In lieu of an abstract, here is a brief excerpt of the content:Benjamin I. Schwartz (1916-1999)Hoyt Cleveland TillmanBenjamin Sadie Schwartz was born on December 12, 1916,1 to Hyman and Jennie Weinberg Schwartz. In the wake of the Depression, this struggling family moved from the immigrant section of East Boston (near what became Logan Airport) to Orchestra, a working-class section of the city. Ben's intelligence and dedication to learning earned him the opportunity to study at Boston Latin, the city's premier (...) high school for talented youths, and he won a scholarship to attend Harvard College in 1934. Because the collegiate life of Harvard's house system was inaccessible to him, Ben commuted daily from home and ate his sack lunches with the other "townies" on the steps outside the buildings in Harvard Yard. The nationalizing experiences of being Jewish and poor surely enhanced his sensitivity to tensions within cultures and sharpened the critical edge of his reflections on elites and their ideologies. Moreover, his own experiences enabled an empathy with economically and culturally disadvantaged students, for he generously extended himself especially to such students during his long teaching career at Harvard, from 1950 through 1987. Indeed, his office door was always open to students, and no one needed an appointment to come to discuss ideas with him. Furthermore, his critical concerns about contemporary trends in society and polity continued to be central to his life as an engaged intellectual even after he had retired from formal teaching duties.After graduating magna cum laude from Harvard College in 1938 with a major in Romance Languages and Literatures, he went on to earn a master's degree from the Harvard Graduate School of Education in 1940. Unable to find a regular teaching position, he worked as a substitute teacher. Blessed with an enduring and profound spirituality, he considered becoming a rabbi. World War II intervened to change his life. Serving as a cryptanalyst from 1942 to 1946 in the Signal Corps, he decoded Japanese military cables; and he worked in 1946-1947 as a censor of the Japanese press during the beginning phase of the American Occupation. He rose to the rank of captain. With the educational benefits extended to veterans, he returned to Harvard, where he initially sought to focus on Buddhism, but his professors discouraged him on the grounds that the field required too many Asian languages for someone to begin in his thirties. He was admonished to focus on modern China, for that field required only that he supplement the Japanese language, which he had gained during his military service, with a reading knowledge of Chinese. He threw himself enthusiastically into reading both modern Chinese and what he referred to as "outbidding classical Chinese" because he loved to read texts to explore cultures and encounter peoples. Within less than three years, he not only earned a master's [End Page 183] in East Asian Studies and a Ph.D. in History and Far Eastern Languages but also became, in 1950, a Harvard instructor in history and government. Rising quickly through the ranks, he was promoted to assistant professor in 1951, associate professor in 1956, and professor in 1960. Moreover, he became widely regarded as "the scholar's scholar" at Harvard's East Asian Research Center.His first book, Chinese Communism and the Rise of Mao (Harvard University Press, 1951), was a revised version of his doctoral dissertation. Modern China scholars have in later years hailed this pioneering work for going against the tide of American political assumptions about Soviet Russian control of the communist movement in China. He demonstrated that Mao had defied Soviet orders and deviated from Soviet plans in struggling to gain power in China; furthermore, Ben also suggested that communism was devolving through expansion. Establishing an intellectual orientation that informed his later work, Ben was also using texts from a movement to explore the conscious life of leading figures and their personalities in the context of concrete historical circumstances and contingencies in order to determine how ideas related to actions. Providing translated texts for others to join the exploration of the interaction between ideology and behavior, he was one of three compilers of A Documentary History of Chinese Communism (Harvard, 1952). He... (shrink)

Women intimately interact with various medical technologies and prosthetic artifacts in the context of breast cancer. While extensive work has been done on the agency of technological artifacts and how they affect users’ perceptions and experiences, the agency of users is largely taken for granted hitherto. In this article, we explore the agency of four women who engage with breast cancer technologies and artifacts by analyzing their narrative accounts of such engagements. This empirical discussion is framed within the tradition of (...) science and technology studies, philosophy of technological mediation and phenomenology of embodied agency as ‘I can/not’. This approach leads to the conclusions that women’s technologically mediated agencies range from being restricted to extended, take place on different bodily levels, within complex temporal structures, and are determined by certain socio-cultural contexts. Furthermore, it reveals that such agency shaping does not imply a one-way conditioning relationship between technologies and users, but rather involves a reciprocal relationship in which both subject and object are co-constituted. We therefore suggest that the ‘material turn’ in philosophy of technology also needs to take into account technologically mediated, material human beings in order to gain a better understanding of human existence. (shrink)

Framed in psychological terms, the basic question of linguistic theory is what is stored in memory, and in what form. Traditionally, what is stored is divided into grammar and lexicon, where grammar contains the rules and the lexicon is an unstructured list of exceptions. We develop an alternative view in which rules of grammar are simply lexical items that contain variables, and in which rules have two functions. In their generative function, they are used to build novel structures, just as (...) in traditional generative linguistics. In their relational function, they capture generalizations over stored items in the lexicon, a role not seriously explored in traditional linguistic theory. The result is a highly structured lexicon with rich patterns among stored items. We further explore the possibility that this sort of structuring is not specific to language, but appears in other cognitive domains as well, such as the structure of physical objects, of music, and of geographical and social knowledge. The differences among cognitive domains do not lie in this overall texture, but in the materials over which stored relations are defined. The challenge is to develop theories of representation in these other domains comparable to that for language. (shrink)

COVID-19 has resulted in extraordinary disruptions to the higher education landscape. Here, we provide a brief report on 295 students’ academic perceptions and emotional well-being in late May 2020. Students reported the high levels of uncertainty regarding their academic futures as well as significant levels of stress and difficulty coping with COVID-19 disruptions. These outcomes were related to the higher levels of neuroticism and an external locus of control. Female students reported worse emotional well-being compared to males, and the students (...) of color reported the significantly higher levels of stress and uncertainty regarding their academic futures compared to White students. These results suggest that some students may be at particular risk for academic stress and poor emotional well-being due to the pandemic and highlight the urgent need for intervention and prevention strategies. (shrink)

When a toddler knows a word, what does she actually know? Many categories have multiple relevant properties; for example, shape and color are relevant to membership in the category banana. How do toddlers prioritize these properties when recognizing familiar words, and are there systematic differences among children? In this study, toddlers viewed pairs of objects associated with prototypical colors. On some trials, objects were typically colored ; on other trials, colors were switched. On each trial, toddlers were directed to find (...) a target object. Overall, recognition was disrupted when colors were switched, as measured by eye movements. Moreover, individual differences in vocabularies predicted recognition differences: Toddlers who say fewer shape-based words were more disrupted by color switches. “Knowing” a word may not mean the same thing for all toddlers; different toddlers prioritize different facets of familiar objects in their lexical representations. (shrink)

Direct to consumer offerings of unproven stem cell interventions is a pressing scientific and policy issue. According to media reports, providers of SCIs have emerged in Canada. This study provides the first systematic scan of Canadian providers and associated trends and claims. The study sample consisted of 15 websites retrieved from a Google™ keyword search. The websites were assessed by a rater using a peer-reviewed coding frame that queried treatment location, stem cell offerings, treatment claims, supporting evidence, and legal and (...) regulatory compliance. A second rater reviewed a subset of the websites for purposes of inter-rater reliability. Disagreements between raters were resolved by consensus. Data collected by the raters was analyzed in SPSS. Physicians are the dominant treatment providers in Canada. Providers operate in urban and semi-urban areas in the most populous provinces. SCIs provided are mainly autologous adult stem cells for multiple conditions including musculoskeletal disorders, spinal cord injury and diabetes. Efficacy and benefits of treatment are prominently and positively portrayed, while risks are not mentioned or portrayed as trivial. Regulatory concerns are not discussed. The involvement of physicians in promoting and providing unproven and unapproved SCIs raises significant ethical, legal and regulatory concerns. Treatment claims and trends appear to contravene applicable professional standards, statutory obligations, and consumer protection laws. While the number of providers observed is still marginal, urgent and proactive regulatory response is needed to prevent proliferation of a potentially exploitative and harmful market for unproven SCIs in Canada. (shrink)

The tension between organizational values and the operation of aged care as a business is often characterized as the “mission versus margin” dilemma. It is common across the industry in both not-for-profit and for-profit organizations. However, in for-profit aged care facilities, there is no question about the intention to make a profit or the purpose of the profits. This is not so clear in not-for-profit aged care organizations. This article explores the tension through the examination of a detailed case study (...) of one of the larger not-for-profit social service organizations—All Saints Christian Care. It analyses the culture and managerial decisions though the lens of the political philosophy value pluralism. Finally, based on the value-plural theory, recommendations are made that would create greater operational transparency in not-for-profit aged care service. (shrink)

Sackris and Beebe (2014) report the results of a series of studies that seem to show that there are cases in which many people are willing to attribute knowledge to a protagonist even when her belief is unjustified. These results provide some reason to conclude that the folk concept of knowledge does not treat justification as necessary for its deployment. In this paper, we report a series of results that can be seen as supporting this conclusion by going some way (...) towards ruling out an alternative account of Sackris and Beebe’s results—the possibility that the knowledge attributions that they witnessed largely stem from protagonist projection, a phenomenon in language use and interpretation in which the speaker uses words that the relevant protagonist might use to describe her own situation and the listener interprets the speaker accordingly. With that said, we do caution the reader against drawing the conclusion too strongly, on the basis of results like those reported here and by Sackris and Beebe. There are alternative possibilities regarding what drives the observed knowledge attributions in cases of unjustified true belief that must be ruled out before, on the basis of such results, we can conclude with much confidence that the folk concept of knowledge does not treat justification as necessary for its deployment. (shrink)

This paper presents the results of five years of research involving three studies. The first two studies investigated the impact of the value honesty/integrity on the ethical decision choice an individual makes, as moderated by the individual personality traits of self-monitoring and private self-consciousness. The third study, which is the focus of this paper, expanded the two earlier studies by varying the level of moral intensity and including the influence of demographical factors and other workplace values: achievement, fairness, and concern (...) for others on the ethical decision process. These studies were designed using a laboratory format and a decision exercise that attempted to establish realistic business conflict situations through decision scenarios. Support is presented for the influence of gender and achievement on ethical choice. Recommendations for the future direction of this stream of research are given. (shrink)

El propósito de este artículo es realizar un análisis de las principales nociones que Wittgenstein elabora en este proceso de transición. La pregunta por resolver será, entonces, cómo Wittgenstein estructura su nueva visión del lenguaje. Para darle respuesta, en el inicio del artículo se trabajará una breve observación respecto al ansia de pureza cristalina, que, de algún modo, fue el plan que marcaba la pauta en la filosofía del Tractatus logico-philosophicus. A continuación, desde la discutida noción del significado como uso, (...) se abordarán los principales elementos que constituyen la nueva concepción del lenguaje del segundo Wittgenstein, a saber: el criterio definidor, los juegos de lenguaje, las formas de vida y los parecidos de familia. Por último, se analizará la relación que esta nueva concepción de lenguaje mantiene con las reglas y con el hecho de seguir una regla. (shrink)

Most children experience some form of grouping in the classroom every day. Understanding how teachers make grouping decisions and their impacts on children’s social development can shed light on effective teacher practices for promoting positive social dynamics in the classroom. This study examined the influence of teachers’ grouping strategies on changes in young children’s social experiences with peers across an academic year. A total of 1,463 children and 79 teachers from kindergarten to third-grade classrooms participated in this study. Teachers rated (...) children’s behavioral problems as the most important consideration when creating seating charts or assigning children to small groups. Promoting existing or new friendships was rated as the least important consideration. Heterogeneous ability grouping, rated as somewhat important by the teachers, was associated with a decrease in children’s friendships and yet also a decrease in girls’ experience with peer conflicts. Our findings begin to fill in the gaps in the literature on the social impacts of ability grouping for young children. (shrink)

Timothy Williamson has argued that the safety condition on knowledge places certain limits on iterations of knowledge. But at the same time, Williamson claims that interpersonal iterations of knowledge aren’t so restricted as to rule out ordinary cases. The present authors show that Williamson’s discussion misconstrues the challenge to iterated interpersonal knowledge. The proper argument against interpersonal iterations is rather what the authors call a third-person argument that does not share the major weaknesses of the argument Williamson considers. The challenge (...) that the safety condition poses to interpersonal iterations of knowledge therefore seems robust, even in ordinary cases. But the authors also identify an underlying assumption that their argument relies on, and they show that Williamson’s original argument as well as his argument against intrapersonal iterations of knowledge rely on analogous assumptions. In assessing the extent of the clash between safety and iterated knowledge, the focus must be on the viability of these assumptions. (shrink)

This qualitative study presents 27 students’ insights about four teachers’ implementation of an immersive Native American history curricular unit designed to equip students with digital skills to critically navigate complex, polarizing social issues. The Digital Civic Learning (DCL) curriculum used Google Suite and Google Classroom or Schoology to provide collaborative slides supporting immersive 2D-graphics, children’s books/resources, immersive activities/artefact-creation, and multimodal tools (e.g., discussion posts, Flipgrid video-essays). Teachers regulated student thinking/behavior towards cohesive outcomes, and encouraged open-ended exploration, operationalizing the design framework (...) as a zone of proximal development (ZPD). The history unit incorporates four cybernetic design features (DF) that enable teachers to steer student-centered collaboration within the curricular unit. The teacher serves four diverse roles (guide, facilitator, modeler, participant observer) mapping onto the DF. Results of focus group interviews with students, which were analyzed based on a theory-informed coding scheme and narrative inquiry, suggest ways for social studies teachers to operationalize the DCL immersive history unit as a cybernetic ZPD by adapting its basic structure to technologies accessible in their schools by adapting its basic structure to technologies accessible in their schools. (shrink)

Previous research has shown that virtuous leader behavior in the form of benevolent leadership has considerable impact on employee creativity. However, little is known as to how and under what conditions these constructs are linked. In the current research, we proposed and tested a moderated mediation model positing leader–member exchange as a mediator, and employee power-distance orientation as a moderator of this relationship. Two studies were conducted to test our hypothesized model. In Study 1, repeated measured data collected from 284 (...) Chinese employees in an information technology company demonstrated that benevolent leadership had a lagged effect on LMX. In Study 2, analyses of multisource and lagged data from 391 Chinese employees in 42 research and development teams, and their direct supervisors indicated that benevolent leadership was positively related to supervisor-rated employee creativity via LMX. In addition, the relationship between benevolent leadership and LMX was stronger for employees high in power-distance orientation. Theoretical implications of benevolent leadership’s research and practical contributions concerning promoting creativity in organizations where benevolent leaders prevail are also discussed. (shrink)

Requirements for business ethics education and organizational ethics trainings mark an important step in encouraging ethical behavior among business students and professionals. However, the lack of specificity in these guidelines as to how, what, and where business ethics should be taught has led to stark differences in approaches and content. The present effort uses meta-analytic procedures to examine the effectiveness of current approaches across organizational ethics trainings and business school courses. to provide practical suggestions for business ethics interventions and research. (...) Thus, the primary questions driving this research are as follows: what course characteristics moderate the effectiveness of ethics instruction?, and have ethics education and training efforts improved? Findings suggest that professional, focused, and workshop-based training programs are especially effective for improving business ethics. However, results also reveal considerable problems with many of the criteria used to evaluate the effectiveness of business ethics interventions. Practical suggestions for course design and evaluation in business ethics efforts are discussed along with future research needs. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work.This work is in the public domain in (...) the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work.As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

During the COVID-19 pandemic, questions have been raised about the impact of face masks on communication in classroom settings. However, it is unclear to what extent visual obstruction of the speaker’s mouth or changes to the acoustic signal lead to speech processing difficulties, and whether these effects can be mitigated by semantic predictability, i.e., the availability of contextual information. The present study investigated the acoustic and visual effects of face masks on speech intelligibility and processing speed under varying semantic predictability. (...) Twenty-six children and twenty-six adults performed an internet-based cued shadowing task, in which they had to repeat aloud the last word of sentences presented in audio-visual format. The results showed that children and adults made more mistakes and responded more slowly when listening to face mask speech compared to speech produced without a face mask. Adults were only significantly affected by face mask speech when both the acoustic and the visual signal were degraded. While acoustic mask effects were similar for children, removal of visual speech cues through the face mask affected children to a lesser degree. However, high semantic predictability reduced audio-visual mask effects, leading to full compensation of the acoustically degraded mask speech in the adult group. Even though children did not fully compensate for face mask speech with high semantic predictability, overall, they still profited from semantic cues in all conditions. Therefore, in classroom settings, strategies that increase contextual information such as building on students’ prior knowledge, using keywords, and providing visual aids, are likely to help overcome any adverse face mask effects. (shrink)

Background Nurses play an integral role in the care of children hospitalised with a serious illness. Although information about diagnostics, treatments, and prognosis are generally conveyed to parents and caregivers of seriously ill children by physicians, nurses spend a significant amount of time at the child’s bedside and have an acknowledged role in helping patients and families understand the information that they have been given by a doctor. Hence, the ethical role of the nurse in truth disclosure to children is (...) worth exploring. Methods A systematic academic database and grey literature search strategy was conducted using CINAHL, Medline Psych Info, and Google Scholar. Keywords used included truth, children, nurse, disclosure, serious illness, and communication. A total of 17 publications of varying types were included in the final data set. Ethical Considerations As this was a review of the literature, there were no direct human participants. Empirical studies included in the review had received ethics approval. Results Of the 17 articles included in the review, only one directly reported on the experiences of nurses asked to withhold the truth from patients. Empirical studies were limited to HIV-positive children and children diagnosed with cancer and the dying child. Conclusion A paucity of literature exploring the experiences, attitudes, and beliefs of nurses with regard to truth-telling to seriously ill children is evident. Little consideration has been given to the role nurses play in communicating medical information to children in a hospital setting. The 17 articles included in the review focused on cancer, and HIV, diagnosis, and end-of-life care. Further research should be undertaken to explore the experiences and attitudes of nurses to clinical information sharing to children hospitalised with a wide range of serious illnesses and in diverse clinical scenarios. (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)

While having a breast reconstruction, women have certain expectations about their future breasted bodies. The aim of this paper is to describe and analyze these expectations in the process of reconstruction. By applying a qualitative, phenomenological study within a longitudinal research design, this paper acknowledges the temporarily complex, contextualized, embodied, and subjective nature of the phenomenon of expectations. The analysis identified expectations regarding three different aspects of women’s embodiment: their gazed body, their capable/practical body, and their felt body. After reconstruction, (...) these women try to reconfigure—adjust, level or retrospectively rewrite—their expectations. Further, some women face what apparently arrives totally unexpected, namely a strange feeling breast or a failed reconstruction. The development of these women’s expectations can be understood as an active, continuously evolving, difficult and sometimes impossible dynamic of expecting the surprise that is a breast reconstruction. Within this dynamic, women formulate and reconfigure—by definition—unrealistic expectations and validate and try to achieve unexpected futures. We suggest that medical professionals can facilitate this dynamic in various ways. (shrink)

The relationship between mental models and ethical decision making, along with the mechanisms through which mental models affect EDM, are not well understood. Using the sensemaking approach to EDM, we empirically tested the relationship of mental models to EDM. Participants were asked to depict their mental models in response to an ethics case to reveal their understanding of the ethical dilemma, and then provide a response, along with a rationale, to a different ethical problem. Findings indicated that complexity of respondents’ (...) mental models was related to EDM, and that this relationship was mediated by sensemaking processes. The implications of these findings for improving integrity training in organizations, as well as ultimately understanding the role of mental models in EDM, are discussed. (shrink)

Biobanks correspond to different situations: research and technological development, medical diagnosis or therapeutic activities. Their status is not clearly defined. We aimed to investigate human biobanking in Europe, particularly in relation to organisational, economic and ethical issues in various national contexts. Data from a survey in six EU countries were collected as part of a European Research Project examining human and non-human biobanking. A total of 147 institutions concerned with biobanking of human samples and data were investigated by questionnaires and (...) interviews. Most institutions surveyed belong to the public or private non-profit-making sectors, which have a key role in biobanking. This activity is increasing in all countries because few samples are discarded and genetic research is proliferating. Collections vary in size, many being small and only a few very large. Their purpose is often research, or research and healthcare, mostly in the context of disease studies. A specific budget is very rarely allocated to biobanking and costs are not often evaluated. Samples are usually provided free of charge and gifts and exchanges are the common rule. Good practice guidelines are generally followed and quality controls are performed but quality procedures are not always clearly explained. Associated data are usually computerised. Biobankers generally favour centralisation of data rather than of samples. Legal and ethical harmonisation within Europe is considered likely to facilitate international collaboration. We propose a series of recommendations and suggestions arising from the EUROGENBANK project. (shrink)

This volume focuses on Maurice Merleau-Ponty’s important contribution to the phenomenology of corporeity and affectivity, and it explores the various influences his work had and still has on other disciplines.

Traditional whistleblowing theories have purported that whistleblowers engage in a rational process in determining whether or not to blow the whistle on misconduct. However, stressors inherent to whistleblowing often impede rational thinking and act as a barrier to effective whistleblowing. The negative impact of these stressors on whistleblowing may be made worse depending on who engages in the misconduct: a peer or advisor. In the present study, participants are presented with an ethical scenario where either a peer or advisor engages (...) in misconduct, and positive and the negative consequences of whistleblowing are either directed to the wrongdoer, department, or university. Participant responses to case questions were evaluated for whistleblowing intentions, moral intensity, metacognitive reasoning strategies, and positive and negative, active and passive emotions. Findings indicate that participants were less likely to report the observed misconduct of an advisor compared to a peer. Furthermore, the findings also suggest that when an advisor is the source of misconduct, greater negative affect results. Post-hoc analyses were also conducted examining the differences between those who did and did not intend to blow the whistle under the circumstances of either having to report an advisor or peer. The implications of these findings for understanding the complexities involved in whistleblowing are discussed. (shrink)

Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians’ and nurses’ perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis (...) was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient’s decision-making process, The challenge awaiting the family members’ processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient’s possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context. (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)

This research explores temporal concept drift and temporal alignment in knowledge organization systems. A comparative analysis is pursued using the 1910 Library of Congress Subject Headings, 2020 FAST Topical, and automatic indexing. The use case involves a sample of 90 nineteenth-century Encyclopedia Britannica entries. The entries were indexed using two approaches: 1) full-text indexing; 2) Named Entity Recognition was performed upon the entries with Stanza, Stanford’s NLP toolkit, and entities were automatically indexed with the Helping Interdisciplinary Vocabulary application, using both (...) 1910 LCSH and FAST Topical. The analysis focused on three goals: 1) identifying results that were exclusive to the 1910 LCSH output; 2) identifying terms in the exclusive set that have been deprecated from the contemporary LCSH, demonstrating temporal concept drift; and 3) exploring the historical significance of these deprecated terms. Results confirm that historical vocabularies can be used to generate anachronistic subject headings representing conceptual drift across time in KOS and historical resources. A methodological contribution is made demonstrating how to study changes in KOS over time and improve the contextualization historical humanities resources. (shrink)

Some transgender and nonbinary people undergo phalloplasty and/or metoidioplasty as part of their medical transition process. Across surgical disciplines, a variety of resources are used to assist patients who are preparing for surgeries, including educational materials, workshops, peer support, and lifestyle changes. For gender-affirming surgeries, patients undergoing assessments to discern whether they are ready to undergo the surgery, and to assist them in achieving preparedness when needed. Little research investigates what resources are useful in helping patients to feel prepared to (...) undergo phalloplasty or metoidioplasty, and how assessments and resources can promote patient autonomy in the process. Respect for patient autonomy is one of the central tenets of ethical healthcare, yet historically, scholarship related to pre-surgical assessments for gender-affirming surgery has focused determining the ideal surgical candidate rather than respecting patient autonomy and ascertaining individual patient needs. This study sought to fill this gap by utilizing data from PROGRESS (Patient-Reported Outcomes of Genital Reconstruction and Experiences of Surgical Satisfaction), a cross-sectional, community-based survey of trans and nonbinary adults from the United States of America and Canada who had undergone one or more of these surgeries. Results revealed most participants (86%, n = 186) felt prepared to undergo surgery, though the majority of our sample (53%, n = 105) did not find referral letter assessments to be helpful. Peer support such as online resources/blogs were rated as highly useful, along with surgical consults. In a multivariable logistic regression, higher perceived preparedness was associated with identifying as queer (inclusive of gay, bi and pansexual compared to being straight), and feeling that one’s assessment process was useful (as opposed to not useful). Type of assessment was not significantly associated with preparedness; therefore, what is most useful when preparing for surgery may vary across individuals. Healthcare professionals who interact with preparing patients should develop new or utilize existing resources to assist patients in identifying their preparation needs and achieving preparedness. Our data supports assessments that center surgical care planning rather than assessing level of gender dysphoria. Future longitudinal research could further refine which assessment processes are most effective in helping patients who are preparing for these surgeries. Assessments should ensure that patients are appropriately prepared to undergo and recover from surgery through a robust process of informed consent. (shrink)