Since its founding in 1943, Medievalia et Humanistica has won worldwide recognition as the first scholarly publication in America to devote itself entirely to medieval and Renaissance studies. Since 1970, a new series, sponsored by the Modern Language Association of America and edited by an international board of distinguished scholars and critics, has published interdisciplinary articles. In yearly hardbound volumes, the new series publishes significant scholarship, criticism, and reviews treating all facets of medieval and Renaissance culture: history, art, literature, music, (...) science, law, economics, and philosophy. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

_Feminist Interpretations of Thomas Hobbes _features the work of feminist scholars who are centrally engaged with Hobbes’s ideas and texts and who view Hobbes as an important touchstone in modern political thought. Bringing together scholars from the disciplines of philosophy, history, political theory, and English literature who embrace diverse theoretical and philosophical approaches and a range of feminist perspectives, this interdisciplinary collection aims to appeal to an audience of Hobbes scholars and nonspecialists alike. As a theorist whose trademark is a (...) compelling argument for absolute sovereignty, Hobbes may seem initially to have little to offer twenty-first-century feminist thought. Yet, as the contributors to this collection demonstrate, Hobbesian political thought provides fertile ground for feminist inquiry. Indeed, in engaging Hobbes, feminist theory engages with what is perhaps the clearest and most influential articulation of the foundational concepts and ideas associated with modernity: freedom, equality, human nature, authority, consent, coercion, political obligation, and citizenship. Aside from the editors, the contributors are Joanne Boucher, Karen Detlefsen, Karen Green, Wendy Gunther-Canada, Jane S. Jaquette, S. A. Lloyd, Su Fang Ng, Carole Pateman, Gordon Schochet, Quentin Skinner, and Susanne Sreedhar. (shrink)

Corporate and commercial values are inducing some healthcare organizations to prescribe a customer service model that reframes the provision of nursing care. In this paper it is argued that such a model is incommensurable with nursing conceived as a moral practice and ultimately places nurses at risk. Based upon understanding from ongoing research on compassion fatigue, it is proposed that compassion fatigue as currently experienced by nurses may not arise predominantly from too great a demand for compassion, but rather from (...) barriers to enacting compassionate care. These barriers are often systemic. The paradigm shift in which healthcare environments are viewed as marketplaces rather than moral communities has the potential to radically affect the evolution of nursing as a discipline. (shrink)

Offering an inside look at the hidden dimensions of teaching, this provocative text presents insight into, and analysis of, the work of teaching--from preparing ...

The goal of this study was to evaluate affective changes induced during mental imaging of instinctual action patterns. Subjects were first trained to simulate the bodily rhythms of laughter and crying and were then trained to image these processes without any movement. The mere imagination of the motor imagery of laughter and crying were sufficient to significantly facilitate happy and sad mood ratings as monitored by subjective self-report. In contrast, no changes in mood were reported while imaging the affectively neutral (...) task of walking. The work suggests that motor imagery is sufficient to modify emotional feelings, suggesting the feasibility of this method for brain imaging of emotional processes. (shrink)

Experiences of moral distress encountered in psychiatric practice were explored in a hermeneutic phenomenological study. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychiatrists describe struggling ‘to do the right thing’ for individual patients within a societal system that places unrealistic demands on psychiatric expertise. Certainty on the part of the psychiatrist is an expectation when judgments of dangerousness and/or the need for coercive treatments are made. This assumption, however, ignores the uncertainty and (...) complexity of reality. Society entrusts psychiatrists to care for and treat those among its most vulnerable members: persons deemed to have a severely diminished capacity for autonomy due to a mental disorder. Simultaneously, psychiatrists are held accountable by society for the protection of the public. Moral distress arose for psychiatrists in their efforts to fulfill both roles. They described an ‘outsider/insider’ status and the ways in which they attempted to cope with moral distress. (shrink)

This article reports the findings of a qualitative study that explored the organizational influences on moral distress for health professionals working in pediatric intensive care units across Canada. Participants were recruited to the study from PICUs across Canada. The PICU is a high-tech, fast-paced, high-pressure environment where caregivers frequently face conflict and ethical tension in the care of critically ill children. A number of themes including relationships with management, organizational structure and processes, workload and resources, and team dynamics were identified. (...) This study provides a rare and important multi-disciplinary perspective on this topic and the findings have implications for administrators and leaders who seek to improve the moral climate of healthcare delivery. (shrink)

Ethical leadership is an important construct in the literature on behavioral ethics in organizations, given its link with employee attitudes and behaviors. What remains unclear, however, is what leader characteristics are associated directly with ethical leader perceptions and indirectly with employee unethical behavior. In this paper, we use a socio-cognitive lens to integrate goal orientation theory with the literature on ethical behavior in organizations. Specifically, we propose that certain patterns of managers’ goal-oriented behavior provide signals and cues to employees about (...) their managers’ ethical leadership, which then relates to employee displays of more unethical behavior. Using a sample of 265 manager–employee dyads, our findings largely support our claims. We found that leader performance-avoid goal orientation was negatively related to perceptions of ethical leadership and positively related to employee unethical behavior. Moderated mediation tests indicated that the positive indirect effect of leader performance-avoid goal orientation on employee unethical behavior through perceptions of ethical leadership was attenuated by higher levels of leader learning goal orientation. Taken together, these findings suggest that when leaders emphasize avoiding failure while downplaying the importance of personal learning and development, employees perceive them as less ethical and are more willing to engage in ethical misconduct. We discuss implications of our findings for both theory and practice. (shrink)

BackgroundKinarm Standard Tests is a suite of upper limb tasks to assess sensory, motor, and cognitive functions, which produces granular performance data that reflect spatial and temporal aspects of behavior. We have previously used principal component analysis to reduce the dimensionality of multivariate data using the Kinarm End-Point Lab. Here, we performed PCA using data from the Kinarm Exoskeleton Lab, and determined agreement of PCA results across EP and EXO platforms in healthy participants. We additionally examined whether further dimensionality reduction (...) was possible by using PCA across behavioral tasks.MethodsHealthy participants were assessed using the Kinarm EXO and EP. Four behavioral tasks were performed that quantified arm sensory and motor function, including position sense [Arm Position Matching ] and three motor tasks [Visually Guided Reaching, Object Hit, and Object Hit and Avoid ]. The number of components to include per task was determined from scree plots and parallel analysis, and rotation type was decided on a per-task basis. To assess agreement, we compared principal components across platforms using distance correlation. We additionally considered inter-task interactions in EXO data by performing PCA across all six behavioral assessments.ResultsBy applying PCA on a per task basis to data collected using the EXO, the number of behavioral parameters were substantially reduced by 58–75% while accounting for 76–87% of the variance. These results compared well to the EP analysis, and we found good-to-excellent agreement values between PCs from the EXO and those from the EP. Finally, we were able to reduce the dimensionality of the EXO data across tasks down to 16 components out of a total of 76 behavioral parameters, which represents a reduction of 79% while accounting for 73% of the total variance.ConclusionPCA of Kinarm robotic assessment appears to capture similar relationships between kinematic features in healthy individuals and is agnostic to the robotic platform used for collection. Further work is needed to investigate the use of PCA-based data reduction for the characterization of neurological deficits in clinical populations. (shrink)

Ethical scandals in business are all too common. Due to the increased public awareness of the transgressions of business executives and the potential costs associated with these transgressions, ethical leadership is among the top qualities sought by organizations as they hire and promote managers. This search for ethical leaders intersects with a labor force that is becoming more racially diverse than ever before. In this paper, we propose that the ethical leadership qualities of business leaders may be perceived differently depending (...) upon the race of the leader. Using two experimental studies in the USA, we examine the difference in ethical leadership perceptions between a Black hypocritical CEO and an ethical CEO. Next, we consider a Black ethically ambiguous CEO and an ethical CEO. The findings indicate that a Black leader faces larger negative impact in hypocritical and ambiguous conditions than a similar White leader. There were no significant race effects in the ethical conditions in which a leader demonstrated a personal commitment to ethics through words or actions. We discuss the implications of these findings. (shrink)

Aims. Currently, methylphenidate (MPH, trade name Ritalin) is the most widely prescribed medication for attention deficit/hyperactivity disorder (ADHD). We examined the ability of repeated MPH administration to produce a sensitized appetitive eagerness type response in laboratory rats, as indexed by 50-kHz ultrasonic vocalizations (50-kHz USVs). We also examined the ability of MPH to reduce play behavior in rats which may be partially implicated in the clinical efficacy of MPH in ADHD. Design. 56 adolescent rats received injections of either 5.0 mg/kg (...) MPH, or vehicle each day for 8 consecutive days, and a week later received a challenge injection of either MPH or vehicle. Measurements. Both play behavior (pins) and 50-kHz USVs were recorded after each drug or vehicle administration. Results. MPH challenge produced a substantial 73% reduction in play behavior during the initial treatment phase, and during the last test (1 week post drug), 50-kHz USVs were elevated approximately threefold only in animals with previous MPH experience. Conclusions. These data suggest that MPH treatment may lead to psychostimulant sensitization in young animals, perhaps by increasing future drug-seeking tendencies due to an elevated eagerness for positive incentives. Further, we hypothesize that MPH may be reducing ADHD symptoms, in part, by blocking playful tendencies, whose neuro-maturational and psychological functions remain to be adequately characterized. (shrink)

This article argues that we could improve the design of research protocols by developing an awareness of and a responsiveness to the social contexts of all the actors in the research enterprise, including subjects, investigators, sponsors, and members of the community in which the research will be conducted. “Social context” refers to the settings in which the actors are situated, including, but not limited to, their social, economic, political, cultural, and technological features. The utility of thinking about social contexts is (...) introduced and exemplified by the presentation of a hypothetical case in which one central issue is limitation of the probability of injury to subjects by selection of individuals who are not expected to live long enough for the known risks of the study to become manifest as harms. Benefits of such considerations may include enhanced subject satisfaction and cooperation, community acceptance, and improved data quality, among other desirable consequences. (shrink)

Across the Euro-Atlantic world, political leaders have been mobilizing their bases with nativism, racism, xenophobia, and paeans to “traditional values,” in brazen bids for electoral support. How are we to understand this move to the mainstream of political policies and platforms that lurked only on the far fringes through most of the postwar era? Does it herald a new wave of authoritarianism? Is liberal democracy itself in crisis? In this volume, three distinguished scholars draw on critical theory to address our (...) current predicament. Wendy Brown, Peter E. Gordon, and Max Pensky share a conviction that critical theory retains the power to illuminate the forces producing the current political constellation as well as possible paths away from it. Brown explains how “freedom” has become a rallying cry for manifestly un-emancipatory movements; Gordon dismantles the idea that fascism is rooted in the susceptible psychology of individual citizens and reflects instead on the broader cultural and historical circumstances that lend it force; and Pensky brings together the unlikely pair of Tocqueville and Adorno to explore how democracies can buckle under internal pressure. These incisive essays do not seek to smooth over the irrationality of the contemporary world, and they do not offer the false comforts of an easy return to liberal democratic values. Rather, the three authors draw on their deep engagements with nineteenth–and twentieth–century thought to investigate the historical and political contradictions that have brought about this moment, offering fiery and urgent responses to the demands of the day. (shrink)

Published in 1913 as _La Philosophie Bergsonienne_, this incisive critique of the thought of Henri Bergson was Jacques Maritain's first book. In it he shows himself already to have an authoritative grasp of the thought of St. Thomas Aquinas and an uncanny ability to demonstrate its relevance to alternative philosophical systems such as that of Henri Bergson. Volume 1 in the series _The Collected Works of Jacques Maritain_, this edition faithfully reproduces the 1955 translation published by the Philosophical Library. It (...) would be difficult to overestimate Bergson’s role in extricating French philosophy from the deadening materialism that dominated the Sorbonne. It was that cultural milieu that brought Maritain and his wife Raïssa to the brink of suicide. They drew back for two major reasons. First were the lectures of Henri Bergson at the Collège de France, in which the Maritains found a defense of metaphysics, of the transcendent beyond the material, within which they could find meaning in life. The second reason was their conversion to Catholicism, a move they and many of their contemporaries made after being introduced to Bergson’s work. Soon after his conversion, Jacques Maritain immersed himself in the thought of Thomas Aquinas and was struck by the comparative weaknesses of Bergson. This book is Maritain’s relentless criticism of the philosophy of the man whose lectures had meant so much to him. Its ferocity marks it as a young man’s book, written in part to exorcize the defects of Bergson’s philosophy as they were understood by one now schooled in Thomism. Twenty-five years later, Maritain, while not retracting his criticisms, regretted their intemperance and, as a result, moderated his assessment of Bergson in a long preface to the second edition. In it, we find a philosopher who mastered his craft and a critic of rare perception and refinement. (shrink)

The seventeen seminal essays by Robert J. Gordon collected here, including three previously unpublished works, offer sharply etched views on the principal topics of macroeconomics - growth, inflation, and unemployment. The author re-examines their salient points in a uniquely creative, accessible introduction that serves on its own as an introduction to modern macroeconomics. Each of the four parts into which the essays are grouped also offers a new introduction. The papers in Part I explore different key aspects of the (...) history, theory, and measurement of productivity growth. The essays in Part II investigate the sources of business cycles and productivity fluctuations. Those in Part III cover the effects of supply shocks in macroeconomics. The final group presents empirical studies of the dynamics of inflation in the United States. The foreword by Nobel Laureate Robert M. Solow comments on the abiding importance of these essays drawn from 1968 to the present. (shrink)

ObjectiveSome people experience post-traumatic growth, entailing positive changes such as a greater appreciation of life following traumatic events. We examined PTG in the context of the negative consequences of the COVID-19 pandemic, notably working from home and social distancing. We aimed to assess whether distinct sub-groups of individuals experiencing PTG could be identified by how they appraised and coped with the COVID-19 pandemic.MethodFor this cross-sectional study, we used convenience sampling. In total, 951 participants from the general population completed an online (...) questionnaire with items focusing on primary and secondary appraisal, positive reappraisal, rumination, and coping flexibility. For the latent profile analysis, we selected a sample of 392 individuals who had experienced moderate degrees of pandemic-related PTG, reporting at least two of the 10 positive changes in the PTG Inventory-Short Form.ResultsWe identified two distinct profiles among people experiencing PTG. The first was characterised by low levels of primary appraisal and stressfulness and higher levels of secondary appraisal, increased coping flexibility and greater use of positive reappraisal. The second was characterised by higher levels of stressfulness and primary appraisal and greater use of rumination.ConclusionThe two sub-groups evidently appraised and coped with the COVID-19 pandemic differently. Therefore, future research should account for these different profiles of people experiencing PTG. (shrink)

Despite a large and multifaceted effort to understand the vast landscape of phenotypic data, their current form inhibits productive data analysis. The lack of a community-wide, consensus-based, human- and machine-interpretable language for describing phenotypes and their genomic and environmental contexts is perhaps the most pressing scientific bottleneck to integration across many key fields in biology, including genomics, systems biology, development, medicine, evolution, ecology, and systematics. Here we survey the current phenomics landscape, including data resources and handling, and the progress that (...) has been made to accurately capture relevant data descriptions for phenotypes. We present an example of the kind of integration across domains that computable phenotypes would enable, and we call upon the broader biology community, publishers, and relevant funding agencies to support efforts to surmount today's data barriers and facilitate analytical reproducibility. (shrink)

It is considered the right of children to have their pain managed effectively. Yet, despite extensive research findings, policy guidelines and practice standard recommendations for the optimal management of paediatric pain, clinical practices remain inadequate. Empirical evidence definitively shows that unrelieved pain in children has only harmful consequences, with no benefits. Contributing factors identified in this undermanaged pain include the significant role of nurses. Nursing attitudes and beliefs about children’s pain experiences, the relationships nurses share with children who are suffering, (...) and knowledge deficits in pain management practices are all shown to impact unresolved pain in children. In this article, a relational ethics perspective is used to explore the need for nurses to engage in authentic relationships with children who are experiencing pain, and to use evidence-based practices to manage that pain in order for this indefensible suffering of children to end. (shrink)

Omnipresent calls for more women in university administration assume these women will prioritize using resources and power to increase female representation, especially in STEM fields where women are most underrepresented. However, empirical evidence is lacking for systematic differences in female versus male administrators’ attitudes. Do female administrators agree on which strategies are best, and do men see things differently? To answer this question, we explored United States college and university administrators’ opinions regarding policies, strategies, and structural changes in their organizations (...) designed to increase women professors’ representation and retention in STEM fields. A comprehensive review of past research yielded a database of potentially-effective, recommended policies (e.g., increasing emphasis on teaching, service, and administration during promotion reviews; stopping the tenure clock for childbearing; providing on-campus childcare; couples-hiring; sharing tenure lines; having more women chair search committees; setting gender quotas for promotion). A survey based on these recommended policies was sent to provosts, deans, associate deans, and department chairs of STEM fields at 96 public and private research universities (formerly called R1s) across the U.S. These administrators were asked to rate the quality and feasibility of each recommended policy; 474 provided data, of which 334 contained complete numerical data used in the analyses, so our results are based on a large, geographically diverse group of administrators at research universities. Our data revealed that female administrators perceived the 44 strategies to be higher in quality overall than did male administrators--but not higher in feasibility--with 9 policies perceived differently when rated by women versus men administrators, after imposing conservative statistical controls. There was broad general agreement on the relative rankings of the 44 policies in terms of their perceived quality. Overall, our national survey of U.S. administrators supported the assertion that placing women in administrative roles creates greater emphasis on the importance of enacting policies to attract and retain women in STEM. Topics of disagreement between women and men regarding strategy quality are important focuses of future policy and planning, because female administrators may have insights into how to retain women professors that male administrators do not share. (shrink)

This case is another in a series intended to highlight the new questions emerging from advances in mapping the human genome and the application of genetic findings to clinical practice. The National Human Genome Research Institute, a component of the National Institutes of Health, by law is directed to designate a portion of its annual budget to furthering understanding of the ethical, legal, and social questions emerging from research on the human genome. As part of the effort, the Institute supports (...) research by scientists and scholars around the nation with the aim of clarifying and resolving the tough ethical and research choices facing this endeavor. But recently it has launched an intramural program, which is expected to take a catalytic role in grappling with the array of issues the researchers face in carrying out investigations in human genetics. (shrink)

Agricultural diversification in the Midwestern Corn Belt has the potential to improve socioeconomic and environmental outcomes by buffering farmers from environmental and economic shocks and improving soil, water, and air quality. However, complex barriers related to agricultural markets, individual behavior, social norms, and government policy constrain diversification in this region. This study examines farmer perspectives regarding the challenges and opportunities for both corn and soybean production and agricultural diversification strategies. We analyze data from 20 focus groups with 100 participants conducted (...) in Indiana, Illinois, and Iowa through a combined inductive and deductive approach, drawing upon interpretive grounded theory. Our results suggest that when identifying challenges and opportunities, participants center economics and market considerations, particularly income, productivity, and market access. These themes are emphasized both as benefits of the current corn-soybean system, as well as challenges for diversification. Additionally, logistical, resource and behavioral hurdles– including the comparative difficulty and time required to diversify, and constraints in accessing land, labor, and technical support– are emphasized by participants as key barriers to diversification. Agricultural policies shape these challenges, enhancing the comparative advantage and decreasing the risk of producing corn and soybeans as compared to diversified products. Meanwhile, alternative marketing arrangements, farmer networks, family relationships, and improved soil health are highlighted as important opportunities for diversification. We contextualize our findings within the theories of reasoned action and diffusion of innovation, and explore their implications for farmer engagement, markets, and agricultural policy, and the development of additional resources for business and technical support. (shrink)

This study aims to investigate mental health among Chinese people living in areas with differing levels of infection severity during the COVID-19 outbreak. It also assesses the association between reciprocal and authoritarian filial piety and mental health in times of crises. A sample of 1,201 Chinese participants was surveyed between April and June 2020. Wuhan city, Hubei province outside Wuhan, and elsewhere in China were categorized into high, moderate, and low infection severity areas, respectively. The Depression, Anxiety, and Stress Scale’s (...) severity cut-points were used to categorize participants. In the overall sample, 20.9, 34.2, and 29.0% of the participants showed elevated levels of stress, anxiety, and depression. Those in the highest infection severity group were significantly more likely to be categorized as having elevated levels of stress, anxiety, and depression. General linear modeling was performed on a composite mental distress variable. This model indicated that, even after adjusting for group differences in age, gender, education, and filial piety, the high infection severity group displayed more mental distress than the low infection severity groups. The model also found reciprocal filial piety to have a negative association with mental distress. Conversely, authoritarian filial piety was found to be unrelated to mental distress when controlling for the other variables in the model. No evidence was found for an interaction between either authoritarian or reciprocal filial piety and infection severity, which suggests that the negative association observed between reciprocal filial piety and mental distress was relatively consistent across the three infection severity groups. The findings suggest that future public health programs may integrate the promotion of filial piety as a strategy to help Chinese people maintain good mental health in the face of pandemic crises. (shrink)

Rationale, aims and objectives: Bioethics and professionalism are standard subjects in medical training programmes, and these curricula reflect particular representations of meaning and practice. It is important that these curricula cohere with the actual concerns of practicing clinicians so that students are prepared for real-world practice. We aimed to identify ethical and professional concerns that do not appear to be adequately addressed in standard curricula by comparing ethics curricula with themes that emerged from a qualitative study of medical practitioners. Method: (...) Curriculum analysis: Thirty-two prominent ethics and professionalism curricula were identified through a database search and were analysed thematically. Qualitative study: In-depth, semi-structured interviews were conducted with 20 medical practitioners. Participants were invited to reflect upon their perceptions of the ways in which values matter in their practices and their educational experiences. The themes emerging from the two studies were compared and contrasted. Results: While representations of meaning and value in ethics and professionalism curricula overlap with the preoccupations of practicing clinicians, there are significant aspects of ‘real-world’ clinical practice that are largely ignored. These fell into two broad domains: ‘sociological’ concerns about enculturation, bureaucracy, intra-professional relationships, and public perceptions of medicine; and epistemic concerns about making good decisions, balancing different kinds of knowledge, and practising within the bounds of professional protocols. Conclusions: Our findings support the view that philosophy and sociology should be included in medical school and specialty training curricula. Curricula should be reframed to introduce students to habits of thought that recognize the need for critical reflection on the social processes in which they are embedded, and on the philosophical assumptions that underpin their practice. (shrink)

RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)