The assumption in current U.S. mainstream medicine is that birthing requires hospitalization. In fact, while the American College of Obstetricians and Gynecologists supports the right of every birthing person to make a medically informed decision about their delivery, they do not recommend home birth owing to data indicating greater neonatal morbidity and mortality. In this article, we examine the evidence surrounding home birth in the United States and its current limitations, as well as the ethical considerations around birth setting.

This book addresses fundamental issues in linguistic theory, including the relation between formal and cognitive approaches, the autonomy of syntax, the content of universal grammar, and the value of generative and functional approaches to grammar. It focuses on the grammar of case relations, signalled by morphological case, prepositions, and word order. Part I offers a critical history of modern grammars of case, focussing on the last four decades and setting this in the context of earlier, including ancient, developments. The subjects (...) considered include the evolution of ideas concerning deep structure and semantic and grammatical relations, and arguments for the maintenance of the traditional central position of case in the grammar. In parts II and III Professor Anderson examines the category of case and central unresolved issues in the grammar of case. The latter include questions relating to the idea of an ontologically-based grammar, particularly the degree to which syntactic categories and relationships are grounded in meaning, and the notion of linguistic creativity. This involves a consideration of the way in which cases may be identified and whether their distribution is determined through semantics. The book sheds new light on the interactions between meaning and grammar and on the structure and development of lexical and grammatical systems. The argument and its far-reaching consequences will be of wide interest to linguists, philosophers and others seeking to understand the workings of language. (shrink)

Spatial skills predict important life outcomes, such as mathematical achievement or entrance into Science, Technology, Engineering, and Mathematics disciplines. Children significantly vary in their spatial performance even before they enter formal schooling. One correlate of children's spatial performance is the spatial language they produce and hear from others, such as their parents. Because the emphasis has been on spatial language, less is known about the role of hand gestures in children's spatial development. Some children are more likely to fall behind (...) in their spatial skills than others. Children born premature constitute such a risk group. Here, we compared performance of term and preterm-born children on two non-verbal spatial tasks—mental transformation and block design. We also examined relations of children's performance on these tasks to parental spatial language and gesture input and their own production of spatial language and gesture during an independent puzzle play interaction. We found that while term and preterm-born children as a group did not differ in the mental transformation or block design performance, children varied widely in their performance within each group. The variability in mental transformation scores was predicted by both a subset of spatial words and all spatial gestures children produced. Children's spatial language and gesture were in turn related to their parents' spatial language and gesture. Parental spatial language and gesture had an indirect relation on children's mental transformation, but not block design, scores via children's spatial language, and gesture use. Overall, results highlight the unique contributions of speech and gesture in communicating spatial information and predicting children's spatial performance. (shrink)

This textbook offers a unique and accessible approach to ethical decision-making for practicing pharmacists and student pharmacists. Unlike other texts, it gives clear guidance based on the fundamental principles of moral philosophy, explaining them in simple language and illustrating them with abundant clinical examples and case studies. The strength of this text is in its emphasis on normative ethics and critical thinking, and that there is truly a best answer in the vast majority of cases, no matter how complex. The (...) authors place high trust in a pharmacist’s moral judgment. This teaches the reader how to think, based on ethical principles, not necessarily what to think. This means navigating between the two extremes of overly theoretical and excessively prescriptive. The cogent framework given in this text uses the language of competing duties, identifying the moral principles at stake that create duties for the pharmacist. This is the balancing act of normative ethics, and of deciding which duties should prevail in a given clinical situation. This work presents a clear-cut pathway for resolving ethical dilemmas encountered by pharmacists, based on foundational principles and critical thinking. Presents a clear-cut pathway for resolving the ethical dilemmas encountered by pharmacists, based on foundational principles and critical thinking. Jon E. Sprague, RPh, PhD, Director of Science and Research for the Ohio Attorney General. (shrink)

We studied collaborative skill acquisition in a dynamic setting with the game Co-op Space Fortress. While gaining expertise, the majority of subjects became increasingly consistent in the role they adopted without being able to communicate. Moreover, they acted in anticipation of the future task state. We constructed a collaborative skill acquisition model in the cognitive architecture ACT-R that reproduced subject skill acquisition trajectory. It modeled role adoption through reinforcement learning and predictive processes through motion extrapolation and learned relevant control parameters (...) using both a reinforcement learning procedure and a new to ACT-R supervised learning procedure. This is the first integrated cognitive model of collaborative skill acquisition and, as such, gives us valuable insights into the multiple cognitive processes that are involved in learning to collaborate. (shrink)

In this article we describe our approach to understanding wrongdoing in medical research and practice, which involves the statistical analysis of coded data from a large set of published cases. We focus on understanding the environmental factors that predict the kind and the severity of wrongdoing in medicine. Through review of empirical and theoretical literature, consultation with experts, the application of criminological theory, and ongoing analysis of our first 60 cases, we hypothesize that 10 contextual features of the medical environment (...) (including financial rewards, oversight failures, and patients belonging to vulnerable groups) may contribute to professional wrongdoing. We define each variable, examine data supporting our hypothesis, and present a brief case synopsis from our study that illustrates the potential influence of the variable. Finally, we discuss limitations of the resulting framework and directions for future research. (shrink)

Local sustainable food systems have captured the popular imagination as a progressive, if not radical, pillar of a sustainable food future. Yet these grassroots innovations are embedded in a dominant food regime that reflects productivist, industrial, and neoliberal policies and institutions. Understanding the relationship between these emerging grassroots efforts and the dominant food regime is of central importance in any transition to a more sustainable food system. In this study, we examine the encounters of direct farm marketers with food safety (...) regulations and other government policies and the role of this interface in shaping the potential of local food in a wider transition to sustainable agri-food systems. This mixed methods research involved interview and survey data with farmers and ranchers in both the USA and Canada and an in-depth case study in the province of Manitoba. We identified four distinct types of interactions between government and farmers: containing, coopting, contesting, and collaborating. The inconsistent enforcement of food safety regulations is found to contain progressive efforts to change food systems. While government support programs for local food were helpful in some regards, they were often considered to be inadequate or inappropriate and thus served to coopt discourse and practice by primarily supporting initiatives that conform to more mainstream approaches. Farmers and other grassroots actors contested these food safety regulations and inadequate government support programs through both individual and collective action. Finally, farmers found ways to collaborate with governments to work towards mutually defined solutions. While containing and coopting reflect technologies of governmentality that reinforce the status quo, both collaborating and contesting reflect opportunities to affect or even transform the dominant regime by engaging in alternative economic activities as part of the ‘politics of possibility’. Developing a better understanding of the nature of these interactions will help grassroots movements to create effective strategies for achieving more sustainable and just food systems. (shrink)

Most relational theories assert both that spatial discourse is reducible to talk about physical objects and their spatial relations, and that the relation of congruence derives from a non-metrical relation which intervals bear or possibly bear to measuring instruments. We have shown that there are serious logical difficulties involved in maintaining both these positions and the thesis of the continuity of space. We have also shown that Grünbaum's motivating argument for the reduction of congruence is unsound, and, moreover, that the (...) prospects of formulating the kind of definition which this reduction requires seem to rest upon a wholly vague notion of physical possibility. Alternatively, if congruence is taken as primitive, it seems plausible that spatial discourse can be reconstructed so that there is no ontological commitment to spatial objects other than physical objects. Whether or not this relational thesis is ultimately defensible requires more elaboration of the relational theory, and investigation of its role in the formalizations of current physical theories. It is odd, considering the wide currency of relational theories, that this work has never been done. (shrink)

The conduct of research in settings affected by disasters such as hurricanes, floods and earthquakes is challenging, particularly when infrastructures and resources were already limited pre-disaster. However, since post-disaster research is essential to the improvement of the humanitarian response, it is important that adequate research ethics oversight be available. We aim to answer the following questions: 1) what do research ethics committee members who have reviewed research protocols to be conducted following disasters in low- and middle-income countries perceive as the (...) key ethical concerns associated with disaster research?, and 2) in what ways do REC members understand these concerns to be distinct from those arising in research conducted in non-crisis situations? This qualitative study was developed using interpretative description methodology; 15 interviews were conducted with REC members. Four key ethical issues were identified as presenting distinctive considerations for disaster research to be implemented in LMICs, and were described by participants as familiar research ethics issues that were amplified in these contexts. First, REC members viewed disaster research as having strong social value due to its potential for improving disaster response, but also as requiring a higher level of justification compared to other research settings. Second, they identified vulnerability as an overarching concern for disaster research ethics, and a feature that required careful and critical appraisal when assessing protocols. They noted that research participants’ vulnerabilities frequently change in the aftermath of a disaster and often in unpredictable ways. Third, they identified concerns related to promoting and maintaining safety, confidentiality and data security in insecure or austere environments. Lastly, though REC members endorsed the need and usefulness of community engagement, they noted that there are significant challenges in a disaster setting over and above those typically encountered in global health research to achieve meaningful community engagement. Disaster research presents distinctive ethical considerations that require attention to ensure that participants are protected. As RECs review disaster research protocols, they should address these concerns and consider how justification, vulnerability, security and confidentially, and community engagement are shaped by the realities of conducting research in a disaster. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

Leveraging, according to David M. Anderson and his colleagues, is both a basic principle of human conduct and the most dominant strategy in recent years that individuals, organizations and countries use to pursue their ends. Although many scholars agree that a crisis of "over-leveraging" caused the financial crisis of 2008-2010, it has not been appreciated that an "over-leveraging" crisis has existed in American politics and the American family system as well. This book addresses the need for a "Leverage Mean" (...) (falling between the extremes of too much leverage and too little leverage) in the economy, politics, family life, and international relations. It identifies three different kinds of leveraging-bargaining, resource, and investment and provides an explanatory and normative theory which draws on the fields of economics, political science, sociology, history, psychology, international relations, law, and philosophy. Moreover, it shows how the dissolution of the Cold War, the dismantling of the modern family, and the rise of the Internet along with the deregulation of the financial services industry led to the diffusion of power which has made leveraging of the first importance for everyone. This book should be of interest to social scientists, philosophers, political theorists, public policy makers and politicians. David Anderson and his colleagues are the first to characterize and assess one of the major instruments of power of the contemporary era. This volume represents the best work on leverage since Archimedes and will be widely read and discussed. Benjamin Ginsberg, David Bernstein Professor of Political Science and Chair, Center for Advanced Governmental Studies, Johns Hopkins University Leverage might literally be the operative word of the 21st century. Anderson's volume is a wide-ranging and illuminating study of this fundamental and dynamic concept. Parag Khanna, Senior Fellow, New Amer ica Foundation, author of The Second World: How Emerging Powers Are Redefining Global Competition in the Twenty-first Century. (shrink)

The social principle of subsidiarity, both regarding the federalism debate in North America and the principle’s role in the formation of the European Union, has garnished increased attention in recent years. In this paper I will argue that if one looks for the historical seed of the principle of subsidiarity in Aristotle—as many authors do—then attention should fall more properly on his analysis of practical reasoning in Book VI of the Nicomachean Ethics than on Book I of the Politics. The (...) treatment of practical reasoning more aptly explains the need for the principle of subsidiarity and, indeed, averring that it is based on an Aristotelian sense of autonomy is misplaced at best and dangerous at worst. (shrink)

In this paper we continue an ongoing dialogue that has as its goal the critical appraisal of theoretical perspectives on culture and health, in an effort to move forward scholarship on culture and health. We draw upon a programme of scholarship to explicate theoretical tensions and challenges that are manifest in the discourses on culture and health and to explore the possibilities Bourdieu's theoretical perspective offers for reconciling them. That is, we hope to demonstrate the need to move beyond descriptions (...) ‘of’ culture to an understanding of cultures as dynamic, and to show ways cultural practices create contexts that have the potential to foster or impede health.In our early research, largely undertaken in Canada's multicultural context, we sought to make visible the ways in which culture shaped conceptions of health and influenced health practices of immigrant groups. In recent years this focus has expanded to include populations that reflect the cultural and social diversity of our region. From the outset we attempted to move towards a conception of culture as negotiated, unifying, transformative and dynamic. While this position continues to hold appeal we are continually reminded that, despite our leanings towards constructivism, there is salience to the notion of culture as having enduring elements. It is this tension between the view of culture as embodied and enduring and culture as constructed and dynamic that we seek to examine.We explore whether Bourdieu's theoretical perspective offers promise for reconciling these apparently competing views. Using exemplars from our research we share insights that Bourdieu's work has offered to our analyses, thereby enabling us to move towards a view of culture that holds in tension these apparently contradictory positions of culture as both essence (albeit unstable, negotiated) and constructed. (shrink)

Institutional Review Board decisions hinge on the availability and interpretation of information. This is demonstrated by the following well-known historical example. In 2001, 24-year-old Ellen Roche died from respiratory distress and organ failure as a result of her participation in a study at Johns Hopkins Asthma and Allergy Center. The non-therapeutic physiological study, “Mechanisms of Deep Inspiration-Induced Airway Relaxation,” was designed to examine airway hyperresponsiveness in healthy individuals in order to better understand the pathophysiology of asthma. Participants inhaled hexamethonium, a (...) chemical ganglionic blocker that was not FDA-approved for use as specified in the experimental protocol. Risks of inhaling hexamethonium, including lung damage, had been reported in the 1950s and ‘60s. An investigation conducted after Roche's death determined that the study's principal investigator had failed to adequately search the medical literature; the protocol submitted for IRB review cited articles indexed in online literature databases that went back only as far as the 1970s. (shrink)

We present a cross-sectional study of ethical decision-making correlated with spirituality and utilizing moral intensity as a moderator for workers in the Southeastern United States. This study presents spirituality as an individual variable and moral intensity as a situational variable along with ethical decision-making to examine the interaction of these factors in moral dilemmas. Utilizing previously validated instruments for ethical decision-making and individual spirituality, we find that workers with relatively high measured spirituality made less ethical decisions compared to workers with (...) relatively lower measures of spirituality. Further, we find that the introduction of high moral intensity as a situational variable does not moderate the observed correlation between spirituality and ethical decision-making. This research supports the conceptual nature of the Interactionist Theory by presenting in a single study both individual and situational variables in ethical decision-making. (shrink)

This article investigates the potential of fMRI to test assumptions about different components in models of complex cognitive tasks. If the components of a model can be associated with specific brain regions, one can make predictions for the temporal course of the BOLD response in these regions. An event‐locked procedure is described for dealing with temporal variability and bringing model runs and individual data trials into alignment. Statistical methods for testing the model are described that deal with the scan‐to‐scan correlations (...) in the errors of measurement of the BOLD signal. This approach is illustrated using a “sacrificial” ACT‐R model that involves mapping 6 modules onto 6 brain regions in an experiment from concerned with equation solving. The model's visual encoding predicted the BOLD response in the fusiform gyrus, its controlled retrieval predicted the BOLD response in the lateral inferior prefrontal cortex, and its subgoal setting predicted the BOLD response in the anterior cingulate cortex. On the other hand, its motor programming failed to predict anticipatory activation in the motor cortex, its representational changes failed to predicted the pattern of activity in the posterior parietal cortex, and its procedural component failed to predict an initial spike in caudate. The results illustrate the power of such data to direct the development of a theory of complex problem solving, both at the level of a specific task model as well as at the level of the cognitive architecture. (shrink)