Understanding the clinical significance of variants associated with hereditary cancer risk requires access to a pooled data resource or network of resources—a “cancer gene variant commons”—incorporating representative, well-characterized genetic data, metadata, and, for some purposes, pathways to case-level data. Several initiatives have invested significant resources into collecting and sharing cancer gene variant data, but further progress hinges on identifying and addressing unresolved policy issues. This commentary provides insights from a modified policy Delphi process involving experts from a range of stakeholder (...) groups involved in the data-sharing ecosystem. In particular, we describe policy issues and options generated by Delphi participants in five domains critical to the development of an effective cancer gene variant commons: incentives, financial sustainability, privacy and security, equity, and data quality. Our intention is to stimulate wider discussion and lay a foundation for further work evaluating policy options more in-depth and mapping them to those who have the power to bring about change. Addressing issues in these five domains will contribute to a cancer gene variant commons that supports better care for at-risk and affected patients, empowers patient communities, and advances research on hereditary cancers. (shrink)

Although children learn more when teachers gesture, it is not clear how gesture supports learning. Here, we sought to investigate the nature of the memory processes that underlie the observed benefits of gesture on lasting learning. We hypothesized that instruction with gesture might create memory representations that are particularly resistant to interference. We investigated this possibility in a classroom study with 402 second‐ and third‐grade children. Participants received classroom‐level instruction in mathematical equivalence using videos with or without accompanying gesture. After (...) instruction, children solved problems that were either visually similar to the problems that were taught, and consistent with an operational interpretation of the equal sign (interference), or visually distinct from equivalence problems and without an equal sign (control) in order to assess the role of gesture in resisting interference after learning. Gesture facilitated learning, but the effects of gesture and interference varied depending on type of problem being solved and the strategies that children used to solve problems prior to instruction. Some children benefitted from gesture, while others did not. These findings have implications for understanding the mechanisms underlying the beneficial effect of gesture on mathematical learning, revealing that gesture does not work via a general mechanism like enhancing attention or engagement that would apply to children with all forms of prior knowledge. (shrink)

A dearth of literature focuses on the relationship between acculturation, power distance and liminality for migrant nurses entering foreign workplaces. Expectations are for migrant nurses to be practice‐ready swiftly. However, this aspiration is naïve given the complex shifts that occur in deeply held cultural beliefs and practices and is dependent on an organisational climate of reciprocal willingness to adapt and learn. This exploratory study identified that although a plethora of literature addresses challenges migrant nurses face, there are limited data that (...) link these transitional processes to concepts that might usefully guide transitions. This study draws from the overarching concept of acculturation, together with Hofstede's (2011) notion of power distance and the theory of liminality to explore the experiences of eight migrant nurses. Data highlighted that adjusting to altered hierarchical relationships took many months because negotiating power distance challenged deeply held beliefs and assumptions about professional and organisational hierarchies. Migrant nurses’ accounts indicated a paucity of organisational processes to address these difficulties; therefore, they navigated this liminal space of adjustment to power distance differences in an ad hoc manner. Their acculturation experiences, arguably unnecessarily prolonged, indicate the value in workplace commitment to exploring a collaborative, critically reflective approach to optimise transitions. (shrink)

Making data broadly accessible is essential to creating a medical information commons. Transparency about data-sharing practices can cultivate trust among prospective and existing MIC participants. We present an analysis of 34 initiatives sharing DNA-derived data based on public information. We describe data-sharing practices captured, including practices related to consent, privacy and security, data access, oversight, and participant engagement. Our results reveal that data-sharing initiatives have some distance to go in achieving transparency.

Advances in technologies and biomedical informatics have expanded capacity to generate and share biomedical data. With a lens on genomic data, we present a typology characterizing the data-sharing landscape in biomedical research to advance understanding of the key stakeholders and existing data-sharing practices. The typology highlights the diversity of data-sharing efforts and facilitators and reveals how novel data-sharing efforts are challenging existing norms regarding the role of individuals whom the data describe.

BackgroundDecision-making in initiating life-sustaining health technology is complex and often conducted at time-critical junctures in clinical care. Many of these decisions have profound, often irreversible, consequences for the child and family, as well as potential benefits for functioning, health and quality of life. Yet little is known about what influences these decisions. A systematic review of reasoning identified the range of reasons clinicians give in the literature when initiating technology dependence in a child, and as a result helps determine the (...) range of influences on these decisions.MethodsMedline, EMBASE, CINAHL, PsychINFO, Web of Science, ASSIA and Global Health Library databases were searched to identify all reasons given for the initiation of technology dependence in a child. Each reason was coded as a broad and narrow reason type, and whether it supported or rejected technology dependence.Results53 relevant papers were retained from 1604 publications, containing 116 broad reason types and 383 narrow reason types. These were grouped into broad thematic categories: clinical factors, quality of life factors, moral imperatives and duty and personal values; and whether they supported, rejected or described the initiation of technology dependence. The majority were conceptual or discussion papers, less than a third were empirical studies. Most discussed neonates and focused on end-of-life care.ConclusionsThere is a lack of empirical studies on this topic, scant knowledge about the experience of older children and their families in particular; and little written on choices made outside ‘end-of-life’ care. This review provides a sound basis for empirical research into the important influences on a child’s potential technology dependence. (shrink)

The free market theory has as its basis the assumption of equity. This equity is ascribed to both purchasers and providers in a perfectly balanced system so that there are seen to be no 'winners' or 'losers' in the market-place. The health system that is developing in the UK is structured as a managed market, but agency relationships between GPs and health authorities buffer the costing process of goods and therefore may be described as distorting the price. This could also (...) be distorting the ability of the users, who are the real purchasers, from exercising their economic freedom. They may also lose the autonomy to choose goods that suit their particular needs, and equally not to choose those services that they do not want or wish to pay for vicariously (i.e. that the common good is respected by both providers and purchasers). This assumes that users of the service know the level of choice that they have and that not only are providers protected at present by the practices of the purchasers but also entry into the market for new providers is severely curtailed. The exercise of true freedom of the market in economic terms is one of moral obliga tion to provide services that not only have a market value that is affordable and a require ment of the 'common good' but also are historically acceptable for social requirements (i.e. that the services are valued as fundamental tenets of the rights of individuals in soci ety). The expression of this need will therefore be utilitarian (i.e. the users of the services should benefit from them rather than the providers). (shrink)

Providing efficient and clean power is a challenge for devices that range from the micro to macro in scale. Although there has been significant progress in the development of micro-, meso-, and macro-scale power supplies and technologies, realization of many devices is limited by the inability of power supplies to scale with the diminishing sizes of CMOS-based technology. Here, the authors provide an overview of piezoelectric energy harvesting technology along with a discussion of proof of concept devices, relevant governing equations, (...) and figures of merit. They present two case studies: (a) energy capture from the operation of a novel shear and elastic modulus indentation device subjected to applied voltage and (b) energy capture from vibrating commercial bimorph piezoelectric structures mounted on household appliances. Lastly, areas of development needed for realization of commercial energy harvesting devices are suggested. (shrink)

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

A 2011 National Academies of Sciences report called for an “Information Commons” and a “Knowledge Network” to revolutionize biomedical research and clinical care. We interviewed 41 expert stakeholders to examine governance, access, data collection, and privacy in the context of a medical information commons. Stakeholders' attitudes about MICs align with the NAS vision of an Information Commons; however, differences of opinion regarding clinical use and access warrant further research to explore policy and technological solutions.

A medical information commons is a networked data environment utilized for research and clinical applications. At three deliberations across the U.S., we engaged 75 adults in two-day facilitated discussions on the ethical and social issues inherent to sharing data with an MIC. Deliberants made recommendations regarding opt-in consent, transparent data policies, public representation on MIC governing boards, and strict data security and privacy protection. Community engagement is critical to earning the public's trust.

In lieu of an abstract, here is a brief excerpt of the content:Critical Piety: Our Urgent Need to Recover an Ancient VirtueMary Nickel (bio)But, you see, if you eats these dinners and don’t cook ’em, if you wears these clothes and don’t buy or iron them, then you might start thinking that the good fairy or some spirit did all that. They asked a little white girl in this family I used to work for who made her cake at (...) one of her little tea parties. She said she made it and then she hid her face and said the good fairies made it. Well, you are looking at that good fairy. Black folks don’t have no time to be thinking like that. If I thought like that, I’d burn cakes and scorch skirts. But when you don’t have anything else to do, you can think like that. It’s bad for your mind, though.—Rosa Wakefield1There has been a lamentable trend, in the age since the Great Awakenings, to use the word “piety” as a synonym for “devoutness.” Piety, to the contemporary ear, conjures a sense of personal religious feeling and practice. For example, Saba Mahmood’s distinguished text, Politics of Piety, has as its theme the individual agency of women in Islamic societies. Meanwhile, untold books in the field of religious studies simply use “piety” as a stand-in for “religion.”2 This use of the term is not limited to the academic study of religion; recently, one liberation theologian has even demanded that we move, in the words of the title of his book, Beyond Piety.3 The thesis of that book rests on the premise that piety is altogether private, and insufficiently materially productive.4 [End Page 5]According to the ancients, though, piety is neither of these things. Piety, for Cicero, motivates the pious to “render kind offices and loving service to one’s kin and country.”5 As such, the ancient virtue of piety is fundamentally public, insofar as it pertains to one’s public tribute to her kin and fellow citizens. Furthermore, piety is productive, insofar as it motivates the pious to accomplish good things on behalf of her kin and fellow citizens. The ancient virtue therefore involves the near inverse of what the modern term suggests today.6 Where contemporary uses of the word “piety” are often preceded by the word “personal,” the ancients would have been bewildered by such a formulation.This essay does not dare try to account for how the ancient virtue of piety disintegrated to the point of becoming a matter of private religious practice. For those who are interested in that topic, many historians (and non-historians) offer various narratives to explain that trajectory.7 However, I will refrain from so doing. Instead, in what follows, I seek to illuminate the ancient virtue of piety, and show why we need so urgently to recover it. Piety, the ancients believed, is the virtuous act of acknowledging those things that make our lives possible.Furthermore, I will also update the ancient virtue, so to speak, to situate it in our modern context. That requires three substantial interventions. First, I show that piety must be comprehensive and even prospective. That is: not only ought we to be grateful for those who have made our lives possible up to and including the present moment, but we ought also to be grateful for those whose future work will sustain our continued wellbeing. Second, I show that piety must not only be symbolic or expressive, but also material. However, I do [End Page 6] not intend to neglect the importance of expressive piety. Third, I concentrate on the appropriate means for acknowledging those sources of our being that are not altogether (or at all) commendable. Finally, I offer some reflections on what this meditation on piety might tell us about contemporary American society, including two policy proposals regarding public education and paid family leave.I. Piety, Ancient and ModernPremodern Piety. It can take some effort to comprehend what pietas meant to the ancients, especially given the modern connotations associated with its contemporary English cognate. It takes even more to grasp how central this virtue... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:240 Feminist Studies 45, no. 1. © 2019 by Mary Anna Evans Mary Anna Evans Personal Continuum The scent of gasoline is neither attractive nor repulsive. It falls somewhere on the continuum between. It is medicinal, but without the acrid bitterness of medicine. It draws children like a drug, but only when their parents aren’t hovering to warn of danger. Adults know about fire and poisoning and (...) long-range carcinogenic doom. Children only know that the odor around gas pumps smells naughty and fun, until their lips open and the flavor of petroleum turns their stomachs. Why do some things smell so much better than they taste? Gasoline, unlike honey, draws humans but not flies. Sarah was not thinking of fire, poisoning, or doom when she fitted the long metal nozzle into the mouth of her car’s fuel tank. She was trying not to think at all, though the customary thoughts slipped in. None of them were about gasoline. The pump’s air pollution control system was working well but not perfectly, so it took a moment for the odor to reach her nose. Her body roused and snarled at her. The baby. What are you thinking? If you breathe those fumes, what will they do to the baby? A moment passed while her body checked itself, remembering what it already knew. There was no baby. Where is the baby? Mary Anna Evans 241 The frantic voice didn’t echo between her ears. It had nothing to do with her brain at all. It was more than thought. It came from a place deeper than thought, and it wasn’t hers. Her body said things she didn’t want to say, and it needed things she didn’t need. Her body wanted things that were not good for her. Again, Where is the baby? And then, the darker question. What did you do? “Nothing,” she said aloud, since there was no one to hear. I didn’t do anything but bleed. I’m still bleeding. She resisted the instinct to clap her hands over her ears to shut out the voice that couldn’t be shut out. Her defiant hold on the nozzle kept her upright. She listened to the rhythmic throb of the pump. Refusing to turn her face from the gasoline’s stench, she opened her mouth and let the fumes seep in. * * * “Hello, sweetheart,” Frederick said as he came in the door. His peck on the cheek didn’t linger, so Sarah knew there would be no more expressions of affection that day. He had read in a self-help book that it was important for couples to use terms of endearment as a form of bonding. Physical displays of affection were important, too, or so said the self-affirmed relationship expert who wrote the book. In public, displays of affection affirmed the pair bond. In private, even a quick smooch forced men and women to secrete an attachment chemical called oxy-whatever. Oh, hell. She was a chemist. She knew what oxytocin was. She was just mystified by the notion of reading a book to find out how to get some. He turned away and went into the kitchen to fetch the marinating chicken. He always grilled when it was his night to cook. She had come to wonder whether modern men were drawn to cook with fire by an ageold hunter instinct, or whether they were attracted to an activity that put a well-insulated exterior wall between them and the women who remained inside to toss the salads. All across America, every warm summer night, lonely women toss salads and hope for romance. His head poked in the back door. “I bought slivered almonds and croutons.” 242 Mary Anna Evans Her “Thanks for remembering, sweetheart,” bounced off the closing door. Shit. She could have spared herself that soulless term of endearment. Leaving the lettuce in the refrigerator, she thrust her soapy hands under warm running water, because even thinking the word “shit” made the idea of handling raw food appalling. Her body, which had forgotten again that she’d lost the baby, approved of her caution. She guarded her thoughts against disturbing its... (shrink)

In this paper I examine the prospects for a successful neo–logicist reconstruction of the real numbers, focusing on Bob Hale's use of a cut-abstraction principle. There is a serious problem plaguing Hale's project. Natural generalizations of this principle imply that there are far more objects than one would expect from a position that stresses its epistemological conservativeness. In other words, the sort of abstraction needed to obtain a theory of the reals is rampantly inflationary. I also indicate briefly why this (...) problem is likely to reappear in any neo–logicist reconstruction of real analysis. (shrink)

"Multiverse" cosmologies imagine our universe as just one of a vast number of others. While this idea has captivated philosophy, religion, and literature for millennia, it is now being considered as a scientific hypothesis--with different models emerging from cosmology, quantum mechanics, and string theory. Beginning with ancient Atomist and Stoic philosophies, Mary-Jane Rubenstein links contemporary models of the multiverse to their forerunners and explores the reasons for their recent appearance. One concerns the so-called fine-tuning of the universe: nature's constants (...) are so delicately calibrated that it seems they have been set just right to allow life to emerge. For some thinkers, these "fine-tunings" are evidence of the existence of God; for others, however, and for most physicists, "God" is an insufficient scientific explanation. Hence the allure of the multiverse: if all possible worlds exist somewhere, then like monkeys hammering out Shakespeare, one universe is bound to be suitable for life. Of course, this hypothesis replaces God with an equally baffling article of faith: the existence of universes beyond, before, or after our own, eternally generated yet forever inaccessible to observation or experiment. In their very efforts to sidestep metaphysics, theoretical physicists propose multiverse scenarios that collide with it and even produce counter-theological narratives. Far from invalidating multiverse hypotheses, Rubenstein argues, this interdisciplinary collision actually secures their scientific viability. We may therefore be witnessing a radical reconfiguration of physics, philosophy, and religion in the modern turn to the multiverse. (shrink)

Developing and implementing artificial intelligence (AI) systems in an ethical manner faces several challenges specific to the kind of technology at hand, including ensuring that decision-making systems making use of machine learning are just, fair, and intelligible, and are aligned with our human values. Given that values vary across cultures, an additional ethical challenge is to ensure that these AI systems are not developed according to some unquestioned but questionable assumption of universal norms but are in fact compatible with the (...) societies in which they operate. This is particularly pertinent for AI research and implementation across Africa, a ground where AI systems are and will be used but also a place with a history of imposition of outside values. In this paper, we thus critically examine one proposal for ensuring that decision-making systems are just, fair, and intelligible—that we adopt a principle of explicability to generate specific recommendations—to assess whether the principle should be adopted in an African research context. We argue that a principle of explicability not only can contribute to responsible and thoughtful development of AI that is sensitive to African interests and values, but can also advance tackling some of the computational challenges in machine learning research. In this way, the motivation for ensuring that a machine learning-based system is just, fair, and intelligible is not only to meet ethical requirements, but also to make effective progress in the field itself. (shrink)

This paper presents an overview of the dimensions of unsafe motherhood, contrasting data from economically developed countries with some from developing countries. It addresses many common factors that shape unsafe motherhood, identifying medical, health system and societal causes, including women's powerlessness over their reproductive lives in particular as a feature of their dependent status in general. Drawing on perceptions of Jonathan Mann, it focuses on public health dimensions of maternity risks, and equates the role of bioethics in conscientious medical care (...) to that of human rights in public health care. The microethics of medical care translate into the macroethics of public health, but the transition compels some compromise of personal autonomy, a key feature of Western bioethics, in favour of societal analysis. Religiously‐based morality is seen to have shaped laws that contribute to unsafe motherhood. Now reformed in former colonizing countries of Europe, many such laws remain in effect in countries that emerged from colonial domination. UN conferences have defined the concept of ‘reproductive health’ as one that supports women's reproductive self‐determination, but restrictive abortion laws and practices epitomize the unjust constraints to which many women remain subject, resulting in their unsafe motherhood. Pregnant women can be legally compelled to give the resources of their bodies to the support of others, while fathers are not legally compellable to provide, for instance, bone‐marrow or blood donations for their children's survival. Women's unjust legal, political, economic and social powerlessness explains much unsafe motherhood and maternal mortality and morbidity. (shrink)

Here is Lukcs among his friends, lovers, and peers in those important years before 1918, when he converted to Communism and Marxism at the age of thirty-nine.

Universals are a class of mind independent entities, usually contrasted with individuals, postulated to ground and explain relations of qualitative identity and resemblance among individuals. Individuals are said to be similar in virtue of sharing universals. An apple and a ruby are both red, for example, and their common redness results from sharing a universal. If they are both red at the same time, the universal, red, must be in two places at once. This makes universals quite different from individuals, (...) and controversial. (shrink)

Retaliation against whistleblowers is a well-recognized problem, yet there is little explanation for why uninvolved peers choose to retaliate through ostracism. We conduct two experiments in which participants take the role of a peer third-party observer of theft and subsequent whistleblowing. We manipulate injunctive norms and descriptive norms. Both experiments support the core of our theoretical model, based on social intuitionist theory, such that moral judgments of the acts of wrongdoing and whistleblowing influence the perceived likeability of each actor and (...) ultimately influence intention to ostracize each actor and indicate more willingness to ostracize the whistleblower than the wrongdoer. When we vary norms for the wrongdoing in Experiment 1, we find that descriptive and injunctive norms indirectly influence intentions to ostracize both the wrongdoer and whistleblower. These relationships are serially mediated by the observers’ moral judgments of the act and likeability of the actor. When we vary norms for whistleblowing in Experiment 2, the injunctive norm manipulation affected moral judgment of the action of whistleblowing, and we do not observe any other significant effects of the norm manipulations on moral judgments of the actions of wrongdoing or whistleblowing. (shrink)

This book provides a comprehensive insight into the ways in which psychoanalysts think and work. Mary Brownescombe Heller and Sheena Pollet bring together internationally known contributors trained at the Institute of Psychoanalysis to explore the broad range of clinical work, thinking, and teaching undertaken with children, families, adults and staff by psychoanalysts in the UK public health sector. Divided into four sections, _The Work of Psychoanalysts in the Public Health Sector_ covers: clinical work with parents and young children clinical (...) work with adults and their families analytic thinking in health service practice analytic support for health service staff. Experienced psychoanalysts discuss work with various client groups including parents with babies, children, adolescents who self harm, and adults with serious mental health conditions and psychosis. The book also explores how psychoanalytically-informed work can be used alongside other treatment methods, and how health service staff can best be trained and supported. _The Work of Psychoanalysts in the Public Health Sector_ offers the reader a broad perspective and a clear understanding of the various analytical concepts used in clinical practice. It will be invaluable reading for anyone interested in, or already using psychoanalytic ideas and techniques in the health sector, as well as students in training. (shrink)

M. M. McCabe presents a selection of her essays which explore the Platonic method of conversation: how it may inform our understanding both of Plato and of his predecessors and successors, and how its centrality accounts for the connections between argument, knowledge, and virtue in the texts McCabe examines.