By focusing on the caloric composition of hunted prey species, optimal foraging research has shown that hunters usually make economically rational prey choice decisions. However, research by meat scientists suggests that the gustatory appeal of wildlife meats may vary dramatically. In this study, behavioral research indicates that Mayangna and Miskito hunters in Nicaragua inconsistently pursue multiple prey types in the optimal diet set. We use cognitive methods, including unconstrained pile sorts and cultural consensus analysis, to investigate the hypothesis that these (...) partial preferences are influenced by considerations of meat flavor. Native informants exhibit high agreement on the relative appeal of different meats. Given the absence of other noteworthy differences between spider monkeys (Ateles geoffroyi) and howler monkeys (Alouatta palliata), the unappealing flavor of howler monkeys seems to be a factor in the partial preference for this species. (shrink)

The idea that acquired brain injury (ABI) caused by stroke, hemorrhage, infection or traumatic insult to the brain can result in post-traumatic growth (PTG) for individuals is increasingly attracting psychological attention. However, PTG also attracts controversy as a result of ambiguous empirical findings. The extent that demographic variables, injury factors, subjective beliefs, and psychological health are associated with PTG following ABI is not clear. Consequently, this systematic review and meta-analysis explores the correlates of variables within these four broad areas and (...) PTG. From a total of 744 published studies addressing PTG in people with ABI, eight studies met inclusion criteria for detailed examination. Meta-analysis of these studies indicated that growth was related to employment, longer education, subjective beliefs about change post-injury, relationship status, older age, longer time since injury, and lower levels of depression. Results from homogeneity analyses indicated significant inter-study heterogeneity across variables. There is general support for the idea that people with ABI can experience growth, and that various demographics, injury-related variables, subjective beliefs and psychological health are related to growth. The contribution of social integration and the forming of new identities post-ABI to the experience of PTG is explored. These meta-analytic findings are however constrained by methodological limitations prevalent in the literature. Clinical and research implications are discussed with specific reference to community and collective factors that enable PTG. (shrink)

For International Relations scholars, discussions of globalization inevitably turn to questions of sovereignty. How much control does a country have over its borders, people and economy? Where does that authority come from? _Sovereign Lives_ explores these changes through reading of humanitarian intervention, human rights discourses, securitization, refugees, the fragmentation of identities and the practices of development.

This paper offers four contrasting perspectives on the role of the nurse ethicist from authors based in different areas of world, with different professional backgrounds and at different career stages. Each author raises questions about how to understand the role of the nurse ethicist. The first author reflects upon their career, the scope and purpose of their work, ultimately arguing that the distinction between ‘nurse ethicist’ and ‘clinical ethicist’ is largely irrelevant. The second author describes the impact and value that (...) a nurse in an ethics role plays, highlighting the ‘tacit knowledge’ and ‘lived experience’ they bring to clinical ethics consultation. However, the second author also warns that the ‘nurse ethicist’ must be cautious in their approach to avoid being viewed as a resource only for nurses. The third author questions the introduction of additional professional distinctions such as ‘nurse ethicist’ on the basis that distinctions threaten the creation of egalitarian healthcare systems, while also acknowledging that clinical ethicists ought not strive for objective attachment in their work. In direct contrast, the final author suggests that the nurse ethicist can play a pivotal role in highlighting and addressing ethical challenges that are specific to nurses. These four short pieces raise questions and point to concepts that will be expanded upon and debated throughout this special issue of Nursing Ethics. (shrink)

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)

Student evaluations of teaching are ubiquitous in the academe as a metric for assessing teaching and frequently used in critical personnel decisions. Yet, there is ample evidence documenting both measurement and equity bias in these assessments. Student Evaluations of Teaching have low or no correlation with learning. Furthermore, scholars using different data and different methodologies routinely find that women faculty, faculty of color, and other marginalized groups are subject to a disadvantage in SETs. Extant research on bias on teaching evaluations (...) tend to review only the aspect of the literature most pertinent to that study. In this paper, we review a novel dataset of over 100 articles on bias in student evaluations of teaching and provide a nuanced review of this broad but established literature. We find that women and other marginalized groups do face significant biases in standard evaluations of teaching – however, the effect of gender is conditional upon other factors. We conclude with recommendations for the judicious use of SETs and avenues for future research. (shrink)

The authors explore the changing dynamics of gendered familial caregiving in urban China within the context of economic reforms and the continued cultural influence of xiao. Data collected in China through interviews with 110 familial caregivers were used to examine cultural and structural influences on the caregiving behavior of adult children. Results from multiple regression analyses provide evidence of a gendered division of parental care tasks, a decline in the patrilocal tradition of caregiving, and a strong social pressure that influences (...) caregiving behavior. Structural factors linked to caregiving performance included family size, lack of pensions for elders, and caregivers’ employment status and income. Findings portend deleterious effects for the women who are now caregivers as they are likely to live longer but be more financially dependent and have fewer children available to help them. (shrink)

In the UK, the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a widely used process, designed to facilitate shared decision-making between a clinician and a patient or, if the patient lacks capacity to participate in the conversation, a person close to the patient. A key outcome of the ReSPECT process is a set of recommendations, recorded on the patient-held ReSPECT form, that reflect the conversation. In an emergency, these recommendations are intended to inform clinical decision-making, and thereby (...) enable the attending clinician—usually a general practitioner (GP) or paramedic—to act in the patient’s best interests. This study is the first to explore the extent to which ReSPECT recommendations realise their goal of informing best interests decision-making in community contexts. Using a modified framework analysis approach, we triangulate interviews with patients and their relatives, GPs and nurses and care home staff. Our findings show that inconsistent practices around recording patient wishes, diverging interpretations of the meaning and authority of recommendations and different situational contexts may affect the interpretation and enactment of ReSPECT recommendations. Enacting ReSPECT recommendations in an emergency can be fraught with complexity, particularly when attending clinicians need to interpret recommendations that did not anticipate the current emergency. This may lead to decision-making that compromises the patient’s best interests. We suggest that recording patients’ values and preferences in greater detail on ReSPECT forms may help overcome this challenge, in providing attending clinicians with richer contextual information through which to interpret treatment recommendations. (shrink)

Melanomas arise from transformed melanocytes, positioned at the dermal‐epidermal junction in the basal layer of the epidermis. Melanocytes are completely surrounded by keratinocyte neighbors, with which they communicate through direct contact and paracrine signaling to maintain normal growth control and homeostasis. UV radiation from sunlight reshapes this communication network to drive a protective tanning response. However, repeated rounds of sun exposure result in accumulation of mutations in melanocytes that have been considered as primary drivers of melanoma initiation and progression. It (...) is now clear that mutations in melanocytes are not sufficient to drive tumor formation—the tumor environment plays a critical role. This review focuses on changes in melanocyte‐keratinocyte communication that contribute to melanoma initiation and progression, with a particular focus on recent mechanistic insights that lay a foundation for developing new ways to intercept melanoma development. (shrink)

ABSTRACTInitial evaluations generalise to new contexts, whereas counter-attitudinal evaluations are context-specific. Counter-attitudinal information may not change evaluations in new contexts beca...

A diagnosis of dementia often comes with difficulties in understanding a conversational context and expressing how one feels. So far, research on how to facilitate advance care planning for people with dementia focused on defining relevant themes and topics for conversations, or on how to formalize decisions made by surrogate decision makers, e.g., family members. The aim of this review is to provide a better scope of the existing research on practical communication aspects related to dementia in ACP conversations. In (...) November 2020, seven databases were searched to select papers for inclusion. This search was updated in December 2021. The search strategy consisted of three tiers, intersected by using the Boolean term “AND,” and resulted in 787 studies. Two researchers followed explicit criteria for two sequential levels of screening, based on titles and abstracts and full papers. A total of 22 studies were included for data analysis. Seven topics emerged clustered around two themes. This scoping review provides practical suggestions for healthcare professionals to improve ACP communication and uncovered gaps in research on communication aspects related to dementia in ACP conversations, such as non-verbal behavior, timing and implementation, and personal preferences. (shrink)

L’emploi est au cœur du bien-être d’un individu. Les attentes liées au travail des personnes ayant une déficience intellectuelle ont été comparées à celles des coordonnateurs de services. Les variables comprenaient le type de travail attendu, le nombre d’heures de travail prévu, les préoccupations liées à l’emploi, les mesures de soutien souhaitées sur le lieu de travail et l’influence de la gravité de la déficience intellectuelle et de l’expérience de travail du coordonnateur de services sur les attentes en matière de (...) travail. Les données ont été recueillies auprès de 46 personnes ayant une déficience intellectuelle par le biais d’entretiens et de 46 coordonnateurs au moyen d’un sondage en ligne. Les résultats indiquaient des attentes professionnelles positives globales. Le travail le plus courant attendu était le service et le commerce. L’emploi concurrentiel était attendu plus fréquemment que les ateliers protégés. Alors que les attentes des coordonnateurs de services et des personnes ayant une déficience intellectuelle légère étaient étroitement alignées, il existait une distinction plus grande entre les attentes des coordonnateurs et celles ayant une déficience intellectuelle modérée ou grave. Ces résultats ont des implications importantes pour faciliter le placement des adultes ayant une déficience intellectuelle. (shrink)

Peer review is a widely accepted instrument for raising the quality of science. Peer review limits the enormous unstructured influx of information and the sheer amount of dubious data, which in its absence would plunge science into chaos. In particular, peer review offers the benefit of eliminating papers that suffer from poor craftsmanship or methodological shortcomings, especially in the experimental sciences. However, we believe that peer review is not always appropriate for the evaluation of controversial hypothetical science. We argue that (...) the process of peer review can be prone to bias towards ideas that affirm the prior convictions of reviewers and against innovation and radical new ideas. Innovative hypotheses are thus highly vulnerable to being “filtered out” or made to accord with conventional wisdom by the peer review process. Consequently, having introduced peer review, the Elsevier journal Medical Hypotheses may be unable to continue its tradition as a radical journal allowing discussion of improbable or unconventional ideas. Hence we conclude by asking the publisher to consider re-introducing the system of editorial review to Medical Hypotheses. (shrink)

Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient’s values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge (...) the information needs of the individual patient. The aim of this paper is to describe ‘core information sets’ which are defined as a minimum set of consensus-derived information about a given procedure to be discussed with all patients. Importantly, they are intended to catalyse discussion of subjective importance to individuals. The model described in this paper applies health services research and Delphi consensus-building methods to an idea orginally proposed 30 years ago. The hypothesis is that, first, large amounts of potentially-important information are distilled down to discrete information domains. These are then, secondly, rated by key stakeholders in multiple iterations, so that core information of agreed importance can be defined. We argue that this scientific approach is key to identifying information important to all stakeholders, which may otherwise be communicated poorly or omitted from discussions entirely. Our methods apply systematic review, qualitative, survey and consensus-building techniques to define this ‘core information’. We propose that such information addresses the ‘reasonable patient’ standard for information disclosure but, more importantly, can serve as a spring board for high-value discussion of importance to the individual patient. The application of established research methods can define information of core importance to informed consent. Further work will establish how best to incorporate this model in routine practice. (shrink)

The specialist field of intellectual disability nursing has been subjected to a number of changes since the move towards deinstitutionalisation from the 1970s. Government policies sought to change the nature of the disability workforce from what was labelled as a medicalised approach, towards a more socially oriented model of support. Decades on however, many nurses who specialise in the care of people with intellectual disability are still employed. In Australia, the advent of the National Disability Insurance Scheme offers an apt (...) moment to reflect upon these decades of specialised nursing care as the context of this nursing care will continue to evolve. A review of the published literature was conducted to explore what has shaped the field in the past and how this might inform the future of this speciality area under new policy and service contexts. People with intellectual disability have specific health and support needs that require a specialised workforce. Specialist nurses continue to be needed for people with intellectual disability. (shrink)

James Frederick Ferrier was one of the first post-Hegelian British idealists, developing his idealism via a rejection of Thomas Reid’s common sense philosophy and from a reappraisal of Berkeley’s idealism. This chapter is a critical consideration of his major work, the Institutes of Metaphysic in which he develops a complete system of metaphysics. From an examination of the laws of knowledge and by applying the deductive method he determines that the absolute in cognition is an indivisible subject-object synthesis and it (...) follows from this that absolute existence must involve some self in union thoughts and things. His move from knowing to being is problematic and in this way his ontology falls short of his ambitious aims. Nevertheless, Ferrier provides an unusual and astute idealist epistemology several years before idealism became influential in British philosophy. (shrink)

To understand public discourse in the United States on genetic causation of behavioral disorders, we analyzed media representations of genetic research on addiction published between 1990 and 2010. We conclude first that the media simplistically represent biological bases of addiction and willpower as being mutually exclusive: behaviors are either genetically determined, or they are a choice. Second, most articles provide only cursory or no treatment of the environmental contribution. A media focus on genetics directs attention away from environmental factors. Rhetorically, (...) media neglect the complexity underlying the etiology the addiction and direct focus back toward individual causation and responsibility. (shrink)

Voluntades anticipadas: desafíos éticos en el cuidado del paciente Diretivas antecipadas de vontade: desafios éticos no cuidado do paciente Advance healthcare directives are intended for the individual to personally express their will and preferences about healthcare and treatment ahead of time. This literature review aims to describe the concept and structure of advance directives and the ethical aspects involved in patient care. Using the keywords “Advance Healthcare Directive” AND “Ethical Implication” and its Spanish equivalents, five databases were accessed: ProQuest, Philosophy, (...) PubMed, Web of Science and Scielo. Publications were narrowed down to the 2010-2018 period. Thirty-one articles were obtained and read critically. Results of this review were grouped into the following categories: concept, structure, clinical situations in which advance directives apply, strengths and limitations, as well as the ethical aspects involved. End of life-related experiences in which a person loses their ability to make decisions and cannot express their wishes, so it is impossible to know their will, are more common nowadays. Most health workers are not appropriately trained in the preparation and application of advance directives, which becomes an opportunity to research and delve deeper into the subject. Advance directives are a tool that gives health workers reliable information on a patient’s values and wishes, so it is vital to train them to provide respectful quality care. Para citar este artículo / To reference this article / Para citar este artigo Forero J, Vargas I, Bernales M. Voluntades anticipadas: desafíos éticos en el cuidado del paciente. Pers Bioet. 2019;23:224-244. DOI: https://doi.org/10.5294/pebi.2019.23.2.5 Recibido: 26/01/2019 Aceptado: 22/08/2019. (shrink)

This essay considers how the Zhuangzi 莊子 sheds light on a new direction to the contemporary discussion of desires. Harry Frankfurt proposes an account of personhood based on a hierarchy of desires. He defines a wanton as a being that does not have second-order volitions, the desires that a certain desire of action becomes her will. J. David Velleman proposes, in the context of the Zhuangzi, that when a Daoist sage performs her skills she can be regarded as a “higher” (...) wanton because her actions are spontaneous flows of skillful actions. In this essay, I propose along the line of Velleman a constructive interpretation of the Zhuangzian way to deal with desires from my reading of the Zhuangzi. I argue that there are two roles a Daoist sage can play: the observer and the performer. A Daoist sage can be an observer at a certain time and a performer at other times. Although a performer can be regarded as a higher wanton, it is inappropriate to regard an observer as a wanton. Also, I propose that observation is a means to transform desires—once the practitioner achieves high spirituality, one does not need to possess second-order volitions because one’s first-order desires are transformed such that they are in accordance with the Dao 道. (shrink)

The meaning of κερτομω and its congeners in Homer has been the subject of debate in this journal. Jones has argued that ‘to κερτομω someone is to speak in such a way as to provoke a powerful emotional reaction’, whether of anger or fear, and thus means ‘“to utter stinging words at [someone]”, “pierce to the heart”, “cut to the quick”, rather than merely “provoke” This definition seems to work well enough for some cases, but certainly not for all, and (...) especially not for the passage from which the whole controversy began: Iliad 24.649, where Achilles speaks to Priam ༐πικερτομέωυ. As Richardson says in his Iliad commentary, ‘there is no sign that Akhilleus’ speech has this direct effect [i.e. arouses fear] on Priam’. Jones's article was responding to an earlier one by J. T. Hooker, who attempted to ascertain the sense of Achilles’ ༐πικερτομέυ by surveying the usage of kertom- words throughout Homeric epic. He concluded that the basic meaning is ‘to taunt’ or, more abstractly, it ‘indicates the provocation of another person into behaving in a certain way, whether that is the behaviour desired by the speaker… or is not desired by the speaker’. The problem was that this definition did not seem to fit the very line from which his inquiry began, the words of Achilles to Priam. Hooker then hypothesized that the verse betrayed signs of an ‘imperfect adaptation’ of a different version of the poem in which Achilles taunted a defeated enemy or perhaps preserved his grudge against Agamemnon to its end. This explanation is unpersuasive. (shrink)

© 2017. The American Astronomical Society. All rights reserved.We present new observations of the low-mass companion to HD 984 taken with the Gemini Planet Imager as a part of the GPI Exoplanet Survey campaign. Images of HD 984 B were obtained in the J and H bands. Combined with archival epochs from 2012 and 2014, we fit the first orbit to the companion to find an 18 au orbit with a 68% confidence interval between 14 and 28 au, an eccentricity (...) of 0.18 with a 68% confidence interval between 0.05 and 0.47, and an inclination of 119°with a 68% confidence interval between 114°and 125°. To address the considerable spectral covariance in both spectra, we present a method of splitting the spectra into low and high frequencies to analyze the spectral structure at different spatial frequencies with the proper spectral noise correlation. Using the split spectra, we compare them to known spectral types using field brown dwarf and low-mass star spectra and find a best-fit match of a field gravity M6.5 ±1.5 spectral type with a corresponding temperature of K. Photometry of the companion yields a luminosity of log=2.88 ± 0.07 dex with DUSTY models. Mass estimates, again from DUSTY models, find an age-dependent mass of 34 ±1 to 95 ±4 M Jup. These results are consistent with previous measurements of the object. (shrink)