Should fetal stem (...) cells be experimented upon in an effort to eventually palliate or cure debilitating diseases? Bioethicists analyze and assess moral dilemmas raised by medical research and innovative treatments; they also counsel healthcare practitioners, patients, and their families. In this anthology, fifteen philosophers, social scientists, and academic lawyers assess various aspects of this field. (shrink)

The notion of obligation of what an agent owes to himself, to others, or to society generally occupies a central place in morality. But what are the sources of our moral obligations and what are their limits? To what extent do obligations vary in their stringency and severity, and does it make sense to talk about imperfect obligations, that is, obligations that leave the individual with a broad range of freedom to determine how and when to fulfil them? The twelve (...) essays in this volume address these and other questions and explore related issues. Some of them discuss broad theoretical questions, some essays look at moral reasons for action. Others discuss specific moral obligations or the tensions that may exist between our obligations and our other concerns. (shrink)

The essays in this volume discuss a range of questions relating to virtue ethics - a form of moral theory that has gained considerable attention in recent years. These questions include: what traits ought to be considered virtues? What is the proper place of virtue in a complete moral theory? Is it true, as the ancients thought, that there is a 'unity of virtue', so that having one virtue entails having all the others? What is the nature of vice or (...) wickedness? Some of the essays in this volume explore the connection between virtue and flourishing or well-being, asking whether virtue is necessary or sufficient for leading a happy life. Some deal with specific virtues, such as pride or respect, or with the relationship between the virtues and emotions. Taken together, these essays offer valuable insights into the nature of virtue and its role in moral theory. (shrink)

In this essay, we explore a fresh avenue into mind-body dualism by considering a seemingly distant question posed by Frege: "Why is it absurd to suppose that Julius Caesar is a number?". The essay falls into three main parts. In the first, through an exploration of Frege’s Julius Caesar problem, we attempt to expose two maxims applicable to the mind-body problem. In the second part, we draw on those maxims in arguing that “full blown dualism” is preferable to more modest, (...) property-theoretic, versions. Finally, in the third part we close by suggesting that full blown dualism need not be spooky, resurrecting a broadly Lockean, rather than Cartesian, metaphysical picture. (shrink)

Short-term performance increases that are sometimes observed after CEO successions may be evidence of self-interested behavior. New CEOs may cut allocations to long-term investment areas such as research and development (R&D), capital equipment and pension funds in an effort to drive up short-term profits and secure their positions. However, such actions have unfavorable consequences for some stakeholders. This study provides evidence that both R&D and pension funding are reduced subsequent to a succession, even after accounting for industry trends. The expected (...) short-term profitability increases are also observed.A major implication of these results is that boards of directors and other interested parties should carefully monitor the actions of new CEOs with regard to their treatment of R&D and pension funding if they would like to prevent such actions from occurring. This study also highlights the need to investigate other potential self-interested behaviors of new CEOs. (shrink)

A MAJOR THESIS OF CONTEMPORARY LIBERAL PHILOSOPHY is that its theory of justice, which incorporates strong rights to negative liberty, must be prior to and independent of a theory of the good. This priority is necessary, according to liberal theorists, in view of the requirement that any adequate theory accommodate a plurality of contending views of the good, no one of which is capable of eliciting public assent to it. Recent critics of liberalism have disputed this thesis, maintaining instead that (...) there is indeed an objective good, rather than a plurality of contending goods, which at least seriously compromises and possibly undermines the negative liberty with which liberals traditionally associated their theories. Variously called communitarians, virtue theorists, or republicans, these critics have presented an important challenge to contemporary liberalism whether of the individualist or welfare state variety. (shrink)

Skeletal muscle formation is studied in vitro with myogenic cell lines and primary muscle cell cultures, and in vivo with embryos of several species. We review several of the notable advances obtained from studies of cultured cells, including the recognition of myoblast diversity, isolation of the MyoD family of muscle regulatory factors, and identification of promoter elements required for muscle‐specific gene expression. These studies have led to the ideas that myoblast diversity underlies the formation of the multiple types of fast (...) and slow muscle fibers, and that myogenesis is controlled by a combination of ubiquitous and muscle‐specific transcriptional regulators that may be different for each gene. We further review some unexpected results that have been obtained when ideas from work in culture have been tested in developing animals. The studies in vivo point to additional molecular and cellular mechanisms that regulate muscle formation in the animal. (shrink)

What constitutes a just tax system, and what are its moral foundations? Should a society's tax regime be designed to achieve a just distribution of wealth among its citizens, or should such a regime be designed to promote economic growth, rising standards of living, and increasing levels of employment? Are these two goals compatible or incompatible? Why should justice not require, or at least lead to, an increase in general prosperity? The essays in this volume examine the history of tax (...) policies and the normative principles that have informed the selection of various types of taxes and tax regimes; economic data to discover which tax policies lead to economic growth; particular theories of justice or property rights regarding the design of tax systems; and other essays propose specific tax reforms. Still others challenge traditional theories of taxation, offering new ways of understanding the fiscal relationship between governments and their citizens. (shrink)

What are the core values of liberalism and how can they best be promoted? Liberals in the classical tradition championed individual freedom, limited government and a capitalist economic system with strong rights to private property. Contemporary liberals, in contrast, embrace more egalitarian values and allow for a far more prominent role for government intervention in the market to reduce inequality, redistribute wealth and regulate economic activity. What accounts for these very disparate liberal views of property rights and economic freedom? How (...) should we understand the transition from the classical view of liberalism to its more egalitarian modern version? And what, ideally, should the relationship be between the central values of liberalism and the economic institutions of capitalism? The eleven essays in this volume address these questions and examine related issues. (shrink)

Divisions abound as to whether politics should be held responsible to a higher moral standard or whether pragmatic considerations, or realpolitik, should prevail. The two poles are represented most conspicuously by Aristotle (for whom the proper aim of politics is moral virtue) and Machiavelli (whose prince exalted political pragmatism over morality). The fourteen contributions to this volume address perennial concerns in political and moral theory. They underscore the rekindled yearning of many to hold the political realm to a higher standard (...) despite the skepticism of dissenters who question the likelihood, or even the desirability, of success. (shrink)

Philosophers since ancient times have pondered how we can know whether moral claims are true or false. The first half of the twentieth century witnessed widespread skepticism concerning the possibility of moral knowledge. Indeed, some argued that moral statements lacked cognitive content altogether, because they were not susceptible to empirical verification. The British philosopher A. J. Ayer contends that 'They are pure expressions of feeling and as such do not come under the category of truth and falsehood. They are unverifiable (...) ... because they do not express genuine propositions.' The second half of the twentieth century brought a revival of interest among philosophers in moral and political questions. Whether or not ethics can be founded upon a rational basis continues to preoccupy the philosophical community even now. (shrink)

This volume represents a contribution to the investigation of these issues of perennial interest and import, featuring essays whose authors hope to extend, deepen, and, in some cases, move in new directions, the current state of discussion.

This collection of essays is dedicated to the memory of the late Harvard philosopher Robert Nozick, who died in 2002. The publication of Nozick's Anarchy, State, and Utopia in 1974 revived serious interest in natural rights liberalism, which, beginning in the latter half of the eighteenth century, had been eclipsed by a succession of antithetical political theories including utilitarianism, progressivism, and various egalitarian and collectivist ideologies. Some of our contributors critique Nozick's political philosophy. Other contributors examine earlier figures in the (...) liberal tradition, most notably John Locke, whose Second Treatise of Government, published in the late seventeenth century, profoundly influenced the American founders. The remaining authors analyze natural rights liberalism's central doctrines. (shrink)