Exception from Informed Consent (EFIC) regulations detail specific circumstances in which Institutional Review Boards (IRB) can approve studies where obtaining informed consent is not possible prior to subject enrollment.To better understand how IRB members evaluate community consultation (CC) and public disclosure (PD) processes and results, semi-structured interviews of EFIC-experienced IRB members were conducted and analyzed using thematic analysis.Interviews with 11 IRB members revealed similar approaches to reviewing EFIC studies. Most use summaries of CC activities to determine community members’ attitudes; none (...) reported using specific criteria nor recalled any CC reviews that resulted in modifications to or denials of EFIC studies. Most interviewees thought metrics based on Community VOICES’s domains (feasibility, participant selection, quality of communication, community perceptions, investigator/IRB perceptions) would be helpful.IRB members had similar experiences and concerns about reviewing EFIC studies. Development of metrics to assess CC processes may be useful to IRBs reviewing EFIC studies. (shrink)

Book synopsis: Background In 1998 Routledge published the Routledge Encyclopedia of Philosophy to critical acclaim. The first multi-volume Encyclopedia to be published in the discipline in over thirty years, REP is now regarded as the definitive resource in the field. Featuring 2,000 original entries from a team of over 1,300 of the world's most respected scholars and philosophers, REP swiftly accumulated rave reviews and awards, including selection by Library Journal as one of its 50 Sources for the Millenium, and recognition (...) as an Outstanding Reference Source by the American Library Association. Not content with resting on their laurels, the Routledge Encyclopedia of Philosophy editorial team, led by Professor Edward Craig, then began work on a fully searchable and extensively cross-referenced dynamic Web version, the Routledge Encyclopedia of Philosophy Online. REP Online expands this acclaimed Encyclopedia well beyond print reference boundaries. The full content of the classic 10-volume set remains at its core, but REP Online is also a living, growing resource designed to grow along with the discipline itself. Taking full advantage of the flexibility of the Web format, each year the REP editorial team brings a diverse range of new material, including newly commissioned entries by leading scholars, making REP Online the essential philosophy reference for faculty and students in a wide range of disciplines. As well as regular additions of new articles, REP Online also provides editorially reviewed links to other sites and resources on the web, revisions and updates of key entries, and periodic upgrades of the user environment. In keeping with the 1998 print set's tradition of first class editorial work and unparalleled breadth of subject matter, all new and revised entries are carefully integrated into the REP style and format and are connected to earlier material by the same kind and level of cross-referencing. Key Features · Covers an unparalleled breadth of subject matter, including Anglo-American, ethical and political, cross-cultural, interdisciplinary, continental and contemporary philosophy · Over 25,000 hot-linked cross-references between articles and new links to other editorially reviewed websites · An invaluable resource for all levels of users - students and general readers gain a rapid orientation with accessible summaries at the beginning of every in-depth article. There are 30 overview (signpost) articles which map their subject areas · Regularly upgraded with new material, revisions, and bibliographic updates, REP provides access to the latest scholarship and major developments in philosphical inquiry worldwide. (shrink)

Psychologists have long been concerned with the welfare and competent treatment of underserved populations. However, terminology used in psychological research is not always conducive to cultural sensitivity. This article discusses why the term “non-white” may be less sensitive to diverse populations and provides practical alternatives to this nomenclature. In addition, the authors examine the literature from 2008 to 2012 to establish whether the term “non-white” is still used to describe populations in psychological research. The article concludes with several recommendations for (...) how researchers could choose to proceed in regards to identifying populations using culturally sensitive and relevant language. (shrink)

Understanding positive emotions' shared and differentiating features can yield valuable insight into the structure of positive emotion space and identify emotion states, or aspects of emotion states, that are most relevant for particular psychological processes and outcomes. We report two studies that examined core relational themes (Study 1) and expressive displays (Study 2) for eight positive emotion constructs—amusement, awe, contentment, gratitude, interest, joy, love, and pride. Across studies, all eight emotions shared one quality: high positive valence. Distinctive core relational theme (...) and expressive display patterns were found for four emotions—amusement, awe, interest, and pride. Gratitude was associated with a distinct core relational theme but not an expressive display. Joy and love were each associated with a distinct expressive display but their core relational themes also characterised pride and gratitude, respectively. Contentment was associated with a distinct expressive display but not a core relational theme. The implications of this work for the study of positive emotion are discussed. (shrink)

Background Deep brain stimulation is approved for treating refractory obsessive-compulsive disorder in adults under the US Food and Drug Administration Humanitarian Device Exemption, and studies have shown its efficacy in reducing symptom severity and improving quality of life. While similar deep brain stimulation treatment is available for pediatric patients with dystonia, it is not yet available for pediatric patients with obsessive-compulsive disorder, although soon could be. The prospect of growing indications for pediatric deep brain stimulation raises several ethical concerns relating (...) to bodily integrity, the ability to offer informed assent, and the role pediatric patients play in the decision-making process. Objective The aim of this study is to solicit and assess the views of stakeholders (children, parents, clinicians) on pediatric assent, autonomy, and bodily integrity in the context of potential pediatric deep brain stimulation for obsessive-compulsive disorder. Methods Semi-structured interviews were conducted with pediatric obsessive-compulsive disorder patients ( n = 21), caregivers of pediatric obsessive-compulsive disorder patients aged 14–18 ( n = 19), and clinicians with experience treating refractory obsessive-compulsive disorder ( n = 25). Interviews were transcribed and coded in MAXQDA 2018 and 2020 software and processed for thematic content analysis to isolate and compare specific themes. Results A majority of respondents (74%, 48/65) across all three stakeholder groups voiced that the decision-making process should be collaborative and involve everyone (clinicians: 84% or 21/25, caregivers 71% or 15/21, and patients 63% or 12/19). We identified a split between respondents’ views on who should have the final say in the event of disagreement (38% or 25/65 favored the patient versus 35% or 23/65 favoring caregivers). A split between respondents also emerged concerning the maturity relevant for deep brain stimulation decision-making, with 45% (29/65) favoring developmental maturity (age/physiological development) and 45% (29/65) favoring decisional maturity (capacity to understand and weigh information). A majority of clinicians indicated that they would not move forward with deep brain stimulation without securing patient assent (80% or 20/25), with some stating the only exception is if patient quality of life was very poor and/or they lacked insight. Both caregivers and patients expressed a significant respect for the patient's right to bodily integrity, with 67% of caregivers (14/21) and 68% of patients (13/19) justifying patient involvement in decision-making specifically with reference to infringements of bodily integrity. Conclusion Our findings demonstrate that despite broad agreement across stakeholders that the decision-making process for pediatric deep brain stimulation for obsessive-compulsive disorder should be collaborative and somehow involve pediatric patients, there is disagreement about what this process entails and what factors determine patient involvement in the process. However, there is agreement that children have a right to bodily and brain integrity, which should only be infringed upon in rare circumstances. (shrink)

Institutional review boards distinguish health care quality improvement and health care quality improvement research based primarily on the rigor of the methods used and the purported generalizability of the knowledge gained. Neither of these criteria holds up upon scrutiny. Rather, this apparently false dichotomy may foster under-protection of participants in QI projects and over-protection of participants within QIR.

Law is an essential tool for public health practice, and the use of a systematic legal framework can assist with preventing chronic diseases and addressing the growing epidemic of obesity.The action options available to government at the federal, state, local, and tribal levels and its partners can help make the population healthier by preventing obesity and decreasing the growing burden of associated chronic diseases such as cardiovascular disease and Type 2 diabetes. The Centers for Disease Control and Prevention uses the (...) four-part systematic legal framework commonly referred to as “public health legal preparedness” to demonstrate the essential role law can play for any public health issue. This paper uses the “laws and legal authorities” component of the framework and should be considered in combination with the competencies, coordination, and information-best practices components of the framework. (shrink)

The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients’ views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts (...) to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and “normalcy” in the context of OCD. (shrink)

In “Revive and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose”, Marshall, Derse, Weiner, and Joseph contend that patients who may appear to satisfy the standard criteria for...

Dispositional forgiveness is positively associated with many facets of wellbeing and has protective implications against depression and anxiety in adolescents. However, little work has been done to examine neurobiological aspects of forgiveness as they relate to clinical symptoms. In order to better understand the neural mechanisms supporting the protective role of forgiveness in adolescents, the current study examined the middle frontal gyrus, which comprises the majority of the dorsolateral prefrontal cortex and is associated with cognitive regulation, and its relationship to (...) forgiveness and clinical symptoms in a sample of healthy adolescents. In this cross-sectional study, larger MFG volume was significantly associated with higher self-reported dispositional forgiveness scores and lower levels of depressive and anxiety symptoms. Forgiveness mediated the relationship between MFG volume and both depressive and anxiety symptom levels. The mediating role of forgiveness in the relationship between MFG volume and clinical symptoms suggests that one way that cognitive regulation strategies supported by this brain region may improve adolescent mental health is via increasing a capacity for forgiveness. The present study highlights the relevance of forgiveness to neurobiology and their relevance to emotional health in adolescents. Future longitudinal studies should focus on the predictive quality of the relationship between forgiveness, brain volume and clinical symptoms and the effects of forgiveness interventions on these relationships. (shrink)

As the United States emerges from the worst public health threat it has ever experienced, the Supreme Court is poised to reconsider constitutional principles from bygone eras. Judicial proposals to roll back rights under a federalism infrastructure grounded in states’ interests threaten the nation’s legal fabric at a precarious time. This column explores judicial shifts in 3 key public health contexts — reproductive rights, vaccinations, and national security — and their repercussions.

We used a paper-based survey to explore dynamics of Local Food Networks for fish in the Icelandic Westfjords. Preference for local fish remains high, and fish consumption is largely embedded within a gift network, rather than typical commercial channels off ering costly, frozen, and non-local products. Individuals lacking personal connections to the fishing industry obtain fish from these commercial networks. LFNs for fish in rural Icelandic communities are therefore expressions of power dimensions that are symptomatic (...) of the larger inequalities built into the fisheries management system, designed for globalized food networks. The disconnect between large-scale production mechanisms and local consumption patterns highlights the lack of responsiveness of the fishing industry to local Icelandic consumers and demonstrates the impacts national political structures can have on LFNs. (shrink)

This book brings together contributions from scholars from Europe and the United States to honor the theological work of Antje Jackelén, the first female Archbishop of the Church of Sweden. In Archbishop Antje Jackelén's installation homily, she identifies the strength of the Church as a "global network of prayer threads." This book is an honorary and celebratory volume providing a "global network of prayerful essays" by contributors from a variety of academic disciplines to creatively engage, reflect, and illuminate the theological (...) work of Archbishop Jackelén. Prior to her tenure in the Church of Sweden as Bishop of the Diocese of Lund and now the Archbishop of the Church of Sweden, Jackelén served as professor of Systematic Theology, Director of the Zygon Center and President of European Society for the Study of Science and Religion (ESSSAT). While each essay intentionally embraces the theological and ministerial work of Jackelén during her academic tenure, they also venture into areas as diverse as climate change, media studies, human uniqueness, hermeneutics, time, ethics, Christian theological tradition and history, traumatology, politics and society. As the first diverse explication of the theological thinking of Archbishop Jackelén by her theological colleagues, this text provides scholars with an expansion of the scope of Archbishop Jackelén's theological thinking and initiates laity into the impact of Jackelén thinking that combines with grace and precision the traditions of the Church, the challenges and gifts of the sciences, and the needs and longings of society and the world. (shrink)

Virtue and the Moral Life brings together distinguished philosophers and theologians with younger scholars of consummate promise to produce ten essays that engage both academics and students of ethics. This collection explores the role virtues play in identifying the good life and the good society.

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

The Ontology for Biomedical Investigations (OBI) is an ontology that provides terms with precisely defined meanings to describe all aspects of how investigations in the biological and medical domains are conducted. OBI re-uses ontologies that provide a representation of biomedical knowledge from the Open Biological and Biomedical Ontologies (OBO) project and adds the ability to describe how this knowledge was derived. We here describe the state of OBI and several applications that are using it, such as adding semantic expressivity to (...) existing databases, building data entry forms, and enabling interoperability between knowledge resources. OBI covers all phases of the investigation process, such as planning, execution and reporting. It represents information and material entities that participate in these processes, as well as roles and functions. Prior to OBI, it was not possible to use a single internally consistent resource that could be applied to multiple types of experiments for these applications. OBI has made this possible by creating terms for entities involved in biological and medical investigations and by importing parts of other biomedical ontologies such as GO, Chemical Entities of Biological Interest (ChEBI) and Phenotype Attribute and Trait Ontology (PATO) without altering their meaning. OBI is being used in a wide range of projects covering genomics, multi-omics, immunology, and catalogs of services. OBI has also spawned other ontologies (Information Artifact Ontology) and methods for importing parts of ontologies (Minimum information to reference an external ontology term (MIREOT)). The OBI project is an open cross-disciplinary collaborative effort, encompassing multiple research communities from around the globe. To date, OBI has created 2366 classes and 40 relations along with textual and formal definitions. The OBI Consortium maintains a web resource providing details on the people, policies, and issues being addressed in association with OBI. (shrink)

Researchers and practitioners are increasingly using machine‐generated synthetic data as a tool for advancing health science and practice, by expanding access to health data while—potentially—mitigating privacy and related ethical concerns around data sharing. While using synthetic data in this way holds promise, we argue that it also raises significant ethical, legal, and policy concerns, including persistent privacy and security problems, accuracy and reliability issues, worries about fairness and bias, and new regulatory challenges. The virtue of synthetic data is often understood (...) to be its detachment from the data subjects whose measurement data is used to generate it. However, we argue that addressing the ethical issues synthetic data raises might require bringing data subjects back into the picture, finding ways that researchers and data subjects can be more meaningfully engaged in the construction and evaluation of datasets and in the creation of institutional safeguards that promote responsible use. (shrink)

Introduction Deep brain stimulation (DBS) is approved under a humanitarian device exemption to manage treatment-resistant obsessive-compulsive disorder (TR-OCD) in adults. It is possible that DBS may be trialed or used clinically off-label in children and adolescents with TR-OCD in the future. DBS is already used to manage treatment-resistant childhood dystonia. Evidence suggests it is a safe and effective intervention for certain types of dystonia. Important questions remain unanswered about the use of DBS in children and adolescents with TR-OCD, including whether (...) mental health clinicians would refer pediatric patients for DBS, and who would be a good candidate for DBS.Objectives To explore mental health clinicians’ views on what clinical and psychosocial factors they would consider when determining which children with OCD would be good DBS candidates.Materials and Methods In depth, semi-structured interviews were conducted with n = 25 mental health clinicians who treat pediatric patients with OCD. The interviews were transcribed, coded, and analyzed using thematic content analysis. Three questions focused on key, clinical, and psychosocial factors for assessing candidacy were analyzed to explore respondent views on candidacy factors. Our analysis details nine overarching themes expressed by clinicians, namely the patient’s previous OCD treatment, OCD severity, motivation to commit to treatment, presence of comorbid conditions, family environment, education on DBS, quality of life, accessibility to treatment, and patient age and maturity.Conclusions Clinicians generally saw considering DBS treatment in youth as a last resort and only for very specific cases. DBS referral was predominantly viewed as acceptable for children with severe TR-OCD who have undertaken intensive, appropriate treatment without success, whose OCD has significantly reduced their quality of life, and who exhibit strong motivation to continue treatment given the right environment. Appropriate safeguards, eligibility criteria, and procedures should be discussed and identified before DBS for childhood TR-OCD becomes practice. (shrink)

Businesses often attempt to demonstrate their commitment to diversity, equity, and inclusion (DEI) by showcasing women in their leadership ranks, most of whom are white. Yet research has shown that organizations confer status and power to women who engage in sexist behavior, which undermines DEI efforts. We sought to examine whether women who engage in racist behavior are also conferred relative status at work. Drawing on theory and research on organizational culture and intersectionality, we predicted that a white woman who (...) expresses anti-Black racism is conferred more status in the workplace than a white woman who does not. A pilot study (N = 30) confirmed that making an anti-Black racist comment at work was judged to be more offensive than making no comment, but only for a white man, not a white woman. Study 1 (N = 330) found that a white woman who made an anti-Black racist comment at work was conferred higher status than a white woman who did not, whereas the opposite held true for a white man, with perceived offensiveness mediating these effects. Study 2 (N = 235) revealed that a white woman who made an anti-racist/pro-Black Lives Matter comment was conferred lower status than a white woman who did not, whereas the opposite held true for a white man. Finally, Study 3 (N = 295) showed that people who endorse racist and sexist beliefs confer more status to a white man than to a white woman regardless of speech, but that people low in racism and sexism confer the highest status to a white woman who engages in anti-Black racist speech. These studies suggest that white women are rewarded for expressing support for beliefs that mirror systemic inequality in the corporate world. We discuss implications for business ethics and directions for future research. (shrink)

We sought to evaluate whether health care professionals’ viewpoints differed on the role of ethics committees and hospitals in the resolution of clinical ethical dilemmas based on practice location. We conducted a survey study from December 21, 2013 to March 15, 2014 of health care professionals at six hospitals. The survey consisted of eight clinical ethics cases followed by statements on whether there was a role for the ethics committee or hospital in their resolution, what that role might be and (...) case specific queries. Respondents used a 5-point Likert scale to express their degree of agreement with the premises posed. We used the ANOVA test to evaluate whether respondent views significantly varied based on practice location. 240 health care professionals completed the survey. Only three individual queries of 32 showed any significant response variations across practice locations. Overall, viewpoints did not vary across practice locations within question categories on whether the ethics committee or hospital had a role in case resolution, what that role might be and case specific queries. In this multicenter survey study, the viewpoints of health care professionals on the role of ethics committees or hospitals in the resolution of clinical ethics cases varied little based on practice location. (shrink)

Researchers and practitioners are increasingly using machine-generated synthetic data as a tool for advancing health science and practice, by expanding access to health data while—potentially—mitigating privacy and related ethical concerns around data sharing. While using synthetic data in this way holds promise, we argue that it also raises significant ethical, legal, and policy concerns, including persistent privacy and security problems, accuracy and reliability issues, worries about fairness and bias, and new regulatory challenges. The virtue of synthetic data is often understood (...) to be its detachment from the data subjects whose measurement data is used to generate it. However, we argue that addressing the ethical issues synthetic data raises might require bringing data subjects back into the picture, finding ways that researchers and data subjects can be more meaningfully engaged in the construction and evaluation of datasets and in the creation of institutional safeguards that promote responsible use. (shrink)

Virtue and the Moral Life brings together distinguished philosophers and theologians with younger scholars of consummate promise to produce ten essays that engage both academics and students of ethics. This collection explores the role virtues play in identifying the good life and the good society.

Given the need for enforceable guardrails for artificial intelligence (AI) that protect the public and allow for innovation, the U.S. Government recently issued a Blueprint for an AI Bill of Rights which outlines five principles of safe AI design, use, and implementation. One in particular, the right to notice and explanation, requires accurately informing the public about the use of AI that impacts them in ways that are easy to understand. Yet, in the healthcare setting, it is unclear what goal (...) the right to notice and explanation serves, and the moral importance of patient-level disclosure. We propose three normative functions of this right: (1) to notify patients about their care, (2) to educate patients and promote trust, and (3) to meet standards for informed consent. Additional clarity is needed to guide practices that respect the right to notice and explanation of AI in healthcare while providing meaningful benefits to patients. (shrink)

In another tumultuous term of the United States Supreme Court in 2022-2023 a series of critical cases implicate instant and forthcoming changes in multiple fronts that collectively shift the national public health law and policy environment.

Three decades of concern over consumption of potentially contaminated Great Lakes fish has led government agencies and public health proponents to implement risk assessment and management programs as a means of protecting the health of fishers and their families. While well-meaning in their intent, these programs––and much of the research conducted to support and evaluate them––were not designed to accommodate the understandings and concerns of the fish consumer. Results from a qualitative component of a multi-disciplinary, multi-year research project (...) on frequent (average 108 meals per year) consumers of Great Lakes fish tell the fishers’ side of the story. We present data from 87 tape recorded interviews conducted with Vietnamese, Chinese, and English-speaking participants that underscore the quality of freshly caught Great Lakes fish and the important social and cultural benefits of fish and fishing to the consumer. We also outline the participants’ understandings of risk from eating Great Lakes fish and the way in which fishers and their families manage this risk. The paper concludes with a discussion of these benefits, risks, and risk management strategies as ways that Great Lakes fish consumers “construct” rather than “perceive” risk. We advocate for risk assessment and management protocols that involve those who will be affected the most, such as frequent consumers of Great Lakes fish, from the initial “risk characterization” stage through to any necessary risk communication. (shrink)

In a “mixed bag” 2023-2024 session, the U.S. Supreme Court issued a series of decisions both favorable and antithetical to public health and safety. Taking on tough constitutional issues implicating gun control, misinformation, and homelessness, the Court also avoided substantive reviews in favor of procedural dismissals in key cases involving reproductive rights and government censorship.

A deluge of state “anti-equity” legislative bills seek to reverse prevailing trends in diversity, equity, and inclusion; withdraw protections of LGBTQ+ communities; and deny access to gender-based care for trans minors and adults. While the political and constitutional fate of these acts is undetermined, profound impacts on patients and their providers are already affecting the delivery of health care and public health services.

This volume examines some of the most contentious social justice issues present in the corpus of Augustine's writings. Whether one is concerned with human trafficking and the contemporary slave trade, the global economy, or endless wars, these essays further the conversation on social justice as informed by the writings of Augustine of Hippo.

Robin et al. (1996) suggested a new construct when studying ethical behavioral intention which they entitled PIE (perceived importance). They empirically tested the PIE construct and found it to significantly impact both ethical judgment and behavioral intention. The present study extends and validates Robin et al.s work on PIE using a different context, different scenarios and a different sample. The findings indicate strong support for the validity of Robin et al.s PIE instrument and show PIE to significantly influence ethical judgment (...) (attitude) and behavioral intention. This study also indicates the sex of the individual affects the individuals perception of importance and is a significant influence of ethical judgment and behavioral intention. Future ethical models and studies should include PIE as a possible influence on behavioral intention. (shrink)

Among the morass of critical issues impacting the results of the midterm elections in 2022 were core public health issues related to health care access, justice, and reforms. Collectively, voters’ communal health and safety concerns dominated outcomes in key races which may shape national, state, and local legal approaches to protecting the public’s health in the modern era.

Counterfactual reasoning research typically demonstrates contrast effects—nearly winning evokes frustration, whereas nearly losing evokes exhilaration. The present work, however, describes conditions under which assimilative responses (i.e., when judgements are pulled towards a comparison standard) also occur. Participants solved analogies and learned that they had either nearly attained a target score or nearly failed to attain it. Participants in the no trajectory condition received this feedback in the absence of any prior feedback, whereas those in the trajectory condition received feedback after (...) having received prior feedback conforming to either an ascending or descending pattern. Participants then provided perceptions of their verbal intelligence. Assimilation effects were observed in the trajectory conditions but attenuated in the no trajectory conditions. Discussion focuses on the role of feedback dynamics in determining responses to close-call counterfactuals. (shrink)