Surgery is an important part of health care worldwide. Without access to surgical treatments, morbidity and mortality increase. Access to surgical treatment is a significant problem in global public health because surgical services are not equally distributed in the world. There is a disproportionate scarcity of surgical access in low-income countries. There are many charitable organizations around the world that sponsor surgical missions to under served nations. One such organization is Operation Smile International, a group with which both authors have (...) volunteered. This paper will describe the purpose and processes involved in Operation Smile and identify some of the key ethical issues that arise in short term medical volunteer work highlighting the importance of sustainability. (shrink)

Prenatal screening and testing are preference‐based health care options. They are offered so that pregnant women and their partners can learn genetic information about the developing fetus. In this literature review, I summarize studies of women’s and their partners’ psychological responses to prenatal testing and screening. These studies investigate the experiences of pregnant women, largely in the United States, who have access to health care services. Although the results indicate that these women are receptive to prenatal testing and screening and (...) seem to have limited negative psychological consequences, pregnant women without access to these services are not represented and may have different experiences. With that caveat in mind, based on the evidence, women generally do well psychologically as they manage the options that arise for them in the prenatal context. (shrink)

Integral Science's most distinctive effect is to shift the context of human interactions from competition against one another to seeking what is good for both one's self and the larger whole. The partnership environment it suggests creates a foundation of relationship that powerfully increases organizational intelligence. This simple switch creates the potential for both more humanistic and more effective organizations that are better able to meet the needs of the populations they serve.

Suffering is a universal human phenomenon. In a time when religious differences are evident and often fuel conflict, shared narratives may provide common ground in which true understanding may take root. This paper will consider the problem of suffering and address how adherents of the three great monotheistic traditions seek understanding, comfort, and the believer’s appropriate response from the same story found within their respective sacred texts: the story of Job, the servant of Yahweh in the Tanakh/Old Testament of Judaism (...) and Christianity— known as Ayyub, prophet of Allah, in the Qur’an. The story of Job addresses more than the distribution of evil problem. At stake in the story is Job’s very relationship to his God. This paper will consider a few of the many Jewish, Christian, and Islamic insights from the ancient story, hopefully leading to mutual understanding and empathy. Keywords: suffering, Tanakh, Qur’an, Job, Ayyub. (shrink)

During the past two decades, several reports have documented substantial support from clinicians, policy-makers, and the general public for the use of advance directives, yet studies continue to find that only a minority of individuals have completed these legal documents. Advance directives are written instructions, such as living wills or durable powers of attorney for health care, which describe an individual's medical treatment wishes in the event that individual becomes incapacitated in the future. The completion and use of advance directives (...) is one of several components of the broader activity of advance care planning, that is, the overall planning and communication of personal wishes concerning future medical care.In December 1991, the federal Patient Self-Determination Act became effective. Promoted as a federal initiative to enhance an individual's control over medical treatment decision making and, therefore, patient autonomy and self-determination, PSDA placed several new requirements on health care organizations receiving Medicare or Medicaid payments. (shrink)

During the past two decades, several reports have documented substantial support from clinicians, policy-makers, and the general public for the use of advance directives, yet studies continue to find that only a minority of individuals have completed these legal documents. Advance directives are written instructions, such as living wills or durable powers of attorney for health care, which describe an individual's medical treatment wishes in the event that individual becomes incapacitated in the future. The completion and use of advance directives (...) is one of several components of the broader activity of advance care planning, that is, the overall planning and communication of personal wishes concerning future medical care.In December 1991, the federal Patient Self-Determination Act became effective. Promoted as a federal initiative to enhance an individual's control over medical treatment decision making and, therefore, patient autonomy and self-determination, PSDA placed several new requirements on health care organizations receiving Medicare or Medicaid payments. (shrink)

The purpose of the current study was to examine the reliability and validity of the RESTQ-Sport-36 for use in the collegiate student-athlete population. A total of 494 collegiate student-athletes competing in National Collegiate Athletic Association Division I, II, or III sanctioned sport completed the RESTQ-Sport-36 and Brief Profile of Mood States. Structural equation modeling procedures were used to compare first order to hierarchical model structures. Results of a confirmatory factor analysis and exploratory structural equation modeling analysis indicated that the first (...) order 12-factor structure demonstrated the best fit of all models tested. Support was not observed for the fit of any hierarchical model. Moderate to strong correlations were observed between stress and recovery subscales and mood states, thus supporting the construct validity of the abbreviated RESTQ measurement model. The current findings provide support for the measure’s use in this population and give pause as it relates to the scoring and interpretation of hierarchical factors such as Total Stress and Total Recovery. Overall, the current results indicate that the RESTQ-Sport-36 may be a useful tool for collegiate student-athlete training load and competition monitoring. (shrink)

There is limited knowledge about cancer patients' experiences of uncertainty while waiting for genome sequencing results, and whether prolonged uncertainty contributes to psychological factors in this context. To investigate uncertainty in patients with a cancer of likely hereditary origin while waiting for genome sequencing results, we collected questionnaire and interview data at baseline, and at three and 12 months follow up. Participants had negative attitudes towards uncertainty at baseline, and low levels of uncertainty at three and 12 months. Uncertainty about (...) genome sequencing did not change significantly over time [t = 0.660, p = 0.510]. Greater perceived susceptibility for cancer [r = 0.14, p < 0.01], fear of cancer recurrence [r = 0.19, p < 0.01], perceived importance of genome sequencing [r = 0.24, p < 0.01], intention to change behavior if a gene variant indicating risk is found [r = 0.29, p < 0.01], perceived ability to cope with results [r = 0.36, p < 0.01], and satisfaction with decision to have genome sequencing [r = 0.52, p < 0.01] were significantly correlated with negative attitudes towards uncertainty at baseline. Multiple primary cancer diagnoses [B = −2.364 [−4.238, −0.491], p = 0.014], lower perceived ability to cope with results [B = −0.1.881 [−3.403, −0.359], p = 0.016] at baseline, greater anxiety about genome sequencing [B = 0.347 [0.148, 0.546], p = 0.0012] at 3 months, and greater perceived uncertainty about genome sequencing [B = 0.494 [0.267, 0.721] p = 0.000] at 3 months significantly predicted greater perceived uncertainty about genome sequencing at 12 months. Greater perceived uncertainty about genome sequencing at 3 months significantly predicted greater anxiety about genome sequencing at 12 months [B = 0.291 [0.072, 0.509], p = 0.009]. Semi-structured interviews revealed that while participants were motivated to pursue genome sequencing as a strategy to reduce their illness and risk uncertainty, genome sequencing generated additional practical, scientific and personal uncertainties. Some uncertainties were consistently discussed over the 12 months, while others emerged over time. Similarly, some uncertainty coping strategies were consistent over time, while others emerged while patients waited for their genome sequencing results. This study demonstrates the complexity of uncertainty generated by genome sequencing for cancer patients and provides further support for the inter-relationship between uncertainty and anxiety. Helping patients manage their uncertainty may ameliorate psychological morbidity. (shrink)

Technology assessment (TA) is – for several reasons – not detachable from ethical questions. The development of institutions and concepts for TA, especially in the USA and Western Europe, has been marked by an increasing tendency to focus evaluative and normative questions. In the following paper, we point out, in as far as the common notions of TA are implicitly normative, why reflection upon conceptual options of TA inevitably leads to ethical questions, and that the key question of participation necessarily (...) comes up in the context of societal decisions made under conditions of risk or uncertainty. Arrangements of participatory and discoursive TA are referred to as possible applications of discourse ethics, but there are consequences to consider, which result from discourses in TA not being ideal discourses. Concepts and performance of TA arrangements on biotechnology and gene technology in different European countries are compared, analysing what similarities and differences can be found with respect to ethical clarification. Crucial questions of how to conceptualise participatory TA (pTA) and current topics in ethics of technology are shown to coincide. A proposal is presented of how these – theoretical normative and empirical descriptive – considerations can be used in a comprehensive conception for participatory and discoursive TA. (shrink)

How does evolution grow bigger brains? It has been widely assumed that growth of individual structures and functional systems in response to niche-specific cognitive challenges is the most plausible mechanism for brain expansion in mammals. Comparison of multiple regressions on allometric data for 131 mammalian species, however, suggests that for 9 of 11 brain structures taxonomic and body size factors are less important than covariance of these major structures with each other. Which structure grows biggest is largely predicted by a (...) conserved order of neurogenesis that can be derived from the basic axial structure of the developing brain. This conserved order of neurogenesis predicts the relative scaling not only of gross brain regions like the isocortex or mesencephalon, but also the level of detail of individual thalamic nuclei. Special selection of particular areas for specific functions does occur, but it is a minor factor compared to the large-scale covariance of the whole brain. The idea that enlarged isocortex could be a a by-product of structural constraints later adapted for various behaviors, contrasts with approaches to selection of particular brain regions for cognitively advanced uses, as is commonly assumed in the case of hominid brain evolution. (shrink)

Objective Adolescents have had very limited access to research on biomedical prevention interventions despite high rates of HIV acquisition. One concern is that adolescents are a vulnerable population, and trials carry a possibility of harm, requiring investigators to take additional precautions. Of particular concern is preventive misconception, or the overestimation of personal protection that is afforded by enrolment in a prevention intervention trial. Methods As part of a larger study of preventive misconception in adolescent HIV vaccine trials, we interviewed 33 (...) male and female 16–19-year-olds who have sex with men. Participants underwent a simulated HIV vaccine trial consent process, and then completed a semistructured interview about their understanding and opinions related to enrolment in a HIV vaccine trial. A grounded theory analysis looked for shared concepts, and focused on the content and process of adolescent participants’ understanding of HIV vaccination and the components of preventive misconception, including experiment, placebo and randomisation. Results Across interviews, adolescents demonstrated active processing of information, in which they questioned the interviewer, verbally worked out their answers based upon information provided, and corrected themselves. We observed a wide variety of understanding of research concepts. While most understood experiment and placebo, fewer understood randomisation. All understood the need for safer sex even if they did not understand the more basic concepts. Conclusions Education about basic concepts related to clinical trials, time to absorb materials and assessment of understanding may be necessary in future biomedical prevention trials. (shrink)

Emmanuel Levinas is one of the most important figures of twentieth-century philosophy. Exerting a profound influence upon such thinkers as Derrida, Lyotard, Blanchot, and Irigaray, Levinas's work bridges several major gaps in the evolution of continental philosophy -- between modern and postmodern, phenomenology and poststructuralism, ethics and ontology. He is credited with having spurred a revitalized interest in ethics-based philosophy throughout Europe and America. _Entre Nous_ is the culmination of Levinas's philosophy. Published in France a few years before his death, (...) it gathers his most important work and reveals the development of his thought over nearly forty years of committed inquiry. Along with several trenchant interviews published here, these essays engage with issues of suffering, love, religion, culture, justice, human rights, and legal theory. Taken together, they constitute a key to Levinas's ideas on the ethical dimensions of otherness. Working from the phenomenological method of Edmund Husserl and Martin Heidegger, Levinas pushed beyond the limits of their framework to argue that it is ethics, not ontology, that orients philosophy, and that responsibility precedes reasoning. Ethics for Levinas means responsibility in relation to difference. Throughout his work, Levinas returns to the metaphor of the face of the other to discuss how and where responsibility enters our lives and makes philosophy necessary. For Levinas, ethics begins with our face to face interaction with another person -- seeing that person not as a reflection of one's self, nor as a threat, but as different and greater than self. Levinas moves the reader to recognize the implications of this interaction: our abiding responsibility for the other, and our concern with the other's suffering and death. Situated at the crossroads of several philosophical schools and approaches, Levinas's work illuminates a host of critical issues and has found resonances among students and scholars of literature, law, religion, and politics. _Entre Nous_ is at once the apotheosis of his work and an accessible introduction to it. In the end, Levinas's urgent meditations upon the face of the other suggest a new foundation upon which to grasp the nature of good and evil in the tangled skein of our lives. (shrink)

Until recently, it was assumed that co-representation of others’ actions, an essential part in joint action, is biologically tuned. However, research demonstrated that we also simulate actions of non-biological interaction partners under certain conditions. In the present study, we investigated whether perceived intentionality or perspective taking is the underlying mechanisms of this phenomenon. Participants saw a short video fragment of a non-biological agent as main character. The movements of this agent were either described as intentional or as unintentional. Furthermore, participants (...) were instructed to either take the perspective of this non-biological agent or not. Results show that perspective taking and perceived intentionality both lead to action co-representation of non-biological actions. Possible explanations for these findings are discussed. (shrink)

Until recently, it was assumed that co-representation of others’ actions, an essential part in joint action, is biologically tuned. However, research demonstrated that we also simulate actions of non-biological interaction partners under certain conditions. In the present study, we investigated whether perceived intentionality or perspective taking is the underlying mechanisms of this phenomenon. Participants saw a short video fragment of a non-biological agent as main character. The movements of this agent were either described as intentional or as unintentional. Furthermore, participants (...) were instructed to either take the perspective of this non-biological agent or not. Results show that perspective taking and perceived intentionality both lead to action co-representation of non-biological actions. Possible explanations for these findings are discussed. (shrink)

Until recently, it was assumed that co-representation of others’ actions, an essential part in joint action, is biologically tuned. However, research demonstrated that we also simulate actions of non-biological interaction partners under certain conditions. In the present study, we investigated whether perceived intentionality or perspective taking is the underlying mechanisms of this phenomenon. Participants saw a short video fragment of a non-biological agent as main character. The movements of this agent were either described as intentional or as unintentional. Furthermore, participants (...) were instructed to either take the perspective of this non-biological agent or not. Results show that perspective taking and perceived intentionality both lead to action co-representation of non-biological actions. Possible explanations for these findings are discussed. (shrink)

To understand public discourse in the United States on genetic causation of behavioral disorders, we analyzed media representations of genetic research on addiction published between 1990 and 2010. We conclude first that the media simplistically represent biological bases of addiction and willpower as being mutually exclusive: behaviors are either genetically determined, or they are a choice. Second, most articles provide only cursory or no treatment of the environmental contribution. A media focus on genetics directs attention away from environmental factors. Rhetorically, (...) media neglect the complexity underlying the etiology the addiction and direct focus back toward individual causation and responsibility. (shrink)

The aim of the paper is to show that topoi are useful in the categorial analysis of the constructive logic with strong negation. In any topos ϵ we can distinguish an object Λ and its truth-arrows such that sets ϵ have a Nelson algebra structure. The object Λ is defined by the categorial counterpart of the algebraic FIDEL-VAKARELOV construction. Then it is possible to define the universal quantifier morphism which permits us to make the first order predicate calculus. The completeness (...) theorem is proved using the Kripke-type semantic defined by THOMASON. (shrink)

First, we clarify the central nature of our argument: our attempt is to apportion variation in brain size between developmental constraint, system-specific change, and change, underlining the unexpectedly large role of developmental constraint, but making no case for exclusivity. We consider the special cases of unusual hypertrophy of single structures in single species, regressive nervous systems, and the unusually variable cerebellum raised by the commentators. We defend the description of the cortex (or any developmentally-constrained structure) as a potential spandrel, and (...) weigh the implications of the spandrel concept for the course of human evolution. The empirical and statistical objections raised in the commentary of Barton are discussed at length. Finally, we catalogue and comment on the suggestions of new ways to study brain evolution, and new aspects of brain evolution to study. (shrink)

The first set of case studies on animal use, this volume offers a thorough, up-to-date exploration of the moral issues related to animal welfare. Its main purpose is to examine how far it is ethically justifiable to harm animals in order to benefit mankind. An excellent introduction provides a framework for the cases and sets the background of philosophical and moral concepts underlying the subject. Sixteen original, previously unpublished essays cover controversies associated with the human use of animals in a (...) broad range of contexts, including biomedical, behavioral, and wildlife research, cosmetic safety testing, education, the food industry, commerce, and animal use as pets and in religious practices. Scientific research is accorded the closest scrutiny. The authors represent a wide range of expertise within their specialized areas of research--physiology, public policy, ethics, philosophy, law, veterinary science, and psychology. The careful analysis of each case makes it possible to elevate the discourse beyond over-simplified positions, and to demonstrate the complexity of the issues. The Human Use of Animals will be welcomed by students and faculty in law, philosophy, ethics, public policy, religion, medicine, and veterinary medicine. It will also interest activists in the animal protection movement, and members of animal protection organizations and Institutional Animal Care and Use Committees. (shrink)

The earlier volume in this series dealt with two religions of Indian origin, namely, Buddhism and Jainism. The Indian religious scene, however, is characterized by not only religions which originated in India but also by religions which entered India from outside India and made their home here. Thus religious life in India has been enlivened throughout its history by the presence of religions of foreign origin on its soil almost from the very time they came into existence. This volume covers (...) three such religions—Zoraoastrianism, Judaism, and Islam. In the case of Zoraostianism, even its very beginnings are intertwined with India, as Zoroastrianism reformed a preexisting religion which had strong links to the Vedic heritage of India. This relationship took on a new dimension when a Zoroastrian community, fearing persecution in Persia after its Arab conquest, sought shelter in western India and ultimately went on to produce India’s pioneering nationalist in the figure of Dadabhai Naoroji ( 1825-1917), also known as the Grand Old Man of India. Jews found refuge in south India after the destruction of the Temple by the Romans in 70 C.E. and have remained a part of the Indian religious scene since then, some even returning to Israel after it was founded in 1948. Islam arrived in Kerala as soon as it was founded and one of the earliest mosques in the history of Islam is found in India. Islam differs from the previously mentioned religions inasmuch as it went on to gain political hegemony over parts of the country for considerable periods of time, which meant that its impact on the religious life of the subcontinent has been greater compared to the other religions. It has also meant that Islam has existed in a religiously plural environment in India for a longer period than elsewhere in the world so that not only has Islam left a mark on India, India has also left its mark on it. Indeed all the three religions covered in this volume share this dual feature, that they have profoundly influenced Indian religious life and have also in turn been profoundly influenced by their presence in India. (shrink)

The earlier volume in this series dealt with two religions of Indian origin, namely, Buddhism and Jainism. The Indian religious scene, however, is characterized by not only religions which originated in India but also by religions which entered India from outside India and made their home here. Thus religious life in India has been enlivened throughout its history by the presence of religions of foreign origin on its soil almost from the very time they came into existence. This volume covers (...) three such religions—Zoraoastrianism, Judaism, and Islam. In the case of Zoraostianism, even its very beginnings are intertwined with India, as Zoroastrianism reformed a preexisting religion which had strong links to the Vedic heritage of India. This relationship took on a new dimension when a Zoroastrian community, fearing persecution in Persia after its Arab conquest, sought shelter in western India and ultimately went on to produce India’s pioneering nationalist in the figure of Dadabhai Naoroji ( 1825-1917), also known as the Grand Old Man of India. Jews found refuge in south India after the destruction of the Temple by the Romans in 70 C.E. and have remained a part of the Indian religious scene since then, some even returning to Israel after it was founded in 1948. Islam arrived in Kerala as soon as it was founded and one of the earliest mosques in the history of Islam is found in India. Islam differs from the previously mentioned religions inasmuch as it went on to gain political hegemony over parts of the country for considerable periods of time, which meant that its impact on the religious life of the subcontinent has been greater compared to the other religions. It has also meant that Islam has existed in a religiously plural environment in India for a longer period than elsewhere in the world so that not only has Islam left a mark on India, India has also left its mark on it. Indeed all the three religions covered in this volume share this dual feature, that they have profoundly influenced Indian religious life and have also in turn been profoundly influenced by their presence in India. (shrink)

This manual presents a carefully researched, detailed psychodynamic treatment program for the alleviation of a transdiagnostic range of primary Axis I anxiety disorders, including panic disorder, generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder, and related psychological problems. First exploring the principles of psychodynamic theory and formulation, the authors then present a three-phased process of Panic Focused Psychodynamic Psychotherapy-Extended Range : initial evaluation, interpretation of central conflicts and defense mechanisms, and termination. Each phase is discussed in depth and relies (...) on central case illustrations to demonstrate techniques and results. A subsequent chapter explores how to address complex issues that may arise during the course of treatment. Altogether, this manual not only provides a demonstrated, adaptable approach for anxiety disorders, but also clearly embodies a spirit of research and empiricism heretofore rare in psychodynamic psychotherapies, with an eye toward future development. (shrink)

Conversation analysis (CA) of children-adult—interaction in various contexts has become an established field of research. However,child therapyhas received limited attention in CA. In child therapy, the general psychotherapeutic practice of achieving empathy faces particular challenges. In relation to this, our contribution sets out three issues for investigation and analysis: the first one is that practices of achieving empathy must be preceded by efforts aiming to establish which kind of individualized conversation works with this child (Midgley,2006). Psychotherapy process researchers in adult (...) therapy (Stiles et al.,2015) have found that therapists “invent” a new therapy for each patient (Norcross and Wampold,2018). The second issue is that it can be difficult for adults to understand the ways in which children express their conflicts and issues. In particular, play activities in therapy, e.g., with dolls, can open up additional scenarios of interaction. The play scenario can be used to disclose unformulated problems masked in everyday and family interactions. The third issue is how to respect the child's higher degree of vulnerability, compared with adult patients. How is it communicated and dealt with in therapy? We present an interaction analysis of a single case study of the first 20 min of a child therapy session with an adopted girl aged 4 years brought to treatment because of “unexplainable rage.” The session was videotaped; parents granted permission. We analyze this session using an applied version of CA. In our analysis, we describe “doing contrariness,” as a conversational practice producing epistemic and affiliative disruptions, while “avoiding doing contrariness” and “remedying contrariness” are strategies for preserving or restoring the affiliative dimension of a relationship (in child therapy). We show how these practices operate in various modes and how they are used by both parties in our case study to variously aid and impedethe achievement of empathy and understanding. (shrink)

Scientists seeking hard evidence of prayer's curative powers misunderstand the nature of prayer in the Western theistic traditions. Yet theistically consonant ways in which religious belief may influence health do not figure as they should in current professional practice.

In this work, we evaluate the status of both theory and empirical evidence in the field of experimental rest-break research based on a framework that combines mental-chronometry and psychometric-measurement theory. To this end, we provide a taxonomy of rest breaks according to which empirical studies can be classified. Then, we evaluate the theorizing in both the basic and applied fields of research and explain how popular concepts relate to each other in contemporary theoretical debates. Here, we highlight differences between all (...) these models in the light of two symbolic categories, termed the resource-based and satiation-based model, including aspects related to the dynamics and the control mechanisms at work. Based on a critical assessment of existing methodological and theoretical approaches, we finally provide a set of guidelines for both theory building and future empirical approaches to the experimental study of rest breaks. We conclude that a psychometrically advanced and theoretically focused research of rest and recovery has the potential to finally provide a sound scientific basis to eventually mitigate the adverse effects of ever increasing task demands on performance and well-being in a multitasking world at work and leisure. (shrink)