Background: Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic. Objective: To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency. Research design: A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses (...) caring for Covid-19 patients in the acute care units within large academic medical systems in Maryland and New York City during April to June 2020. Ethical considerations: We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore. Results: We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies. Discussion/Conclusion: Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences. (shrink)

Public education is not just a way to organise and fund education. It is also the expression of a particular ideal about education and of a particular way to conceive of the relationship between education and society. The ideal of public education sees education as an important dimension of the common good and as an important institution in securing the common good. The common good is never what individuals or particular groups want or desire, but always reaches beyond such particular (...) desires towards that which societies as a whole should consider as desirable. This does, of course, put the common good in tension with the desires of individuals and groups. Neo-liberal modes of governance have, over the past decades, put this particular educational set up under pressure and have, according to some, eroded the very idea of the common good. This set of contributions reflects on this state of affairs, partly through an exploration of the idea of publicness itself – how it can be rearticulated and regained – and partly through reflections on the current state of education in the ‘north’ and the ‘south.’. (shrink)

A growing volume of research from global data demonstrates that institutional care under conditions of deprivation is profoundly damaging to children, particularly during the critical early years of development. However, how these individuals develop over a life course remains unclear. This study uses data from a survey on the health and development of 420 children mostly under the age of three, placed in 12 infant care institutions between 1958 and 1961 in Zurich, Switzerland. The children exhibited significant delays in cognitive, (...) social, and motor development in the first years of life. Moreover, a follow-up of a subsample of 143 children about 10 years later revealed persistent difficulties, including depression, school related-problems, and stereotypies. Between 2019 and 2021, these formerly institutionalized study participants were located through the Swiss population registry and invited to participate once again in the research project. Now in their early sixties, they are studied for their health, further development, and life-course trajectories. A mixed-methods approach using questionnaires, neuropsychological assessments, and narrative biographical interviews was implemented by a multidisciplinary team. Combining prospective and retrospective data with standardized quantitative and biographical qualitative data allows a rich reconstruction of life histories. The availability of a community sample from the same geographic location, the 1954–1961 cohort of the Zurich Longitudinal Studies, described in detail in a paper in this issue, enables comparison with an unaffected cohort. This article describes the study design and study participants in detail and discusses the potential and limitations of a comparison with a community sample. It outlines a set of challenges and solutions encountered in the process of a lifespan longitudinal study from early childhood into the cusp of old age with a potentially vulnerable sample and summarizes the lessons learned along the way. (shrink)

Sudden infant death syndrome (SIDS) has been mainly described from a risk perspective, with a focus on endogenous, exogenous, and temporal risk factors that can interact to facilitate lethal outcomes. Here we discuss the limitations that this risk-based paradigm may have, using two of the major risk factors for SIDS, prone sleep position and bed-sharing, as examples. Based on a multipronged theoretical model encompassing evolutionary theory, developmental biology, and cultural mismatch theory, we conceptualize the vulnerability to SIDS as an imbalance (...) between current physiologic-regulatory demands and current protective abilities on the part of the infant. From this understanding, SIDS appears as a developmental condition in which competencies relevant to self-protection fail to develop appropriately in the future victims. Since all of the protective resources in question are bound to emerge during normal infant development, we contend that SIDS may reflect an evolutionary mismatch situation—a constellation in which certain modern developmental influences may overextend the child’s adaptive (evolutionary) repertoire. We thus argue that SIDS may be better understood if the focus on risk factors is complemented by a deeper appreciation of the protective resources that human infants acquire during their normal development. We extensively analyze this evolutionary-developmental theory against the body of epidemiological and experimental evidence in SIDS research and thereby also address the as-of-yet unresolved question of why breastfeeding may be protective against SIDS. (shrink)

Evidence is accumulating that individual and environmental factors in childhood and adolescence should be considered when investigating adult health and aging-related processes. The data required for this is gathered by comprehensive long-term longitudinal studies. This article describes the protocol of the Zurich Longitudinal Studies (ZLS), a set of three comprehensive cohort studies on child growth, health, and development that are currently expanding into adulthood. Between 1954 and 1961, 445 healthy infants were enrolled in the first ZLS cohort. Their physical, motor, (...) cognitive, and social development and their environment were assessed comprehensively across childhood, adolescence, and into young adulthood. In the 1970s, two further cohorts were added to the ZLS and assessed with largely matched study protocols: Between 1974 and 1979, the second ZLS cohort included 265 infants (103 term-born and 162 preterm infants), and between 1970 and 2002, the third ZLS cohort included 327 children of participants of the first ZLS cohort. Since 2019, the participants of the three ZLS cohorts have been traced and invited to participate in a first wave of assessments in adulthood to investigate their current health and development. This article describes the ZLS study protocol and discusses opportunities, methodological and conceptual challenges, and limitations arising from a long-term longitudinal cohort recruited from a study about development in early life. In the future, the ZLS will provide data to investigate childhood antecedents of adult health outcomes and, ultimately, will help respond to the frequent call of scientists to shift the focus of aging research into the first decades of life and, thus, to take a lifespan perspective on aging. (shrink)

I develop a theory of counterfactuals about relative computability, i.e. counterfactuals such as 'If the validity problem were algorithmically decidable, then the halting problem would also be algorithmically decidable,' which is true, and 'If the validity problem were algorithmically decidable, then arithmetical truth would also be algorithmically decidable,' which is false. These counterfactuals are counterpossibles, i.e. they have metaphysically impossible antecedents. They thus pose a challenge to the orthodoxy about counterfactuals, which would treat them as uniformly true. What’s more, I (...) argue that these counterpossibles don’t just appear in the periphery of relative computability theory but instead they play an ineliminable role in the development of the theory. Finally, I present and discuss a model theory for these counterfactuals that is a straightforward extension of the familiar comparative similarity models. (shrink)

This article discusses how research on the image-based analysis of facial images has informed this debate by demonstrating that a single representational system for facial identity and facial expression is not only computationally viable, but can simulate existing cognitive data demonstrating apparent dissociable processing of these two facial properties. It discusses the increasing number of cognitive studies that provide support for this view. Neuropsychological case studies of brain-injured patients and provide limited evidence for separate visual routes processing facial identity and (...) facial expression. It deals with neuroimaging studies addressing both facial identity and facial expression processing which shows that the fusiform gyrus contributes to the recognition of both facial properties. Research continues to reinforce the proposal that a common visual framework supports the representation of at least some aspects of facial identity and facial expression. (shrink)

Augustin-Louis Cauchy publie une majorité de ses recherches arithmétiques entre 1829 et 1840. Celles-ci ne sont pourtant qu’évoquées dans certaines histoires de la théorie des nombres centrées sur les lois de réciprocité ou sur la théorie des nombres algébriques. Elles y sont décrites comme contenant quelques résultats similaires à ceux de Gauss, Jacobi ou Dirichlet mais de manière incomplète et désordonnée. L’objectif de cet article est de présenter une analyse des textes arithmétiques de Cauchy publiés entre 1829 et 1840 pour (...) montrer qu’ils contiennent au contraire un ensemble cohérent de résultats en lien avec les formes quadratiques \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$4p^{\mu }=x^2+ny^2$$\end{document}, où \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p$$\end{document} est un nombre premier et \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$n$$\end{document} un diviseur de \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p-1$$\end{document}. Nous discuterons également la forme particulière de ce corpus et la stratégie utilisée pour retrouver les lignes directrices du travail de Cauchy. Augustin-Louis Cauchy published most of his arithmetical research between 1829 and 1840. These are however only mentioned in some number theory history centered on reciprocity laws or on theory of algebraic numbers. They are described as containing some results similar to those of Gauss, Jacobi and Dirichlet but in a incomplete and disorganized way. The objective of this paper is to present an analysis of Cauchy’s arithmetical texts published between 1829 and 1840 to show that they contain a rather consistent set of results related to quadratic forms \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$4p^{\mu } = x ^2 + ny ^2$$\end{document}, where \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p$$\end{document} is a prime and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$n$$\end{document} a divisor of \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p-1$$\end{document}. We will also discuss the particular form of this body of texts and the strategy we used to find the guidelines of the work of Cauchy. (shrink)

In the C case, the turnaround at SBM has been effected. Most significant is the company’s realization that it exists to serve the consumer and, through that service, the broader society. This brief case outlines the successes Hiwasa pushed SBM management to accomplish and introduces the challenges the company faced in 2009: primarily, continuing to build its corporate social responsibility approach and addressing environmental and social issues.

The ever increasing ability of medical technology to reshape the human body in fundamental ways—from organ and tissue transplants to reconstructive surgery and prosthetics—is something now largely taken for granted. But for a philosopher, such interventions raise fundamental and fascinating questions about our sense of individual identity and its relationship to the physical body. Drawing on and engaging with philosophers from across the centuries, Jenny Slatman here develops a novel argument: that our own body always entails a strange dimension, a (...) strangeness that enables us to incorporate radical physical changes. (shrink)

The moral status of some particularly horrendous actions cannot be adequately captured by the concept of wrongdoing.See Daniel Haybron, “Moral Monsters and Saints,” Monist, Vol. 85 : p. 260; Paul Formosa, “Evil, Wrongs and Dignity: How to Test a Theory of Evil,” Journal of Value Inquiry, Vol. 47 : pp. 235–253; Eve Garrard, “The Nature of Evil,” Philosophical Explorations: An International Journal for the Philosophy of Mind and Action, Vol. 1 : pp. 43–45; Hillel Steiner, “Calibrating Evil,” The Monist, Vol. (...) 85 : pp. 183–185. For instance, sadistic torture and genocidal mass murder are not just wrong, or very wrong, or very very wrong. We need the concept of evil to make sense of the moral status of these actions. But what is evil? And how is it distinct from mere wrongdoing?In recent years, several theorists writing about the concept of evil have argued that the best way to proceed is to think reflectively about evil’s opposite. Call this the mirror methodology. .. (shrink)

In the past thirty years, face perception has become an area of major interest within psychology. The Oxford Handbook of Face Perception is the most comprehensive and commanding review of the field ever published.For anyone looking for the definitive review of this burgeoning field, this is the essential book.

The Enlightenment commitment to reason naturally gave rise to a belief in the perfectibility of man. Influenced by John Locke and Jean-Jacques Rousseau, many eighteenth-century writers argued that the proper education and upbringing—breeding—could make any man a member of the cultural elite. Yet even in this egalitarian environment, the concept of breeding remained tied to theories of blood lineage, caste distinction, and biological difference. Turning to the works of Locke, Rousseau, Swift, Defoe, and other giants of the British Enlightenment, Jenny (...) Davidson revives the debates that raged over the husbandry of human nature and highlights their critical impact on the development of eugenics, the emergence of fears about biological determinism, and the history of the language itself. Combining rich historical research with a keen sense of story, she links explanations for the physical resemblance between parents and children to larger arguments about culture and society and shows how the threads of this compelling conversation reveal the character of a century. A remarkable intellectual history, _Breeding_ not only recasts the fundamental concerns of the Enlightenment but also uncovers the seeds of thought that bloomed into contemporary notions of human perfectibility. (shrink)

Rather than focusing on political and legal debates surrounding attempts to determine if and when genocidal rape has taken place in a particular setting, this essay turns instead to a crucial, yet neglected area of inquiry: the moral significance of genocidal rape, and more specifically, the nature of the harms that constitute the culpable wrongdoing that genocidal rape represents. In contrast to standard philosophical accounts, which tend to employ an individualistic framework, this essay offers a situated understanding of harm that (...) features the importance of interdependence and relationality and that conceptualizes harms as embodied and contextual. The paper ultimately reveals what is distinctive about this particular crime of sexual violence by exploring the logic of genocidal rape: genocidal rape involves the harm of forced self-betrayal unleashed relationally, causing victims as representatives of their group to participate inadvertently in the destruction of that group. (shrink)

edited by Doris Schroeder, welcomes contributions on all health topics related to human rights and relevant generic contributions from the human rights debate. To submit a paper or to discuss suitable topics, please e-mail Doris Schroeder at dschroeder@uclan.ac.uk. a.

Recent critiques of normative universalism have helped entrench a dichotomy between formalist universal egalitarian claims (typical of the liberal tradition) and particularist attention to cultural difference (in contemporary communitarianism, and in more or less postmodernist approaches). Focusing on the work of Richard Rorty and Iris Marion Young, this article explores whether, and how, we might find space for a universalism which avoids problems encountered by the formalist model. I argue that, while both Rorty and Young reject ‘Enlightenment’ universalism, the approaches (...) of both contain covert universalist assumptions. They thus represent different forms of ‘soft’ universalism: approaches which are fallibilist about current moral knowledge but which hold out the possibility of genuinely inclusive pan‐human normative frameworks. The trouble with both is that neither, in the end, provides a persuasive basis for their own position – one which avoids an ultimate arbitrariness about the winning out of one normative conception (be it humanitarian or not) over another. I suggest that recourse to ontology, and the kinds of metaphysical claim deemed outmoded in the mainstream of social and moral philosophy, provide such a basis. I argue too that a conception of human being as relational, and of the flourishing of the individual as requiring relations with others, is the best‐placed candidate to do the work required. (shrink)

In one of his Quodlibeta, William of Ockham entertains two concepts of God, one theological and the other philosophical. He argues that conclusions involving a theological concept of God are believable and can only be established in theology where recourse to faith is permissible. By contrast, conclusions involving a philosophical concept of God are knowable and can be proved in philosophy and theology. The source of these two concepts lies in the Sentences commentary of his confrère Walter Chatton,1 who explores (...) how different descriptions of God affect the provability of theological conclusions about God. Chatton himself is reacting to Ockham’s earlier Sentences commentary where Ockham suggests that a... (shrink)

In this paper, I seek to examine three ancient literary couples to discover the nature of their relationships. Specifically, I will argue that Enkidu and Gilgamesh, David and Jonathan, and Achilles and Patroclus each participated in a relationship that went beyond the trope of heroic friendship. I will also examine how previous scholars portrayed these men in an attempt to remove homoeroticism from their mythologies.

When defining science as a problem-solving activity, philosophers of science have mainly focussed on "the context of discovery," the process of finding creative solutions to problems; and "the context of justification," the process of evaluating new theories. This article takes a step backward and proposes ways to find problems with a creative potential: Seek areas of theoretical controversy—respect all the facts and set out to find a new theory that can encompass the contradictions; move beyond the realm of research proper—take (...) an interest in phenomena that do not fit into any established theory or frame of reference; give a break to discovery by chance—be attentive and welcoming to unexpected results; look for exceptions—treat them as first-class facts instead of ignoring them or trying to explain them away. (shrink)

Braun explores the use of digital twin technology in medicine with a particular emphasis on the question of how such simulations can represent a person.1 In defining some first conditions for ethically justifiable forms of representation of digital twins, he argues that digital twins do not threaten an embodied person, as long as that person retains control over their simulated representation via dynamic consent, and ideally with the option to choose both form and usage of the simulation. His thoughtful elaboration (...) provides insight into the challenges inherent in interactions between a person and their digital twin, emphasising the modes of control required to respect personal modes of freedom. This individual-centric approach to the question of representation leaves out the important ethical consideration of ensuring that all, not merely some, can be represented. Braun describes dynamic consent as a necessary mode of control, arguing that where a person is unable to give consent, ‘such simulations threaten to become illegitimate representations. They would then shift the kind of interaction from representation to illegitimate forms of prediction or surveillance and thereby could lead to infringements to individual modes of freedom.’ Consequently, the implementation of digital twin technology in healthcare would seem to exclude the most vulnerable members of society from participation in and benefiting from medical innovation, …. (shrink)

Does the real difference between non-consequentialist and consequentialist theories lie in their approach to value? Non-consequentialist theories are thought either to allow a different kind of value (namely, agent-relative value) or to advocate a different response to value ('honouring' rather than 'promoting'). One objection to this idea implies that all normative theories are describable as consequentialist. But then the distinction between honouring and promoting collapses into the distinction between relative and neutral value. A proper description of non-consequentialist theories can only (...) be achieved by including a distinction between temporal relativity and neutrality in addition to the distinction between agent-relativity and agent-neutrality. (shrink)

Is evil a distinct moral concept? Or are evil actions just very wrong actions? Some philosophers have argued that evil is a distinct moral concept. These philosophers argue that evil is qualitatively distinct from ordinary wrongdoing. Other philosophers have suggested that evil is only quantitatively distinct from ordinary wrongdoing. On this view, evil is just very wrong. In this paper I argue that evil is qualitatively distinct from ordinary wrongdoing. The first part of the paper is critical. I argue that (...) Luke Russell’s attempt to show that evil is only quantitatively distinct from ordinary wrongdoing fails. Russell’s argument fails because it is based on an implausible criterion for determining whether two concepts are qualitatively distinct. I offer a more plausible criterion and argue that based on this criterion evil and wrongdoing are qualitatively distinct. To help make my case, I sketch a theory of evil which makes a genuinely qualitative distinction between evil and wrongdoing. I argue that we cannot characterize evil as just very wrong on plausible conceptions of evil and wrongdoing. I focus on act-consequentialist, Kantian, and contractarian conceptions of wrongdoing. (shrink)

El articulo analiza experiencias de corporeidad de mujeres excombatientes de las FARC-EP, a partir de una investigación sociocrítica, fenomenológica y feminista, que implementó estrategias dialógicas, participativas, contextualizadas y problematizadoras. Los resultados describen los órdenes discursivos insurgentes en torno a la igualdad, los procesos de socialización que moldean cuerpos militantes y a la vez los controlan desde lo normativo; frente a estos últimos se vislumbran prácticas de fuga que evidencian las tensiones entre el orden insurgente y el de la vida civil. (...) Se concluye que el grupo armado moldea una subjetividad que combina elementos de las construcciones de género del contexto campesino de origen y referentes ideológicos y prácticos del contexto bélico que se esfuerza por configurar cuerpos fuertes y disciplinados. (shrink)

Immortality has recently become a prominent topic of discussion, particularly in light of advancing technologies aimed at enhancing human life expectancy. Proposed scenarios encompass improved treatments for various diseases and the development of longevity medicine. In this essay, I examine the theory of the self and the concept of immor‑ tality as presented in Heshanggong’s commentary on the Daodejing. This analysis serves as a case study aimed at illuminating a unique perspective on the self that contributes to contemporary discussions of (...) immortality. I argue that Heshanggong’s commentary em‑ phasizes the significance of jing 精, qi 氣, and shen 神, positing that our essential property is to have the essential spirits (jingshen 精神). Furthermore, it suggests the possibility of a disembodied form of immortality without a physical human body. This interpretation of immortality offers a novel understanding of how immortality may be achievable. (shrink)

In this paper I explore the various meanings of embodiment from a patient’s perspective. Resorting to phenomenology of health and medicine, I take the idea of ‘lived experience’ as starting point. On the basis of an analysis of phenomenology’s call for bracketing the natural attitude and its reduction to the transcendental, I will explain, however, that in medical phenomenological literature ‘lived experience’ is commonly one-sidedly interpreted. In my paper, I clarify in what way the idea of ‘lived experience’ should be (...) revisited and, subsequently, what this reconsideration means for phenomenological research on embodiment in health and medicine. The insight that the body is a condition of possibility for world-disclosing yet, at the same time, itself conditioned by this world forces us to not only zoom in on the body’s subject-side, but also on its object-side. I argue that in order to render account for this double body ontology, phenomenology should include empirical sociological analyses as well. I thus argue in favor of the idea of a socio-phenomenology. Drawing on material from my own research project on embodied self-experiences after breast surgery, I show how this approach can be fruitful in interpreting the impact of disfigurements on a person’s embodied agency, or a person’s ‘I can’. (shrink)

Is liberalism adaptable enough to the ecological agenda to deal satisfactorily with the challenges of anthropogenic climate change while leaving its normative foundations intact? Compatibilists answer yes; incompatibilists say no. Comparing such answers, this article argues that it is not discrete liberal principles which impede adapatability, so much as the constructivist model (exemplified in Rawls) of what counts as a valid normative principle. Constructivism has both normative and ontological variants, each with a realist counterpart. I argue that normative constructivism in (...) the Rawlsian mode, whatever its strengths elsewhere, is markedly ill‐equipped to deal with the particular normative challenges posed by climate change – and that that these doubts holds regardless of which stance is adopted as its ontological corollary. (shrink)

Contesting Conformity investigates the writings of Tocqueville, Mill, and Nietzsche in order to examine the relationship between non-conformity and modern democracy. Jennie Ikuta argues that non-conformity is an intractable issue for democracy while non-conformity is often important for cultivating a just polity, non-conformity can also undermine democracy. Democracy therefore needs non-conformity, but not in an unconditional way. This book examines this intractable relationship, and offers resources for navigating the relationship in contemporary democracies in ways that promote justice and freedom.

James Frederick Ferrier James Frederick Ferrier was a mid-nineteenth-century Scottish metaphysician who developed the first post-Hegelian system of idealism in Britain. Unlike the British Idealists in the latter half of the nineteenth century, he was neither a Kantian nor a Hegelian. Instead, he largely develops his idealist metaphysics via his defense of Berkeley and … Continue reading Ferrier, James Frederick →.

This book explores how and why some people and practices are made invisible in science, featuring 25 case studies and commentaries that explore how invisibility can bolster or undermine credibility, how race, gender, class, and nation frame who can see what, how invisibility empowers and marginalizes, and the epistemic ramifications of concealment.