Energy has an ambivalent status in social theory, variously figuring as a driver or an outcome of social and institutional change, or as something that is woven into the fabric of society itself. In this article the authors consider the underlying models on which different approaches depend. One common strategy is to view energy as a resource base, the management and organization of which depends on various intersecting systems: political, economic and technological. This is not the only route to take. (...) The authors develop an alternative approach, viewing energy supply and energy demand as part of the ongoing reproduction of bundles and complexes of social practice. In articulating and comparing these two positions they show how social-theoretical commitments influence the ways in which problems like those of reducing carbon emissions are framed and addressed. Whereas theories of practice highlight basic questions about what energy is for, these issues are routinely and perhaps necessarily obscured by those who see energy as an abstract resource that structures or that is structured by a range of interlocking social systems. (shrink)

Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centred outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated (...) patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centred TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centred TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centred outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarised, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilisation of multivariate prediction models to inform individually-tailored interventions targeting a range of health conditions. (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)

Adopting the perspective of another person is an important aspect of social cognition and has been shown to depend on multisensory signals from one’s own body. Recent work suggests that interoceptive signals not only contribute to own-body perception and self-consciousness, but also to empathy. Here we investigated if social cognition – in particular adopting the perspective of another person – can be altered by a systematic manipulation of interoceptive cues and further, if this effect depends on empathic ability. The own-body (...) transformation task – wherein participants are instructed to imagine taking the perspective and position of a virtual body presented on a computer screen – offers an effective way to measure reaction time differences linked to the mental effort of taking an other’s perspective. Here, we adapted the OBT with the flashing of a silhouette surrounding the virtual body, either synchronously or asynchronously with the timing of participants’ heartbeats. We evaluated the impact of this cardio-visual synchrony on reaction times and accuracy rates in the OBT. Empathy was assessed with the empathy quotient questionnaire. Based on previous work using the cardio-visual paradigm, we predicted that synchronous cardio-visual stimulation would increase self-identification with the virtual body and facilitate participants’ ability to adopt the virtual body’s perspective, thereby enhancing performance on the task, particularly in participants with higher empathy scores. We report that participants with high empathy showed significantly better performance during the OBT task during synchronous versus asynchronous cardio-visual stimulation. Moreover, we found a significant positive correlation between empathic ability and the synchrony effect. We conclude that synchronous cardio-visual stimulation between the participant’s body and a virtual body during an OBT task makes it easier to adopt the virtual body’s perspective, presumably based on multisensory integration processes. However, this effect depended on empathic ability, suggesting that empathy, interoception and social perspective taking are inherently linked. (shrink)

Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and communicating their values (...) and responsibilities in situations of moral distress. We also discuss the importance of nurses creating “counterstories” of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life. (shrink)

Walker Percy was both a medical doctor and a serious Catholic—a scientist and a religious believer. He thought, however, that science had become hegemonic in the twentieth century and that it was incapable of answering the most fundamental needs of human beings. He thus leveled a critique of the scientific method and its shortcomings in failing to address the individual person over against the group. In response to these shortcomings Percy postulates a religious understanding of human life, one in (...) which man's life is understood as a pilgrimage or a search. The person who searches may not find the “object” of his search during his earthly life, but it is likely that he will come to a better understanding of himself by means of it. (shrink)

It may be the case that the most challenging moral problem of the twenty‐first century will be the relationship between the individual moral agent and the practices and institutions in which the moral agent is embedded. In this paper, we continue the efforts that one of us, Joan Liaschenko, first called for in 1993, that of using feminist ethics as a lens for viewing the relationship between individual nurses as moral agents and the highly complex institutions in which they do (...) the work of nursing. Feminist ethics, with its emphasis on the inextricable relationship between ethics and politics, provides a useful lens to understand the work of nurses in context. Using Margaret Urban Walker's and Hilde Lindemann's concepts of identity, relationships, values, and moral agency, we argue that health care institutions can be moral communities and profoundly affect the work and identity and, therefore, the moral agency of all who work within those structures, including nurses. Nurses are not only shaped by these organizations but also have the power to shape them. Because moral agency is intimately connected to one's identity, moral identity work is essential for nurses to exercise their moral agency and to foster moral community in health care organizations. We first provide a brief history of nursing's morally problematic relationship with institutions and examine the impact institutional master narratives and corporatism exert today on nurses’ moral identities and agency. We close by emphasizing the significance of ongoing dialogue in creating and sustaining moral communities, repairing moral identities, and strengthening moral agency. (shrink)

This essay explores small “ordinary” experiences of moral harm as problems of social injustice. Starting with two stories, we first argue against a dominant framework of personal responsibility that assigns responsibility to particular blameworthy agents. Instead we sketch an account of why structural responsibility for social harm must be considered, drawing on the work of Iris Marion Young and Pierre Bourdieu. Finally, drawing on Margaret Walker’s notion of moral repair and Christopher Marshall’s interpretation of the parable of the Good (...) Samaritan, we sketch an account of Christian moral responsibility grounded in restorative justice that seeks to address daily experiences of moral harm through the moral repair work of neighbor-love. (shrink)

For deliberations on the ethical and meta-ethical implications of Alfred North Whitehead's process philosophy, here are abstracts and papers from the Ethics Section of the 6th International Whitehead Conference held at the University of Salzburg in Salzburg, Austria in July 2006. In accordance with the conference schedule, there are three subsections. The subsection on "Metaphysics of Morals and Moral Theory" includes contributions from Franklin I. Gamwell (Does Morality Presuppose God?), John W. Lango (abstract only), Duane Voskuil ("Ethics' Dipolar Necessities and (...) Theistic Implications), and Theodore Walker Jr. ("Neoclassical Cosmology and Matthew 22:36-40). The subsection on "Evaluating Moral Practices" includes contributions from Frederick Ferrè (abstract only), Seung Gap Lee (Hope for the Earth: A Process Eschatological Eco-ethics for South Korea), Mary Elizabeth Mullino Moore (Compassion, Creativity, and Form: The Ethics of Institutions), and George W. Shields (Ruse, Altruism, and Process Philosophy). The subsection on "Ethics and Aesthetic Values" includes contributions from Stephen T. Franklin (abstract only), Brian G. Henning (Is There an Ethics of Creativity?), Mihàly Tòth (Art of Life and the Ethics of Life Forming), and Guorong Yang (Problems and Perspectives in the Emerging of Global Society). (shrink)

Medical futility is often defined as providing inappropriate treatments that will not improve disease prognosis, alleviate physiological symptoms, or prolong survival. This understanding of medical futility is problematic because it rests on the final outcomes of procedures that are narrow and medically defined. In this article, Walker's `expressivecollaborative' model of morality is used to examine how certain critical care interventions that are considered futile actually have broader social functions surrounding death and dying. By examining cardiopulmonary resuscitation and life-sustaining intensive (...) care measures as moral practices, we show how so-called futile interventions offer ritualistic benefit to patients, families, and health care providers, helping to facilitate the process of dying. This work offers a new perspective on the ethical debate concerning medical futility and provides a means to explore how the social value of treatments may be as important in determining futility as medical scientific criteria. (shrink)

Background:While there have been studies exploring moral habitability and its impact on the work environments of nurses in Western countries, little is known about the moral habitability of the work environments of nurses and midwives in resource-constrained settings.Research objective:The purpose of this research was to examine the moral habitability of the work environment of nurses and midwives in Ghana and its influence on their moral agency using the philosophical works of Margaret Urban Walker.Research design and participants:A critical moral ethnography (...) was conducted through the analysis of interviews with 30 nurses and midwives, along with observation, and documentary materials.Ethical considerations:After receiving ethics approval, signed informed consent was obtained from participants before data collection.Results:Five themes were identified: (1) holding onto the values, identities, and responsibilities of being a midwife/nurse; (2) scarcity of resources as limiting capacity to meet caring responsibilities; (3) gender and socio-economic inequities shaping the moral-social context of practice; (4) working with incoherent moral understandings and damaged identities in the context of inter- and intra-professional relationships; and (5) surviving through adversity with renewed commitment and courage.Discussion:The nurses and midwives were found to work in an environment that was morally uninhabitable and dominated by the scarcity of resources, overwhelming and incoherent moral responsibilities, oppressive conditions, and workplace violence. These situations constrained their moral agency and provoked suffering and distress. The nurses and midwives negotiated their practice and navigated through morally uninhabitable work environment by holding onto their moral values and commitments to childbearing women.Conclusion:Creating morally habitable workplaces through the provision of adequate resources and instituting interprofessional practice guidelines and workplace violence prevention policies may promote safe and ethical nursing and midwifery practice. (shrink)

Grosz gives a critical overview of Lacan's work from a feminist perspective. Discussing previous attempts to give a feminist reading of his work, she argues for women's autonomy based on an indifference to the Lacanian phallus.

Face perception, perhaps the most highly developed visual skill in humans, is mediated by a distributed neural system in humans that is comprised of multiple, bilateral regions. We propose a model for the organization of this system that emphasizes a distinction between the representation of invariant and changeable aspects of faces. The representation of invariant aspects of faces underlies the recognition of individuals, whereas the representation of changeable aspects of faces, such as eye gaze, expression, and lip movement, underlies the (...) perception of information that facilitates social communication. The model is also hierarchical insofar as it is divided into a core system and an extended system. The core system is comprised of occipitotemporal regions in extrastriate visual cortex that mediate the visual analysis of faces. In the core system, the representation of invariant aspects is mediated more by the face-responsive region in the fusiform gyrus, whereas the representation of changeable aspects is mediated more by the face-responsive region in the superior temporal sulcus. The extended system is comprised of regions from neural systems for other cognitive functions that can be recruited to act in concert with the regions in the core system to extract meaning from faces. (shrink)

A new resolution of the mind-body problem that reconciles materialism and idealism.

Marking a ground-breaking moment in the debate surrounding bodies and "body politics," Elizabeth Grosz's Space, Time and Perversion contends that only by resituating and rethinking the body will feminism and cultural analysis effect and unsettle the knowledges, disciplines and institutions which have controlled, regulated and managed the body both ideologically and materially. Exploring the fields of architecture, philosophy, and--in a controversial way--queer theory, Grosz shows how these fields have conceptually stripped bodies of their specificity, their corporeality, and the vestigal (...) traces of their production as bodies. Her tour de corpe investigates the work of Michel Foucault, Teresa de Lauretis, Gilles Deleuze, Judith Butler and Alphonso Lingis. Grosz considers their work by examining the ways in which the functioning of bodies transforms understandings of space and time, knowledge and desire. Begining with an exposition of the epistemological implications of bodily and sexual difference, Grosz examines the effects such knowledge have on the reception of meaning. She looks at the relationship between the knowledge of difference and the way that knowledge validates, affirms, avows and valorizes subjects. Grosz then extends this analysis to an investigation of the relationship between space, time, bodies and the spatial "arts" such as architecuture, urban planning and geography. In the last section, Grosz moves toward a radical consideration of bodies and their relationship to transgression and perversity. Controversially showing the ways in which "queer" theory fails to offer a truly transformative conception of bodies and their politics, Grosz finds "queer" a reactive category "which sees itself in opposition to a straight norm and thus defines itself in terms of this norm." Consequentially, "queer" theory inherits the acceptance of an entire range of sexual practices, without "asking what they share and without taking into account the profound tension that may exist among these practices." Grosz's Space, Time and Perversity is a diverse and incisive collection of essays from a renowned feminist philosopher. (shrink)

Introduction: Depression, biology, aggression -- Underbelly -- The biological unconscious -- Bitter melancholy -- Chemical transference -- The bastard placebo -- The pharmakology of depression.

Though emotion conveys memory benefits, it does not enhance memory equally for all aspects of an experience, nor for all types of emotional events. In this review, I outline the behavioral evidence for arousal's focal enhancements of memory and describe the neural processes that may support those focal enhancements. I also present behavioral evidence to suggest that these focal enhancements occur more often for negative experiences than for positive ones. This result appears to arise because of valence-dependent effects on the (...) neural processes recruited during episodic encoding and retrieval, with negative affect associated with increased engagement of sensory processes, and positive affect leading to enhanced recruitment of conceptual processes. (shrink)

This book explores the tradition of the 'science of man' in French medicine of the era 1750-1850, focusing on controversies about the nature of the 'physical-moral' relation and their effects on the role of medicine in French society. Its chief purpose is to recover the history of a holistic tradition in French medicine that has been neglected because it lay outside the mainstream themes of modern medicine, which include experimental, reductionist, and localistic conceptions of health and disease. Professor Williams also (...) challenges existing historiography, which argues that the 'anthropological' approach to medicine was a short-term by-product of the leftist politics of the French Revolution. This work argues instead that the medical science of man long outlived the Revolution, that it spanned traditional ideological divisions, and that it reflected the shared aim of French physicians, whatever their politics, to claim broad cultural authority in French society. (shrink)

In this work of sweeping erudition, one of our foremost historians of early Christianity considers a variety of theoretical critiques to examine the problems ...

Background The opioid epidemic has enabled rapid and unsurpassed use of big data on people with opioid use disorder to design initiatives to battle the public health crisis, generally without adequate input from impacted communities. Efforts informed by big data are saving lives, yielding significant benefits. Uses of big data may also undermine public trust in government and cause other unintended harms. Objectives We aimed to identify concerns and recommendations regarding how to use big data on opioid use in ethical (...) ways. Methods We conducted focus groups and interviews in 2019 with 39 big data stakeholders who had interest in or knowledge of the Public Health Data Warehouse maintained by the Massachusetts Department of Public Health. Results Concerns regarding big data on opioid use are rooted in potential privacy infringements due to linkage of previously distinct data systems, increased profiling and surveillance capabilities, limitless lifespan, and lack of explicit informed consent. Also problematic is the inability of affected groups to control how big data are used, the potential of big data to increase stigmatization and discrimination of those affected despite data anonymization, and uses that ignore or perpetuate biases. Participants support big data processes that protect and respect patients and society, ensure justice, and foster patient and public trust in public institutions. Recommendations for ethical big data governance offer ways to narrow the big data divide, enact shared data governance, cultivate public trust and earn social license for big data uses, and refocus ethical approaches. Conclusions Using big data to address the opioid epidemic poses ethical concerns which, if unaddressed, may undermine its benefits. Findings can inform guidelines on how to conduct ethical big data governance and in ways that protect and respect patients and society, ensure justice, and foster patient and public trust in public institutions. (shrink)

A basic model of hierarchical structure, expressed by simple, linear differential equations, shows that the pattern of population growth is essentially determined by conditions of redundancy in the sub-structure of individuals. There does not exist any possible combination between growth rate and accident rate that could balance population numbers and/or the level of redundancy within the population; all possible combinations either lead to extinction or to positive population growth with a decline of the fraction of individuals with redundant substructure. Declining (...) populations, however, can be held fluctuating between certain limits by periodic phases of sub-unit repair. These results are particularly pertinent to the population dynamics of diploid (polyploid) organisms. (shrink)

In typical statistical learning studies, researchers define sequences in terms of the probability of the next item in the sequence given the current item (or items), and they show that high probability sequences are treated as more familiar than low probability sequences. Existing accounts of these phenomena all assume that participants represent statistical regularities more or less as they are defined by the experimenters—as sequential probabilities of symbols in a string. Here we offer an alternative, or possibly supplementary, hypothesis. Specifically, (...) rather than identifying or labeling individual stimuli discretely in order to predict the next item in a sequence, we need only assume that the participant is able to represent the stimuli as evincing particular similarity relations to one another, with sequences represented as trajectories through this similarity space. We present experiments in which this hypothesis makes sharply different predictions from hypotheses based on the assumption that sequences are learned over discrete, labeled stimuli. We also present a series of simulation models that encode stimuli as positions in a continuous two‐dimensional space, and predict the next location from the current location. Although no model captures all of the data presented here, the results of three critical experiments are more consistent with the view that participants represent trajectories through similarity space rather than sequences of discrete labels under particular conditions. (shrink)

The vivid, dramatic images of distant stars and galaxies taken by the Hubble Space Telescope have come to define how we visualize the cosmos. In their immediacy and vibrancy, photographs from the Hubble show what future generations of space travelers might see should they venture beyond our solar system. But their brilliant hues and precise details are not simply products of the telescope's unprecedented orbital location and technologically advanced optical system. Rather, they result from a series of deliberate decisions made (...) by the astronomers who convert raw data from the Hubble into spectacular pictures by assigning colors, adjusting contrast, and actively composing the images, balancing the desire for an aesthetically pleasing representation with the need for a scientifically valid one. In Picturing the Cosmos, Elizabeth A. Kessler examines the Hubble's deep space images, highlighting the remarkable resemblance they bear to nineteenth-century paintings and photographs of the American West and their invocation of the visual language of the sublime. Drawing on art history and the history of science, as well as interviews with astronomers who work on the Hubble Heritage Project, Kessler traces the ways that the sublime, with its inherent tension between reason and imagination, not only forms the appearance of the images, but also operates on other levels. The sublime informs the dual expression—numeric and pictorial—of digital data and underpins the relevance of the frontier for a new era of exploration performed by our instruments rather than our bodies. Through their engagement with the sublime the Hubble images are a complex act of translation that encourages an experience of the universe as simultaneously beyond humanity's grasp and within the reach of our knowledge. Strikingly illustrated with full-color images, this book reveals the scientific, aesthetic, and cultural significance of the Hubble pictures, offering a nuanced understanding of how they shape our ideas—and dreams—about the cosmos and our places within it. (shrink)

"This work is a valuable casebook, specifically for library and information science professionals, that presents numerous case studies that combine theories of ...

In my original review (Kensinger, 2009), I proposed that to understand the effects of emotion on memory accuracy, we must look beyond effects of arousal and consider the contribution of valence. In discussing this proposal, the commentators raise a number of excellent points that hone in on the question of when valence does (and does not) account for emotion's effects on memory accuracy. Though future research will be required to resolve this issue more fully, in this brief response, I address (...) some of the concerns outlined by the commentators and suggest a few steps that may help to elucidate the dimensions that should be incorporated in models of emotional memory. (shrink)

This article presents an overview of significant issues facing contemporary information professionals. As the world of information continues to grow at unprecedented speed and in unprecedented volume, questions must be faced by information professionals. Will we participate in the worldwide mythology of equal access for all, or will we truly work towards this debatable goal? Will we accept the narrowing of choice for our corresponding increasing diverse clientele? Such questions must be considered in a holistic context and an understanding of (...) the many levels of information inequities is requisite.Beginning with an historical perspective, Buchanan presents Mustapha Masmoudi''s seminal review of forms of information inequities. She then describes qualitative forms of inequities, such as information imperialism and cultural bias embedded in such practices as cataloging and classification. Following, a review of quantitative inequities is presented. Such issues as the growing commoditization of information and information services demand attention from the ethical perspective. And, finally, the Internet and implications surrounding the world-wide dissemination of information is discussed. (shrink)

This paper reflects on certain working assumptions of Husserlian phenomenological practice, using an investigation of interkinaesthetic affectivity as an example. I suggest that in some cases, Husserl’s “stratificational” model should be replaced with the notion of the ongoing dynamic efficacy of mutually co-founding, interpenetrating, and interfunctioning moments-“through”-which experience proceeds. Finally, I relate the latter model to Patočka’s call for a genuine integration of the three movements of embodied human life.

This paper is a critical examination of Lonergan’s notion of moral conversion. Conversion in general is described as a mode of self-transcendence and distinguished from development. Then moral conversion is contrasted with the two other basic forms of conversion, intellectual and religious. Next, I propose that there are two distinct moments of moral conversion: a negative moment of rational compunction, which is more Kantian in nature, and a positive moment of passionate transcendence, which is consonant with Scheler’s value ethics. I (...) draw on philosophical accounts of the initial awakening of moral consciousness, and argue that it is possible to make this first movement yet fail to make the second movement. (shrink)