Background Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design. Methods We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. (...) We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism. Results Participant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism. Conclusions Organizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism. (shrink)

Background Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses’ experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. Research aim To analyze frontline U.S. nurses’ experiences of ethics during the COVID-19 pandemic. Research design Qualitative analysis using a directed content (...) methodology. Participants and research context The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. Ethical considerations Participant privacy and data confidentiality were addressed. Findings Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. Discussion This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. Conclusions Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available. (shrink)

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, CERN (...) sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

Growing evidence suggests that nurses and other clinicians often feel insufficiently equipped to manage ethical issues that arise in their practice (Truog et al. 2015; Woods 2005; Darmon et al. 201...

Se muestra cómo la “inteligencia sentiente”, en sus elementos “noológicos”, adquiere cierto carácter “técnico” primario y constitutivo que se despliega en el logos y en la razón de manera individual, social e histórica. En la aprehensión primordial de la realidad se juega la viabilidad misma del hombre en su estar siendo en el mundo como animal humano, donde lo “técnico” juega un papel relevante. En los elementos noológicos primarios de la aprehensión primordial se hallan los cimientos de los que surge (...) la “técnica”, que no es entonces elemento accesorio, sino parte constitutiva del hacerse cargo de la realidad. (shrink)

In response to recent work on the nature of human aggression, and to shed light on the proximate, as opposed to ultimate, causes of tribal warfare, we present a record of events leading to a fatal Waorani raid on a family from another tribe, followed by a detailed first-person observation of the behavior of the raiders as they prepared themselves for war, and upon their return. We contrast this attack with other Waorani aggressions and speculate on evidence regarding their hormonal (...) underpinnings. On-the-ground ethnographic observations are examined in light of the neuroendocrinological literature. The evidence suggests a chain of causality in launching lethal violence, beginning with a perceived injury, culminating in a massacre, and terminating in rejoicing. Although no blood or saliva samples were taken at the time of this raid, the behaviors were consistent with a deliberate initiation of the hormonal cascade characterizing the “fight-or-flight” response, along with other hormonal changes. We conclude with observations on the stratified interrelationships of the cognitive, social, emotional, and neuroendocrinological causes of aggression leading to coalitional male homicide. (shrink)

Ethical awareness enables nurses to recognize the ethical implications of all practice actions, and is an important component of safe and high quality nursing care (Milliken 2016; Milliken and Grac...

Juan Huarte de San Juan (1529–88) was a physician of the Spanish Renaissance. He wrote the Examen de Ingenios para las Ciencias, translated as The Trial of Men’s Wits (1989[1575–94]), a book that has been acknowledged as a precursor of educational psychology, organizational psychology, behaviorism, neuropsychology and psychiatry. Huarte suggested that before beginning a course of study, students’ intellectual capabilities (i.e. ingenio) should be matched up with the professional studies that best suit their aptitudes. His book had a great impact (...) in Europe from the late 16th century to the mid-18th century. The influence of the Trial spread throughout many areas including philosophy, politics, linguistics and literature. Although there has been a growing interest in Huarte’s work in recent years, biographical studies have been rare; as a result, the information about Huarte’s life is currently incomplete, scattered and sometimes inaccurate. This study presents a systematic archival research on Spanish original sources. We present a reconstruction of Huarte’s life-story based on 32 original documents (1549– c.1650), some of them first discovered during the present survey. Documents are described according to the General International Standard of Archival Description, ISAD(G). The documents uncovered allow for a reappraisal of Huarte’s biography. (shrink)

A high percent of oxidative energy metabolism is needed to support brain growth during infancy. Unhealthy diets and limited nutrition, as well as other environmental insults, can compromise these essential developmental processes. In particular, iron deficiency anemia has been found to undermine both normal brain growth and neurobehavioral development. Even moderate ID may affect neural maturation because when iron is limited, it is prioritized first to red blood cells over the brain. A primate model was used to investigate the neural (...) effects of a transient ID and if deficits would persist after iron treatment. The large size and postnatal growth of the monkey brain makes the findings relevant to the metabolic and iron needs of human infants, and initiating treatment upon diagnosis of anemia reflects clinical practice. Specifically, this analysis determined whether brain maturation would still be compromised at 1 year of age if an anemic infant was treated promptly once diagnosed. The hematology and iron status of 41 infant rhesus monkeys was screened at 2-month intervals. Fifteen became ID; 12 met clinical criteria for anemia and were administered iron dextran and B vitamins for 1–2 months. MRI scans were acquired at 1 year. The volumetric and diffusion tensor imaging measures from the ID infants were compared with monkeys who remained continuously iron sufficient. A prior history of ID was associated with smaller total brain volumes, driven primarily by significantly less total gray matter and smaller GM volumes in several cortical regions. At the macrostructual level, the effect on white matter volumes was not as overt. However, DTI analyses of WM microstructure indicated two later-maturating anterior tracts were negatively affected. The findings reaffirm the importance of iron for normal brain development. Given that brain differences were still evident even after iron treatment and following recovery of iron-dependent hematological indices, the results highlight the importance of early detection and preemptive supplementation to limit the neural consequences of ID. (shrink)

We consider the current debate between bioconservatives and their chief opponents — whom we dub bioliberals — about the moral acceptability of human enhancement and the policy implications of moral debates about enhancement. We argue that this debate has reached an impasse, largely because bioconservatives hold that we should honour intuitions about the special value of being human, even if we cannot identify reasons to ground those intuitions. We argue that although intuitions are often a reliable guide to belief and (...) action, there are circumstances in which they are not reliable. Intuitions — including intuitions about enhancement — are subject to various cognitive biases rendering them unreliable in some circumstances. We argue that many bioconservative intuitions about enhancement are examples of such unreliable intuitions. Given this, it is unrealistic of bioconservatives to expect others to rely on their unexamined intuitions. Furthermore, refusing to engage in debates about the reasons and values that underpin their intuitions about enhancement will have the effect of making bioconservative voices less relevant in policy debates about enhancement than they would otherwise be. (shrink)

The Proceedings of the National Summit on Legal Preparedness for Obesity Prevention and Control is based on a two-part conceptual framework composed of public health and legal perspectives. The public health perspective comprises the six target areas and intervention settings that are the focus of the obesity prevention and control efforts of the Centers for Disease Control and Prevention.This paper presents the legal perspective. Legal preparedness in public health is the underpinning of the framework for the four “assessment” papers and (...) the four “action” papers that are integral to the application of public health law to any particular health issue. In addition, this paper gives real-world grounding to the legal framework through examples that illustrate the four core elements of legal preparedness in public health that are at work in obesity prevention and control. (shrink)

Introduction: Parkinson's Disease is characterized by motor and non-motor symptoms, among which deficits in social cognition might affect ~20% of patients. This study aims to evaluate the role of social cognitive abilities in the perceived impact of COVID-19 emergency, and the effects of lockdown measures on patients' social network and caregivers' burden.Methods: Fourteen PD patients performed a neuropsychological battery including sociocognitive tasks before the introduction of COVID-19 restrictive measures. A structured interview through an online platform was performed in the last (...) 2 weeks of the first lockdown phase to assess patients' health status, perception of COVID-19 emergency, changes in caregivers' burden, and patients' social isolation. Non-parametric analyses were performed to evaluate the association between social skills and patients' COVID-19 perception, as well as the effects of restrictive measures.Results: At baseline evaluation, half of the PD patients showed sociocognitive dysfunctions, mainly on mentalizing abilities. Patients with impaired social cognition skills showed a significantly lower concern on the possible effects of COVID-19 on their health. Caregiver burden and patients' social network remained stable during the lockdown.Conclusion: These preliminary results underline that PD sociocognitive dysfunctions might affect patients' abilities to estimate the effects of COVID-19 infection. However, the lack of a significant increase in caregivers' burden and social isolation suggests, in our sample, a good coping to COVID-19 emergency. Since COVID-19 pandemic can have direct and indirect severe consequences in patients with PD, the development of educational and preventive programs is recommended. (shrink)

_341_ _Objectives: _In patients with multivessel disease both the detection of the culprit lesion and the exact allocation are important preconditions for sufficient treatment and improved outcome. In a vessel based approach the combination of quantitative coronary angiography and fractional flow reserve measured by a pressure wire should be advantageous compared to myocardial SPECT, as morphological and functional information is delivered simultaneously. Therefore our aim was to evaluate MS in the detection and allocation of hemodynamically significant stenoses obtained by the (...) combined gold standard QCA plus FFR in patients with multivessel disease. _Methods: _FFR and QCA of 95 vessels in 80 patients have been evaluated. Hemodynamically significant target lesions were defined as intermediate stenoses between 50 and 75% with an FFR. (shrink)

The dominant image of judicial authority is emotional detachment; however, judicial work involves emotion. This presents a challenge for researchers to investigate emotions where they are disavowed. Two projects, one in Australia and another in Sweden, use multiple sociological research methods to study judicial experience, expression, and management of emotion. In both projects, observational research examines judicial officers’ display of emotion in court, while interviews investigate judicial emotional experiences. Surveys in Australia identify emotions judicial officers generally find important in their (...) work; in Sweden, shadowing allows researchers to investigate individual judicial emotion experiences and expression. Evaluating the different methods used demonstrates the limitations and effectiveness of particular research designs, the value of multiple methods and the challenges for researching emotion. (shrink)

Everyday beliefs often organize and guide motivations, goals, and behaviors, and, as such, may also differentially motivate individuals to value and attend to emotion-related cues of others. In this way, the beliefs that individuals hold may affect the socioemotional skills that they develop. To test the role of emotion-related beliefs specific to anger, we examined an educational context in which beliefs could vary and have implications for individuals’ skill. Specifically, we studied 43 teachers’ beliefs about students’ anger in the school (...) setting as well as their ability to recognize expressions of anger in children’s faces in a dynamic emotion recognition task. Results revealed that, even when controlling for teachers’ age and gender, teachers’ belief that children’s anger was useful and valuable in the school setting was associated with teachers’ accuracy at recognizing anger expressions in children’s faces. The belief that children’s anger was harmful and not conducive to learning, however, was not associated with teachers’ accuracy at recognizing children’s anger expressions. These findings suggest that certain everyday beliefs matter for predicting skill in recognizing specific emotion-related cues. (shrink)

This study presents the circuitous route taken in an attempt to identify an assessment mechanism for evaluating the impact of STS courses. After initially developing a survey that faculty felt only allowed for the measurement of student opinions about the impact of required STS general education courses, the faculty at Clemson University identified Aikenhead and Ryan's Views on Science-Technology-Society (VOSTS) as an instrument that, when used with the scoring guide created in this project, might be able to assess the sophistication (...) of students views about science and technology in society. The results from administering the pre- and post-VOSTS surveys in one STS course revealed no significant differences when comparing the sophistication of students' views about STS before and after the course. These findings demonstrate that, among other considerations discussed in the manuscript, it will be difficult to find a way of assessing STS courses that can be used for the diverse courses meeting the requirement. (shrink)

The process of assessing executive functions through behavioral observation scales is still under theoretical and empirical construction. This article reports on the analysis of the factorial structure of the EOCL-1 scale that assesses executive functions, as proposed by the theory developed by Luria, which has not been previously considered in this type of evaluation. In this scale, the executive functions taken into account are error correction, internal behavioral and cognition regulatory language, limbic system conscious regulation, decision making, future consideration of (...) consequences of actions, goal-directed behavior, inhibitory control of automatic responses, creation of new behavioral repertoires, and cognitive–behavioral activity verification. A variety of validity and reliability analyses were carried out, with the following results: an adequate internal consistency level of executive functions between α = 0.70 and α = 0.83, significant convergent validity with a scale that assesses frontal deficits between r = −0.07 and r = 0.28, and the scale’s construct validity that proposes a model with an executive central factor comparative fit index = 0.93, root mean square error of approximation = 0.04, standardized root mean square residual = 0.04, and x2 = 789.29, p = 0.001. The findings are discussed based on previous literature reports and in terms of the benefits of using a scale to assess the proposed executive functions. (shrink)

En los diálogos entre las diferentes voces que aparecen en los medios de comunicación la relación es desigual, y es posible ver cómo se da preponderancia a algunos actores sociales en desmedro de otros. Dicha relación se vuelve todavía más compleja cuando los participantes son de culturas diferentes. La siguiente investigación pretende, por medio de una herramienta metodológica ligada al Análisis Crítico del Discurso (ACD) desarrollado por Teun van Dijk, develar los procesos y formas de representación con los que se (...) mira a los bolivianos, a través de las noticias de los diarios de cobertura nacional El Mercurio y La Tercera, durante el mes de junio de 2008. El estudio, por tanto, intenta descubrir cómo la prensa escrita colabora en la representación y construcción de la realidad (Berger y Luckmann 1972) intercultural de sus lectores, formando y promoviendo prejuicios y estereotipos socioculturales. (shrink)

© The Author 2016. Published by Oxford University Press on behalf of Japanese Society of Plant Physiologists. All rights reserved.Cell walls of grasses, including cereal crops and biofuel grasses, comprise the majority of plant biomass and intimately influence plant growth, development and physiology. However, the functions of many cell wall synthesis genes, and the relationships among and the functions of cell wall components remain obscure. To better understand the patterns of cell wall accumulation and identify genes that act in grass (...) cell wall biosynthesis, we characterized 30 samples from aerial organs of rice at 10 developmental time points, 3-100 d post-germination. Within these samples, we measured 15 cell wall chemical components, enzymatic digestibility and 18 cell wall polysaccharide epitopes/ligands. We also used quantitative reverse transcription-PCR to measure expression of 50 glycosyltransferases, 15 acyltransferases and eight phenylpropanoid genes, many of which had previously been identified as being highly expressed in rice. Most cell wall components vary significantly during development, and correlations among them support current understanding of cell walls. We identified 92 significant correlations between cell wall components and gene expression and establish nine strong hypotheses for genes that synthesize xylans, mixed linkage glucan and pectin components. This work provides an extensive analysis of cell wall composition throughout rice development, identifies genes likely to synthesize grass cell walls, and provides a framework for development of genetically improved grasses for use in lignocellulosic biofuel production and agriculture. (shrink)

I discuss theories about the way in which we determine the precedence ofperceived events. I examine Mellor’s account, which claims that it is thetiming of our perceptions of events that enables us to determine their order,and Dennett’s criticism of this. Dennett cites psychological experimentswhich suggest that it is the content of our perceptions, rather than theirtiming, which allows us to determine the order of the events perceived. Iargue that by distinguishing between two different ways of construing‘perception’ we can see not (...) only that the two accounts are compatible, but that Dennett’s account presupposes Mellor’s. (shrink)

Is it conceptually possible for one person to ‘remember’ the experiences of another person? Many philosophical discussions of personal identity suppose that this is possible. For example, some philosophers believe that our personal identity through time consists in the continuation of our mental lives, including the holding of memories over time. However, since a person’s memories are necessarily memories of her own experiences, a definition of personal identity in terms of memory risks circularity. To avoid this, we must invoke the (...) concept of ‘quasi-memory’. From my quasi-memory of doing x, I cannot infer that I did x; but I can infer that somebody did x. It is then a further question as to whether the person who did x is me, the answer to which will depend upon what we believe personal identity to consist in. Quasi-memory, then, allows us to separate the concept of memory from the concept of personal identity. (shrink)

S es un biólogo, un médico, un profesor, un gobierno, un periodista, un usuario de Twitter, Facebook, o YouTube, o una persona común y corriente. Supongamos también que P es el coronavirus SARS-CoVid-2, su origen, su potencial de infestación, patógeno y pandémico. S conoce P, es decir, que su creencia sobre P es verdadera y justificada. El objetivo de este artículo es argumentar que el reduccionismo epistemológico limita el reclamo de S, cuya superación marca los derroteros de la virología, la (...) epidemiologia, así como de la ética y la política para enfrentar la pandemia del COVID-19. (shrink)

Many assume that we can be responsible only what is voluntary. This leads to puzzlement about our responsibility for our beliefs, since beliefs seem not to be voluntary. I argue against the initial assumption, presenting an account of responsibility and of voluntariness according to which, not only is voluntariness not required for responsibility, but the feature which renders an attitude a fundamental object of responsibility (that the attitude embodies one’s take on the world and one’s place in it) also guarantees (...) that it could not be voluntary. It turns out, then, that, for failing to be voluntary, beliefs are a central example of the sort of thing for which we are most fundamentally responsible. (shrink)

In this essay I explore the relation between woman and nature. In the first half, I argue that the environmental slogan "Love Your Mother" is problematical because of the way "mother" and "motherhood" function in patriarchal culture. In the essay's second half, I argue that the question, "Are women closer to nature than men?" is conceptually flawed and that the nature-culture dualism upon which it is predicated is in need of being biodegraded for the sake of environmental soundness.

A good number of people currently thinking and writing about reasons identify a reason as a consideration that counts in favor of an action or attitude.1 I will argue that using this as our fundamental account of what a reason is generates a fairly deep and recalcitrant ambiguity; this account fails to distinguish between two quite different sets of considerations that count in favor of certain attitudes, only one of which are the “proper” or “appropriate” kind of reason for them. (...) This ambiguity has been the topic of recent discussion, under the head “the wrong kind of reasons problem.”2 I will suggest that confusion about “the wrong kind of reason” will be dispelled by changing our account of what a reason is. While I agree both that reasons are considerations and that certain.. (shrink)

I hope to show that, although belief is subject to two quite robust forms of agency, "believing at will" is impossible; one cannot believe in the way one ordinarily acts. Further, the same is true of intention: although intention is subject to two quite robust forms of agency, the features of belief that render believing less than voluntary are present for intention, as well. It turns out, perhaps surprisingly, that you can no more intend at will than believe at will.