This article examines five different Medical-Legal Partnerships associated with Yale Law School in New Haven, Connecticut to illustrate how MLP addresses the social determinants of poor health. These MLPs address varied and distinct health and legal needs of unique patient populations, including: 1) children; 2) immigrants; 3) formerly incarcerated individuals; 4) patients with cancer in palliative care; and 5) veterans. The article charts a research agenda to create the evidence base for quality and evaluation metrics, capacity building, sustainability, and best (...) practices; it also focuses specifically on a research agenda that identifies the value of the lawyers in MLP. Such a focus on the “L” has been lacking and is overdue. (shrink)

Specialists and primary care physicians play an integral role in treating the twin epidemics of pain and addiction. But inadequate access to specialists causes much of the treatment burden to fall on primary physicians. This article chronicles the differences between treatment contexts for both pain and addiction — in the specialty and primary care contexts — and derives a series of reforms that would empower primary care physicians and better leverage specialists.

This paper sheds light on the role of digital platform labour in the development of today’s artificial intelligence, predicated on data-intensive machine learning algorithms. Focus is on the specific ways in which outsourcing of data tasks to myriad ‘micro-workers’, recruited and managed through specialized platforms, powers virtual assistants, self-driving vehicles and connected objects. Using qualitative data from multiple sources, we show that micro-work performs a variety of functions, between three poles that we label, respectively, ‘artificial intelligence preparation’, ‘artificial intelligence verification’ (...) and ‘artificial intelligence impersonation’. Because of the wide scope of application of micro-work, it is a structural component of contemporary artificial intelligence production processes – not an ephemeral form of support that may vanish once the technology reaches maturity stage. Through the lens of micro-work, we prefigure the policy implications of a future in which data technologies do not replace human workforce but imply its marginalization and precariousness. (shrink)

The increasing complexity of human subjects research and its oversight has prompted researchers, as well as institutional review boards, to have a forum in which to discuss challenging or novel ethical issues not fully addressed by regulations. Research ethics consultation services provide such a forum. In this article, we rely on the experiences of a national Research Ethics Consultation Collaborative that collected more than 350 research ethics consultations in a repository and published 18 challenging cases with accompanying ethical commentaries to (...) highlight four contexts in which REC can be a valuable resource. REC assists: 1) investigators before and after the regulatory review; 2) investigators, IRBs, and other research administrators facing challenging and novel ethical issues; 3) IRBs and investigators with the increasing challenges of informed consent and risk/benefit analysis; and 4) in providing flexible and collaborative assistance to overcome study hurdles, mediate conflicts within a team, or directly engage with research participants. Institutions that have established, or plan to establish, REC services should work to raise the visibility of their service and engage in open communication with existing clinical ethics consult services as well as the IRB. While the IRB system remains the foundation for the ethical review of research, REC can be a valuable service for investigators, regulators, and research participants aligned with the goal of supporting ethical research. (shrink)

Although rationing by clinical judgment is controversial, its acceptability partly depends on how it is practiced. In this paper, rationing by clinical judgment is defined in three different circumstances that represent increasingly wider circles of resource pools in which the rationing decision takes place: triage during acute shortage, comparison to other potential patients in a context of limited but not immediately strained resources, and determination of whether expected benefit of an intervention is deemed sufficient to warrant its cost by reference (...) to published population based thresholds. Notions of procedural justice are applied along with an analytical framework of six minimal requisites in order to facilitate fair bedside rationing: (1) a closed system that offers reciprocity, (2) attention to general concerns of justice, (3) respect for individual variations, (4) application of a consistent process, (5) explicitness, and (6) review of decisions. The process could be monitored for its applicability and appropriateness. (shrink)

The aim of J.-L. Marion’s article is to revisit the important debate on the place of Augustine in the history of metaphysics. Often, quibbles arise upon considering the use of substance (substantia) by Augustine, not only as approximative of essentia and as synonymous with ousia, but in deciding whether in so doing Augustine effectuates a ‘metaphysical turn’. While he elsewhere argues that Augustine is a pre-metaphysical thinker, in this article Marion focuses on showing the diverse range of usages (...) of the term substance in the Augustinian corpus. Marion observes: first, whenever substance seems a fixed definition, the term allows for equivocity; second, God is substance in an indeterminate sense or by negation; third, human beings are substances fundamentally to capture the mutability of human existence. As such, Marion concludes, the Augustinian use of substance is insufficient to inelude Augustine in the history of metaphysics. (shrink)

The spacing effect is among the most widely replicated empirical phenomena in the learning sciences, and its relevance to education and training is readily apparent. Yet successful applications of spacing effect research to education and training is rare. Computational modeling can provide the crucial link between a century of accumulated experimental data on the spacing effect and the emerging interest in using that research to enable adaptive instruction. In this paper, we review relevant literature and identify 10 criteria for rigorously (...) evaluating computational models of the spacing effect. Five relate to evaluating the theoretic adequacy of a model, and five relate to evaluating its application potential. We use these criteria to evaluate a novel computational model of the spacing effect called the Predictive Performance Equation. Predictive Performance Equation combines elements of earlier models of learning and memory including the General Performance Equation, Adaptive Control of Thought—Rational, and the New Theory of Disuse, giving rise to a novel computational account of the spacing effect that performs favorably across the complete sets of theoretic and applied criteria. We implemented two other previously published computational models of the spacing effect and compare them to PPE using the theoretic and applied criteria as guides. (shrink)

Excessive prescribing of pain medications after surgery has contributed to the epidemic of opioid misuse and diversion in the United States. Pain specialists may be particularly well situated to address these issues. We describe an attempt to reverse the trend at an orthopedic surgical hospital by implementing a peri-operative assessment and treatment service which minimizes preoperative opioid use, when necessary implements addiction treatment, and encourages early tapering from opioids.

The purpose of this paper is to describe the nature of dental practice and to identify some recent innovations which have effect on cost containment in dentistry. The first of these innovations is dental insurance or prepaid dental services. Dental insurance has only recently emerged as a significant economic factor. The chronic and prevalent nature of dental disease mandates that the management of these programs incorporate insurance devices which limit demand and utilization. These devices amount to cost containment measures. The (...) second factor to be discussed is advertising. Advertising has been foisted on the dental profession by recent rulings of the Federal Trade Commission in an effort to promote competition. The Reagan administration, despite a market oriented approach to health care, had attempted to blunt some of the FTC actions. Advertising, nevertheless, has the potential to stimulate competition and restrain price escalation. The third factor includes a discussion of alternative delivery systems. These commercially oriented dental enterprises have the potential to compete with established practices as well as increase the demand for services. (shrink)

Clinical ethics support services are developing in Europe. They will be most useful if they are designed to match the ethical concerns of clinicians. We conducted a cross-sectional mailed survey on random samples of general physicians in Norway, Switzerland, Italy, and the UK, to assess their access to different types of ethics support services, and to describe what makes them more likely to have used available ethics support. Respondents reported access to formal ethics support services such as clinical ethics committees (...) (23%), consultation in individual cases (17.6%), and individual ethicists (8.8%), but also to other kinds of less formal ethics support (23.6%). Access to formal ethics support services was associated with work in urban hospitals. Informal ethics resources were more evenly distributed. Although most respondents (81%) reported that they would find help useful in facing ethical difficulties, they reported having used the available services infrequently (14%). Physicians with greater confidence in their knowledge of ethics (P = 0.001), or who had had ethics courses in medical school (P = 0.006), were more likely to have used available services. Access to help in facing ethical difficulties among general physicians in the surveyed countries is provided by a mix of official ethics support services and other resources. Developing ethics support services may benefit from integration of informal services. Development of ethics education in medical school curricula could lead to improved physicians sensititity to ethical difficulties and greater use of ethics support services. Such support services may also need to be more proactive in making their help available. (shrink)

As a contribution to a wider discussion on moral discernment in theological anthropology, this paper seeks to answer the question “What is the impact of mental illness on an individual’s ability to make moral decisions?” Written from a clinical psychiatric perspective, it considers recent contributions from psychology, neuropsychology and imaging technology. It notes that the popular conception that mental illness necessarily robs an individual of moral responsibility is largely unfounded. Most people who suffer from mental health problems do not lose (...) the capacity to make moral decisions, and mental illness on its own rarely explains anti-social or criminal behaviour. Moreover, the assumptions of some scientists, that recent developments in neuropsychology and brain imaging suggest biological determinism, must be treated with caution. (shrink)

Examines the relationship between the question of God and the destiny of metaphysics. Concept of the end of metaphysics; Ambiguous relation between phenomenology and metaphysics; Return of special metaphysics in phenomenology; Phenomenological figure of God. Examines the relationship between the question of God and the destiny of metaphysics. Concept of the end of metaphysics; Ambiguous relation between phenomenology and metaphysics; Return of special metaphysics in phenomenology; Phenomenological figure of God.

To function well in an unpredictable environment using unreliable components, a system must have a high degree of robustness. Robustness is fundamental to biological systems and is an objective in the design of engineered systems such as airplane engines and buildings. Cognitive systems, like biological and engineered systems, exist within variable environments. This raises the question, how do cognitive systems achieve similarly high degrees of robustness? The aim of this study was to identify a set of mechanisms that enhance robustness (...) in cognitive systems. We identify three mechanisms that enhance robustness in biological and engineered systems: system control, redundancy, and adaptability. After surveying the psychological literature for evidence of these mechanisms, we provide simulations illustrating how each contributes to robust cognition in a different psychological domain: psychomotor vigilance, semantic memory, and strategy selection. These simulations highlight features of a mathematical approach for quantifying robustness, and they provide concrete examples of mechanisms for robust cognition. (shrink)

One of the most striking findings of the study by Foglia and colleagues (2009) was that clinicians and managers were most concerned with limited resources while ethics committee chairpersons focuse...

The devastating impact of the national opioid epidemic has given rise to hundreds of lawsuits. This article details the extremely broad range of legal claims, compares the opioid cases to other public health litigation efforts, including tobacco, and describes the special mechanism — a multidistrict litigation — through which more than 700 opioid-related cases have been consolidated thus far, with settlement almost certain to follow.

The required professional and ethical pronouncements of accountants mean that auditors need to be competent and exercise due care and skill in the performance of their audits. In this study, we examine what happens when auditors take on more clients than they should, thus raising doubts about their ability to maintain competence and audit quality. Using 2803 observations of Malaysian companies from 2010 to 2013, we find that auditors with multiple clients are associated with lower earnings quality, proxied by total (...) accruals and discretionary accruals. Our results demonstrate that associating client firms’ reported discretionary accruals with individual auditors, rather than their firms or offices, is important in determining audit quality. Moreover, we demonstrate that the disclosure of auditors’ signatures on their reports is useful for assessing auditor quality at the individual level, thus contributing to the debate on the usefulness of having auditor identities on reports. (shrink)

In this paper we provide an interpretation of Aristotle's rule for the universal quantifier in Topics Θ 157a34–37 and 160b1–6 in terms of Paul Lorenzen's dialogical logic. This is meant as a contribution to the rehabilitation of the role of dialectic within the Organon. After a review of earlier views of Aristotle on quantification, we argue that this rule is related to the dictum de omni in Prior Analytics A 24b28–29. This would be an indication of the dictum’s origin in (...) the context of dialectical games. One consequence of our approach is a novel explanation of the doctrine of the existential import of the quantifiers in dialectical terms. After a brief survey of Lorenzen's dialogical logic, we offer a set of rules for dialectical games based on previous work by Castelnérac and Marion, to which we add here the rule for the universal quantifier, as interpreted in terms of its counterpart in dialogical logic. We then give textual evidence of the use of that rule in Plato's dialogues, thus showing that Aris... (shrink)

Following on from _A Life of One’s Own_ and _An Experiment in Leisure_, _Eternity’s Sunrise_ explores Marion Milner’s way of keeping a diary. Recording small private moments, she builds up a store of ‘bead memories.’ A carved duck, a sprig of asphodel, moments captured in her travels in Greece, Kashmir and Israel, circus clowns, a painting _-_ each makes up a 'bead' that has a warmth or glow which comes in response to asking the simple question: What is the (...) most important thing that happened yesterday? From these beads – sacred, horrific, profane, funny – grows a sense of an ‘answering activity’, the result of turning one’s attention inwards to experience real joy. What Marion Milner conveys so vividly and inspirationally is her lifelong intention to live as completely as possible in the moment. With a new introduction by Hugh Haughton, _Eternity’s Sunrise_ will be essential reading for all those interested in reflecting on the nature of their own happiness – whether readers from a literary, an artistic, a historical, an educational or a psychoanalytic/psychotherapeutic background. (shrink)

The question of responsibility plays a critical role not only in our attempts to resolve social and political problems, but in our very conceptions of what those problems are. Who, for example, is to blame for apartheid in South Africa? Is the South African government responsible? What about multinational corporations that do business there? Will uncovering the "true facts of the matter" lead us to the right answer? In an argument both compelling and provocative, Marion Smiley demonstrates how attributions (...) of blame—far from being based on an objective process of factual discovery—are instead judgments that we ourselves make on the basis of our own political and social points of view. She argues that our conception of responsibility is a singularly modern one that locates the source of blameworthiness in an individual's free will. After exploring the flaws inherent in this conception, she shows how our judgments of blame evolve out of our configuration of social roles, our conception of communal boundaries, and the distribution of power upon which both are based. The great strength of Smiley's study lies in the way in which it brings together both rigorous philosophical analysis and an appreciation of the dynamics of social and political practice. By developing a pragmatic conception of moral responsibility, this work illustrates both how moral philosophy can enhance our understanding of social and political practices and why reflection on these practices is necessary to the reconstruction of our moral concepts. (shrink)

Feminist social theory and female body experience are the twin themes of Iris Marion Young's twelve outstanding essays written over the past decade and brought together here. Her contributions to social theory raise critical questions about women and citizenship, the relations of capitalism and women's oppression, and the differences between a feminist theory that emphasizes women's difference and one that assumes a gender-neutral humanity. Loosely following a phenomenological method of description, Young's essays on female embodiment discuss female movement, pregnancy, (...) clothing, and the breasted body. In an introduction that situates her work in the context of shifts in feminist theory and politics over the past decade, Young emphasizes the rootedness of her theorizing in a dedicated and seasoned political activism. (shrink)

Iris Marion Young (1949-2006) was one of the most influential and innovative political theorists of her generation who had a significant impact on a wide range of topics such as democratic theory, feminist theory, and justice. She bridged many longstanding divides among political theorists, engaging in Continental and critical theory, but also insisting on the importance of normative argument: her corpus stands as a testament to the fruitfulness of engaging in both abstract theory and the 'real world' of everyday (...) politics. This volume spans the several decades of her work, illustrating her intellectual development over time through three major areas of innovation: Gender: Maintaining that gender is both conceptually and politically meaningful, Young theorized gender in terms of structures that, in combination, position different people we call "women" in different ways, such that some women have some structures in common, without all women sharing all gendered structures in common. Justice: Young's early writings on a critical theory of justice evolved in her later and posthumously published works where she developed an account of justice that brought together her theorization of structure with her concern to respond to contemporary claims of injustice. The Politics of Difference: Young rejected universal and abstract theories of justice and maintained that justice instead required attending to the experiences of people marked by difference. (shrink)

Many analogies exist between the process of evolution by natural selection and of learning by reinforcement and punishment. A full extension of the evolutionary analogy to learning to include analogues of the fitness, genotype, development, environmental influences, and phenotype concepts makes possible a single theory of the learning process able to encompass all of the elementary procedures known to yield learning.

As pressures increase to contain growing healthcare expenditures, there is currently a prominent rise in the shift of healthcare costs to patients in the form of deductibles, co-pays, and co-insurance. Rising co-payments are part of a larger picture of increasing overall out-of-pocket healthcare expenditures. From 1990 to 2000, per capita out-of-pocket payments for healthcare reached $707 in the United States, and doubled in several European countries with universal health insurance, reaching $396 in Denmark, $290 in Germany, and $466 in Italy (...) in 2000. (shrink)

Along with Husserl's Ideas and Heidegger's Being and Time, Being Given is one of the classic works of phenomenology in the twentieth century. Through readings of Kant, Husserl, Heidegger, Derrida, and twentieth-century French phenomenology (e.g., Merleau-Ponty, Levinas, and Henry), it ventures a bold and decisive reappraisal of phenomenology and its possibilities. Its author's most original work to date, the book pushes phenomenology to its limits in an attempt to redefine and recover the phenomenological ideal, which the author argues has never (...) been realized in any of the historical phenomenologies. Against Husserl's reduction to consciousness and Heidegger's reduction to Dasein, the author proposes a third reduction to givenness, wherein phenomena appear unconditionally and show themselves from themselves at their own initiative. Being Given is the clearest, most systematic response to questions that have occupied its author for the better part of two decades. The book articulates a powerful set of concepts that should provoke new research in philosophy, religion, and art, as well as at the intersection of these disciplines. Some of the significant issues it treats include the phenomenological definition of the phenomenon, the redefinition of the gift in terms not of economy but of givenness, the nature of saturated phenomena, and the question “Who comes after the subject?” Throughout his consideration of these issues, the author carefully notes their significance for the increasingly popular fields of religious studies and philosophy of religion. Being Given is therefore indispensable reading for anyone interested in the question of the relation between the phenomenological and the theological in Marion and emergent French phenomenology. (shrink)

Despite becoming one of the most active research areas in organizational behavior, the field of organizational justice has stayed at a safe distance from moral questions of values, as well as from critical questions regarding the implications of fairness considerations on the status quo of power relations in today’s organizations. We argue that both organizational justice research and the managerial practices it informs lack reflexivity. This manifests itself in two possible hypocrisies of fairness. Managers may apply organizational justice knowledge but (...) fail to increase the actual levels of fairness in employment relations. Researchers, on the other hand, may claim to promote fairness through their work while actually providing managers with tools that enable or even encourage them to feed the hypocrisy of fairness identified above. As␣part of our argument, we identify three types of mechanisms managers may use to influence and manage the formation of fairness perceptions. We consider how the exercise of power is related to the potential application of organizational justice knowledge across individual, interpersonal and social levels. Our approach makes power dynamics and moral implications salient, and questions the purely subjectivist view of justice researchers that deliberately discards normative aspects. The questions opened up by considering alternative mechanisms for creating fairness perceptions have led us to formulate a research agenda for organizational justice research that takes multiple stakeholder interests, power dynamics and ethical implications into account. We believe that the fields of organizational justice and normative justice can benefit from combined research. (shrink)

It is correctly asserted that the intensity of the current debate over the use of animals in biomedical research is unprecedented. The extent of expressed animosity and distrust has stunned many researchers. In response, researchers have tended to take a strategic defensive posture, which involves the assertion of several abstract positions that serve to obstruct resolution of the debate. Those abstractions include the notions that the animal protection movement is trivial and purely anti-intellectual in scope, that all science is good (...) (and some especially so), and the belief that an ethical consensus can never really be reached between the parties. (shrink)

This note provides a definition of evolution by natural selection that is compatible with the extended evolutionary synthesis.

Marion Milner introduces this edited collection of her papers from 1942 to 1977 with a fascinating biographical account of her development in psychoanalysis. The collection includes her classic papers on symbolism.

Theory of mind competence and knowledge of emotions were studied longitudinally in a sample of preschoolers aged 3 (n=263) and 4 (n=244) years. Children were assessed using standard measures of theory of mind and emotion knowledge. Three competing hypotheses were tested regarding the developmental associations between children's theory of mind abilities and their knowledge of emotions. First, that an understanding of emotion develops early and informs children's understanding of others’ thinking. Alternatively, having a basic theory of mind may help children (...) learn about emotions. Third, that the two domains are separate aspects of children's social cognitive skills such that each area develops independently. Results of hierarchical regressions supported the first hypothesis that early emotion understanding predicts later theory-of-mind performance, and not the reverse. (shrink)

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

DREAM complexes are transcriptional regulators that control the expression of hundreds to thousands of target genes involved in the cell cycle, quiescence, differentiation, and apoptosis. These complexes contain many subunits that can vary according to the considered target genes. Depending on their composition and the nature of the partners they recruit, DREAM complexes control gene expression through diverse mechanisms, including chromatin remodeling, transcription cofactor and factor recruitment at various genomic binding sites. This complexity is particularly high in mammals. Since the (...) discovery of the first dREAM complex (drosophila Rb, E2F, and Myb) in Drosophila melanogaster, model organisms such as Caenorhabditis elegans, and plants allowed a deeper understanding of the processes regulated by DREAM‐like complexes. Here, we review the conservation of these complexes. We discuss the contribution of model organisms to the study of DREAM‐mediated transcriptional regulatory mechanisms and their relevance in characterizing novel activities of DREAM complexes. (shrink)

Events in the US in 2020 have laid bare the reality that racism and its effects continue to take a heavy toll on the lives of Black Americans. The three articles in this issue of AJOB each provide...

Usually after a night's rest I would be back again in my vague optimism, never considering that my life was my own to live, ...

Early in the COVID-19 pandemic, researchers reported a surprising trend in disease outcomes: men were more likely to require hospitalization and die from COVID-19 than women. Researchers looked to sex-linked biology to explain these disparities, hypothesizing innate sex differences in immune function, suggesting the use of estrogens or androgen-suppressants as therapy, and even pushing for sex-specific vaccine strategies. Leading bioethicists like Dr. Ezekiel Emanuel at the University of Pennsylvania recently described the sex disparity in COVID-19 outcomes as "the unsolved mystery" (...) of the... (shrink)