As a 2006 Institute of Medicine report highlights, surprisingly little empirical attention has been paid to how prisoners arrive at decisions to participate in modern research. With our study, we aimed to fill this gap by identifying a more comprehensive range of factors as reported by prisoners themselves during semistructured interviews. Our participants described a diverse range of motives, both favoring and opposing their eventual decision to join. Many are well-recognized considerations among nonincarcerated clinical research participants, including a desire for (...) various forms of personal benefit, altruism, and concern about study risks and inconveniences. However, a number of influences seem unique to prisoners. Participants did not report that they were not coerced into enrolling, and they have even been under pressure not to enroll. However, many sought to enroll in order to obtain access to better health care, raising a concern about whether they were unfairly exploited. (shrink)

AS formas históricas e institucionais do cristianismo em Itália fazem com que a filosofia se deva necessariamente confrontar com ele. Além disso, é também evidente que autores como Nietzsche ou Heidegger têm igualmente uma grande influência na península itálica. O artigo examina os escritos de quatro autores contemporêneos os quais, uns mais do que outros, se inspiram nos autores alemães antes mencionados para dar um sentido, frequentemente redutor, mas por vezes também respeitoso da fé dos crentes, ao cristianismo de que (...) a cultura italiana não pode fazer abstracção. Estes filósofos, unidos numa comum sensibilidade ao ser humano, estão também particularmente atentos, ainda que de maneiras muito variadas, à provocação do mal. A categoria da 'Kenose', derivada da meditação sobre a diferença ontológica e da contestação de um saber absoluto disponível para a razão religiosa, acompanha a reconstrução filosófica daquilo que, no cristianismo, mais profundamente toca os autores estudados neste artigo; o seu entendimento do cristianismo, contudo, depende muito da percepção nietzscheana do instante. /// The article starts with the assumption that the historical and institutional forms of Christianity in Italy make it unavoidable for philosophy to confront itself with it. It also mentions the great influence that authors like Nietzsche and Heidegger have in the Italian peninsula. The article proceeds to analyze the writings of four contemporary Italian thinkers. All these authors are inspired by the above mentioned German thinkers and aim at making sense, frequently in a reductive manner but also in a mode respectful of the believers' faith, of Christianity, something of which the Italian culture cannot make abstraction. These four Italian philosophers are particularly united in a common sensibility to the human being and attentive, even though in very different manners, to the provocation of evil. For them, the category of 'Kenosis', derived from the meditation on the ontological difference and the protest against an absolute knowledge available to the religious reason, goes together with the philosophical reconstruction of what in Christianity most touches them. The article also shows, finally, that for these authors the understanding of Christianity depends to a great extent of the impact of nietzschean thought. (shrink)

The target article makes a compelling case for the idea that agents rely on the world for external memory in fast-paced perceptual tasks. As I argue, however, agents also rely on the external environment for computational hardware that helps to keep cognitive computations tractable. Hence the external world provides not only memory for computations involving perceptual system actions, but it provides domain-level actions that figure in cognitive computations as well.

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Hospitalization—Bridging the Gap Between Respect and ControlPaul P. ChristopherIntroductionThis issue of Narrative Inquiry in Bioethics offers varied and somewhat unique perspectives on the experience of psychiatric hospitalization. This commentary highlights a number of salient themes that emerge from reading these essays and attempts to explore how they relate to the broader academic literature on psychiatric hospitalization, particularly with regard to ethical considerations. In reading these narratives, each several (...) times, I was repeatedly struck by the courage required of the authors, both to share their stories publicly and to endure the challenges that the writing process no doubt demanded of them—revisiting and suspending themselves in deeply emotional and, at times, traumatic experiences in order to share the most compelling narrative. Their hard work clearly paid off—the stories are at once intimate and indelible. Still, in many instances, I found myself wanting to know more; to enter the story and sit with the individual through these events; to ask what they were thinking or feeling in a particular situation; to see and hear the world in which they found themselves. Such is the nature of good story telling—the reader, left with the lingering vision created in his mind, turns over the last page, eagerly hoping for more.Narrative ThemesI. Loss of Autonomy or ControlPerhaps the most notable theme had to do with the loss of control or freedom that followed from hospitalization. On first consideration, it may seem odd that this issue appears so often since patient autonomy constitutes one of the fundamental principles of medical ethics. Only under specific circumstances—e.g., when there is a risk of imminent harm—may autonomy be curtailed, and even then only to the extent that is minimally necessary. Yet, as these narratives highlight, there are a multitude of ways in which psychiatric hospitalization engenders actual or perceived restrictions in freedom (Newton-Howes & Mullen, 2011).Consistent with prior research (Goodwin et al., 1999), many of the authors describe a fear or the actual experience of not being able to leave the hospital freely, even when the admission seems to have been voluntary. For example, one writer worries, “I was so afraid that if I ever went ‘in,’ I would never get ‘out’... I thought I would never taste freedom again... alive.” Another describes:When it came time for my possible discharge they told me that I might not get discharged because I was ‘acting up the previous evenings.’ My anxiety level at this point went through the roof. The only reason I was discharged was because my father knew some politicians. If not [End Page 29] for him I would have been a patient there for perhaps years and my life would have been ruined.A third gives this example: “When I asked to sign the form to leave after three days, [the psychiatrist] told me if I did that she would have me committed.” Another writer fears not having any control of how the psychiatrist might approach the treatment: “... I was totally vulnerable... would the doctors blame me, drug me, shock me, kill me?”Somewhat surprising, however, was the fact that so few of the narratives take issue with the decision to hospitalize. This omission is especially striking in light of the fact that prior reports consistently note that a substantial minority (up to nearly half) of voluntarily admitted patients nevertheless experience their admission as coerced (Bonsack & Borgeat, 2005; Hiday et al., 1997; Katsakou et al., 2010; Rogers et al., 1993; Sheehan & Burns, 2011). Because many of these narrators had been hospitalized more than once, the relative absence of expressed resistance to being hospitalized seems strange, particularly when earlier hospital experiences or their aftermath are often described as negative. For example, one individual characterized the time after being released from the hospital as, “My sense of self was questioned. I felt as if I lost my soul.” Another put it this way:When I got out of the private hospital, I felt like my soul had been ripped out of me. I felt like I had a gaping hole in the center of my body... I felt psychically raped, dazed, and confused.Given these... (shrink)

Relatives play an important role in human reproduction according to evolutionary theories of reproductive behavior, but previous empirical studies show large differences in the effects of kin on fertility outcomes. In our paper we examine the effect of co-resident kin and non-kin on the length of birth intervals over the reproductive life course of Dutch women born between 1842 and 1920. We estimate Cox proportional hazard models for parity progression based on the presence of kin and non-kin in the household (...) while controlling for a large number of individual and community-level characteristics. We find that couples living with their brothers experienced shorter birth intervals whereas couples residing with a widowed father had relatively longer birth intervals. The effects of these types of kin on reproduction were most pronounced up to the birth of the fifth child, but not thereafter. We found no effect for mothers or other types of kin. (shrink)

While citizens often use non-instrumental arguments to support environmental protection, most governmental policies are justified by instrumental arguments. This paper explores some of the reasons. We interviewed senior policy advisors to four European governments active in global climate change negotiations and the UNCED (United Nations Conference on Environment and Development) process. In response to our questions, a majority of these advisors articulated deeply held personal environmental values. They told us that they normally keep these values separate from their professional environmental (...) policy activities. We interpret these findings within the context of the literature on environmental ethics and values. We suggest that environmental policy could be improved if widely held environmental values were articulated, validated, and admitted into the process of policy analysis and deliberation. (shrink)

Background: Therapeutic misconception, the misunderstanding of differences between research and clinical care, is widely prevalent among non-incarcerated trial participants. However, little attention has been paid to its presence among individuals who participate in research while incarcerated. Methods: This study examined the extent to which 72 incarcerated individuals may experience therapeutic misconception about their participation in one of six clinical trials, and its correlation with participant characteristics and potential influences on research participation. Results: On average, participants endorsed 70% of items suggestive (...) of therapeutic misconception. The tendency toward therapeutic misconception was significantly higher among African Americans and Latinos compared to Whites, among older and less educated participants, and among enrollment in a substance-abuse-related trial; it was also correlated with a belief that the trial was the only way to obtain needed treatment. Conclusions: Therapeutic misconception may be particularly high among select incarcerated individuals and is associated with a perceived lack of treatment options. Further examination of therapeutic misconception among incarcerated research participants is needed. (shrink)

Inactivation of the Ca2+ extrusion mode of the retinal rod Na- Ca + K exchanger is suggested to be the mechanism that prevents lowering of cytosolic free Ca2+ to < 1 nM when rod cells are saturated for a prolonged time under bright light conditions. Under these conditions, Ca2+ fluxes across disk membranes can contribute significantly to Ca2+ homeostasis in rods.

The practice of paying prisoners to for their participation in research has long been debated, and the controversy is reflected in the differing policies in the U.S. prison systems. Empirical study of financial payments to inmates who enroll in research has focused on whether this practice is coercive. In this study, we examined whether monetary incentives have the potential to be unduly influential among fifty HIV‐positive prisoners. The majority of prisoners surveyed believed that inmates should receive some compensation for their (...) involvement in research and disagreed with statements suggesting that the offer of payment constitutes undue influence. However, a sense of potentially being susceptible to undue influence was significantly higher among participants who had spent a longer time in prison and had less education. Overall, our findings suggest that most prisoners feel that they would be able to make a decision about research enrollment that is not solely based on an offer of monetary payment. (shrink)

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in (...) biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. (shrink)

In this article, we hypothesize that individuals with autism spectrum disorder (ASD) are born with a deficit in invariance detection, which is a learning process whereby people and animals come to attend the relatively stable patterns or structural regularities in the changing stimulus array. This paper synthesizes a substantial body of research which suggests that a deficit in the domain-general perceptual learning process of invariant detection in ASD can lead to a cascade of consequences in different developmental domains. We will (...) outline how this deficit in invariant detection can cause uncertainty, unpredictability, and a lack of control for individuals with ASD and how varying degrees of impairments in this learning process can account for the heterogeneity of the ASD phenotype. We also describe how differences in neural plasticity in ASD underlie the impairments in perceptual learning. The present account offers an alternative to prior theories and contributes to the challenge of understanding the developmental trajectories that result in the variety of autistic behaviors. (shrink)

BackgroundAlthough the number of reporting guidelines has grown rapidly, few have gone through an updating process. The STARD statement (Standards for Reporting Diagnostic Accuracy), published in 2003 to help improve the transparency and completeness of reporting of diagnostic accuracy studies, was recently updated in a systematic way. Here, we describe the steps taken and a justification for the changes made.ResultsA 4-member Project Team coordinated the updating process; a 14-member Steering Committee was regularly solicited by the Project Team when making critical (...) decisions. First, a review of the literature was performed to identify topics and items potentially relevant to the STARD updating process. After this, the 85 members of the STARD Group were invited to participate in two online surveys to identify items that needed to be modified, removed from, or added to the STARD checklist. Based on the results of the literature review process, 33 items were presented to the STARD Group in the online survey: 25 original items and 8 new items; 73 STARD Group members (86 %) completed the first survey, and 79 STARD Group members (93 %) completed the second survey.Then, an in-person consensus meeting was organized among the members of the Project Team and Steering Committee to develop a consensual draft version of STARD 2015. This version was piloted in three rounds among a total of 32 expert and non-expert users. Piloting mostly led to rewording of items. After this, the update was finalized. The updated STARD 2015 list now consists of 30 items. Compared to the previous version of STARD, three original items were each converted into two new items, four original items were incorporated into other items, and seven new items were added.ConclusionsAfter a systematic updating process, STARD 2015 provides an updated list of 30 essential items for reporting diagnostic accuracy studies. (shrink)

Chervenak and McCullough, authors of the most acknowledged ethical framework for maternal–fetal surgery, rely on the ‘ethical–obstetrical’ concept of the fetus as a patient in order to determine what is morally owed to fetuses by both physicians and the women who gestate them in the context of prenatal surgery. In this article, we reconstruct the argumentative structure of their framework and present an internal criticism. First, we analyse the justificatory arguments put forward by the authors regarding the moral status of (...) the fetus qua patient. Second, we discuss the internal coherence and consistency of the moral obligations those authors derive from that concept. We claim that some of the dilemmas their approach is purported to avoid, such as the debate about the independent moral status of the fetus, and the foundation of the moral obligations of pregnant women (towards the fetuses they gestate) are not, all things considered, avoided. Chervenak and McCullough construct the obligations of physicians as obligations towards entities with equal moral status. But, at the same time, they assume that the woman has an independent moral status while the moral status of the fetus is dependent on the decision of the woman to present it to a physician for care. According to the logic of their own argumentation, Chervenak and McCullough implicitly admit a different moral status of the woman and the fetus, which will lead to different ascription of duties of the physician than those they ascribed. (shrink)

This study was designed to investigate the trust relationship between parents and teachers in first grade. Additional research questions were whether trust was related to ethnicity and reading performance. The five facets of trust; benevolence, reliability, competence, honesty and openness, were measured on a 4-point Likert scale. Reading performance was measured by the three-minute test. Parents were found to have more trust in the reliability, competence and honesty of teachers than teachers in parents. Native-Dutch and immigrant parents have the same (...) trust level towards their children?s teacher. However, teachers reported lower trust levels on all five facets of trust for immigrant parents. Our findings indicated that ethnicity has no influence on parents trust in teachers, but ethnicity may explain teachers? trust in parents. Some support was found for the assumption that teachers? trust plays a role in reading performance. Children were found to have higher reading performance when teachers reported higher trust in the benevolence and openness of parents. (shrink)